Sunday March 3, 2013
How to prevent falls in older people
By Dr TAN MAW PIN
YOU may be looking after an elderly parent who has suffered a fall or you may be an older person yourself and live in terror of falling.
Falls are unfortunately very common in older people. The fear of falling, however, is an even greater monster that confines many older persons to the chair or bed, and even leads to many adult children admitting their elder parent to a nursing home.
There are many unhealthy myths surrounding falls in older people. Falls in older people will become a bigger and bigger problem as our country grows “older”. We should therefore do our part in dealing with this problem now.
We are all well aware of the dangers of an older person falling. Older people are more likely than young adults to suffer falls, but the real danger is that older people are also more likely to suffer serious injuries from their falls.
The first thing we always ask when granddad or grandma suffers a fall is: was he or she hurt? We all fear the internal brain bleeding and the hip fracture, as we have all seen or heard of older relatives who have succumbed to such injuries.
Fortunately, most falls do not result in serious injuries, but are often an indicator of a medical problem. The strategies to address falls in older people include global measures to prevent all older people from falling, as well as more targeted measures to prevent falls in high risk groups.
We all know exercise is good for us, but many of us either think that the rule doesn’t really apply to ourselves or are just too apathetic to do it.
Exercise programmes that have been shown to be effective in reducing the risk of falls in older people involve more than just cardiovascular components. This means that walking alone is not enough. Walking is still encouraged as it will reduce our risk of heart disease and stroke, but you need to go beyond just a casual stroll in the park while chit chatting to a friend.
You need to feel slightly out of breath as well as break into a light sweat after exercising.
In addition to cardiovascular exercises such as walking or cycling, strength and balance training components should also be included. Tai chi has been shown to reduce falls in older people, but if it’s not your cup of tea, aerobics exercises and weight training can also work.
You should aim to perform physical exercises for at least 30 minutes, five times a week.
Hoarding is a common behaviour among the older Malaysian population. Times were hard for those who survived the Japanese occupation and the Communist era, which meant that hoarding was a necessary survival skill.
However, with the current situation, the habit of preserving every last plastic bag and holding on to broken furniture can be potentially hazardous. The key to fall prevention is to avoid tripping over the clutter.
Individuals with disabilities or physical problems requiring home adaptations should try to engage professional help from occupational therapists, as unsafe fixtures and adaptations actually pose a great danger.
However, for most of us, just taking a good look around us and being aware of potential dangers can help reduce falls. Safety measures include:
- Avoid floor surfaces that become slippery when wet.
- Do not leaving loose wires lying around.
- Ensure all walkways are clear.
- Make sure that stairs and changes in level are clearly visible (glow tapes or paint are cheap alternatives to expensive renovations).
- Ensure there is adequate lighting in walkways, toilets and stairwells.
- Have a night light or bedside lamp within reach of your bed for toilet visits at night.
If you or your loved one has already suffered a fall, then you may need to act quickly to prevent further falls. Some falls are indeed pure accidents and even healthy adults fall now and then if the environment or insult is challenging enough.
In older individuals, however, they may have slipped on a wet floor or tripped over a step, but they may not have fallen if their muscle strength or balance was normal.
The last thing you should do is confine the older person to a chair or bed and to keep reminding the older person, “don’t get up, you will fall”. Avoiding activity will result in the body becoming weaker with time.
If an older person becomes inactive, they cannot go out, which means less opportunity to socialise. Social isolation can lead to depression. Physically weakened and depressed older people are actually far more likely to fall.
This vicious cycle is the reason behind the extremely damaging myth that falls indicate the beginning of the end.
Instead, consider seeking medical attention. The doctor may be able to detect problems with your heart beat or blood pressure that may have caused a blackout or dizzy spell.
Older people who fall due to loss of consciousness may not remember blacking out, but the tell-tale sign would be them not remembering how they fell.
Heart or blood pressure problems are often easily treatable by getting your doctor to adjust your medications.
Often, falls occur as a result of the side-effects of medications or too many different types of medications which can interact with each other.
Ask your doctor to review your medications. Stopping those medications that are no longer required and those that increase the risk of falls will also help reduce future falls.
At the University of Malaya, we are currently researching falls in older Malaysians. In particular, we are evaluating the characteristics of older individuals who present to the Emergency Department following a fall, assessing older fallers to determine the risk factors for falls in older Malaysians, and testing out treatment strategies for older fallers.
We are also working towards developing new technology with the Biomedical Engineering and Manufacturing and Design Engineering Departments to help prevent falls in older people.
It is also important, however, that the wider public become “falls aware” and takes the necessary positive measures to address this emerging epidemic.
If you are over 65 years old and are interested in taking part in one of our studies, please contact call 03-79493200 or email: firstname.lastname@example.org for more information.
Dr Tan Maw Pin is Associate Professor at the Department of Medicine, Faculty of Medicine, University of Malaya. This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail email@example.com. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.