Introduction

Fall is defined as an event when a person is unintentionally falling to the ground or lower level usually the floor other than the consequence of sustaining a violent blow, loss of consciousness or sudden onset of paralysis due to stroke or seizure.

Falls are common among the older persons. Studies reported that 30 to 40% of older persons aged 65 years old and above in the community had one or more falls in the previous 12 months. A fifth sustained injury due to their falls. About 40% to 50% of residents of institutions fall each year. In a study done in the primary care clinic in Malaysia, the prevalence of falls among the older persons was around 47%.

In order to minimize the unwanted consequences of falls, elderly should practice and take the proper steps to get up from fall and be prepared in case they fall subsequently.

Consequences of falls

• Falls related injury e.g. fracture (5%) and other serious injuries (15%)
• Prolonged post fall immobility can lead to
  • Muscle atrophy
  • Joints contracture
  • Pressure sores
  • Dehydration
  • Pneumonia
  • Deep vein thrombosis
  • Orthostatic hypotension
  • Osteoporosis
• Increase dependency
• Psychological effect leading to loss of confidence, fear of falling, anxiety and depression
• Admission to institutional care
• Major cause of disability and death in elderly

Why is it important to know what to do if you fall?

• Fall is very common among older persons.
• As we age, both the number of falls and the likelihood of injury from the fall will increase.
• So, it is very important for an elderly to know what to do if you fall.
• The proper reaction to a fall can make the difference to minimize the physical and psychological consequences.
• It also enables the elderly to regain your confidence more quickly and to continue to be as independent as possible.

What should a person do after a fall?

In order to minimize the unwanted consequences of falls, the elderly who have fallen should try to take the following steps, depending on the condition of yourself after a fall.

• If the person can get up by himself/herself after a fall
  The first thing to do is to stay calm, catch a breath and find out if you are injured. Even if you think that you are fine, take time before getting up again to prevent worsening of unnoticed injury.
  The following steps can be performed to get up from fall:
  • Turning from the supine position (face down) to the prone position (face up)
  • Getting on all fours limbs
  • Crawling to a strong support surface e.g. armchair or other steady objects
  • Then kneel while placing both hands on the chair or steady object.
  • Try to pull up slowly.
  • Turn and sit down very carefully.

  These steps should be practiced frequently and be prepared before an actual fall.

• If the person cannot get up by himself/herself after a fall
  If you are unable to get up by yourself, please try to get help as soon as possible to decrease the likelihood of lying on the floor for a long time after a fall.
  • You can call out for help if you think you can be heard.
  • If you have an emergency call system or telephone at hand, use it to get help.
  • If you do not have any, try to slide yourself towards a telephone or a place where you are likely to be heard.
  • Make noise with your walking stick or another object to attract attention.
  • Wait for help to arrive in the most comfortable position.
  • If you can, place a pillow under your head and cover yourself with a piece of clothing or a blanket to stay warm.
  • Try to move your joints frequently (if possible) to improve circulation and prevent stiffness.

When to consult a doctor for further assessment?

The victim of fall should never underestimate the seriousness of a fall even if it appears that no harm has occurred.

Reasons to consult a doctor include:

• Loss of consciousness may be transient, just before or after the fall
• Any injuries
• Any strong or persistent pain
• Dizziness or a headache
• Nausea or vomiting
• Any weakness
• Any vision problems

The above symptoms may appear at any time after a fall. It is important to inform the doctor about the circumstances of fall so that the doctor can then assess and determine if the fall is linked to an illness, prescribed medication, over-the-counter drugs or other factors.

How to prevent further fall?

• To ensure safe environment
  To check the surroundings to find out if there are any fall hazards and simple modifications can be applied to prevent further falls e.g. install grab bars in the bathroom, non-slip rugs and handrail on both sides of stairs.
• To wear appropriate footwear
  The older person should wear suitable footwear to reduce the risk of further falling. The suitable shoes should have non-slippery soles, heels of reasonable height, and are wide enough to prevent any twisting of the foot.
• To plan how to get help if they have another fall and share the plan with the family members and neighbors

Consider getting an emergency call device or a cordless phone close at hand, ask a friend or a family member to phone them at regular intervals, give the home keys to someone they trust who could use them in an emergency. In short, think about the plan what they can do to get help if they have another fall.

Conclusion

Falls could lead to significant morbidity and mortality in elderly, as well as affect the quality of life of the older persons. As we age, both the number of falls and the likelihood of injury will increase.

Therefore, it is very important for elderly to know what to do if they fall. The proper reaction to a fall can minimize the physical and psychological consequences of fall and enables the elderly to regain their confidence more quickly and to continue to be as independent as possible.

References

1. The prevention of falls in later life. A report of the Kellogg International Work Group on the Prevention of Falls by the Elderly. Dan Med Bull 1987;34 Suppl 4:1-24.
2. Centers for Disease Control and Prevention(CDC). Self reported falls and falls at home among person more or equal 65 years- United States,2006. MMWR Morb Mortal Wkly Rep.2008:57:225
3. Sazlina SG, Krishnan R, Samsul AS, Zaiton A , Visvanathan R. Prevalence of falls among older people attending a primary care clinic in Kuala Lumpur Malaysia. Malaysian Journal of Community Health (2008) Vol 14(1): 11-15.
4. Ayse O, Hulya D, Nihal G, Mehtap O, Didem K. The relationship between risk factors for falling and the quality of life in older adults. BMC Public Health 2005, 5:90 doi:10.1186/1471-2458
5. Public Health Agency of Canada. If you fall or witness a fall, do you know what to do? (Date modified : 05-07-2011) (http://www.phac-aspc.gc.ca/seniors-aines/publications/ public/injury-blessure/falls-chutes/index-eng.php)(Accessed on 12 August 2015)