Help! I'm falling
Falls are a common and serious occurrence in the elderly.
THE human species is endowed with four limbs, but we chose to walk on two. This certainly brings about some advantages. It leaves the upper limbs free for carrying all the things your spouse tells you to, though it is a trade off as we have lost out on stability, not to mention the back aches that this entails.
Walking is a complex process. Humans, being the most intelligent animal (as we would like to presume) take more than a year to learn to walk.
Walking involves moving and balancing on two legs and it becomes more difficult when one is frail. This is more worrisome in the older person as injuries such as hip fractures are more severe. There may also be psychological trauma leading to fear of further falls, culminating in a person with restricted mobility and consequent social isolation.
People at risk
Studies have identified certain characteristics of older people who are at higher risk of falls. These include older persons with the following:
1. Muscle weakness, gait or balance problems. Their risk is three times higher.
2. Previous recent falls.
3. Poor vision, arthritis, or gait problems requiring walking aids.
If you have any of these conditions, then you should pay special attention.
Contributing factors for falls
The healthy person may fall in a slippery environment whereas a frail person may fall even in a safe environment. Hence both patient and environment factors contribute to falls.
Patient factors include any medical condition that makes one unsteady. These include strokes, Parkinson’s, musculoskeletal problems and side-effects of medications. For example, drugs for hypertension may cause a drop in blood pressure upon standing, causing giddiness.
Environment factors include slippery floors and poor lighting. Wires running across doorways are literally falls waiting to happen.
Interventions to reduce falls
In preventing falls, the idea would be to minimize the contributing factors. Some of the actions that you can take are summarized below. This list is by no means exhaustive, but it is to give you an idea of what could be done.
Factors related to the person
1. Exercise
Exercise is important to maintain both your muscle strength and balance. This may include activities such as tai chi. Remember the axiom, “use it or lose it”. Regular exercise within your capacity is the key word.
2. Eyesight
Poor vision is associated with falls. Glare due to cataracts worsen vision. If you are prescribed with new glasses, be extra careful as a recent change in glasses, especially bifocals, increases your risk.
3. Previous falls
If you have recurrent falls, you should present yourself for further assessment.
4. Medications
Medications are important for treatment of your medical illness. However, increasing the number of medicines leads to drug interactions and side-effects. The risk increases if you are receiving prescriptions from multiple clinics as the doctor may be unaware of what you are taking.
If you feel uncomfortable with any recent change in prescription, consult your doctor. Also please divulge all medicine that is bought over-the-counter, including vitamins, tonics and claimed elixirs of youth that you bought from the very convincing sales person!
If you are a diabetic, be aware of symptoms due to low blood sugar and steps to overcome it.
Factors related to the environment
1. Lighting
The floor space should be lit from above as light shining towards your eyes are glaring. Secondly, install two light points in passageways as it will avoid risky bulb changes in the dark. This hold true especially if you stay alone or have an equally frail spouse who is at equal risk of falls. Keep a torch light handy by your bedside.
2. Stairs, pets and toys
These items form a lethal combination. There should be no toys left on steps, which could cause you to fall should you step on them. This includes your favorite cat that chooses to laze on the steps.
Remember the cat has nine lives, you have one. (The rest of them were used when you paid the installments of the house and your children stopped listening to you!) Install handrails on both sides if there are none.
3. Carpets/rugs
The curled-up edge of your expensive Persian carpet may trip you, leading to a more expensive hospital bill. Carpets, if really necessary, should be fixed to the floor or taped down.
4. Walking stick/walking aids
We know of patients who would hold the wall, furniture, or an umbrella rather than to be caught dead holding the walking stick. The walking aid is to increase your stability (apart from warding off unwelcome creatures). Falls not only dent your pride but your bones and tissues too.
In short, if your healthcare professional has prescribed one for you, chances are you are better off with it than without it.
5. Slippery floors
Your bath area may be having the best floor grip ... until you start soaping yourself. Consider the use of a non-slip mat and handrails. If you are unsteady to begin with, take a bath sitting on a stable bath stool.
6. Old furniture, clutter
As we age, we accumulate furniture and items (by that I do not mean your spouse or children). This clutter makes your home an obstacle course. Furthermore the furniture may be as old you are. If they are not sturdy, get rid of them as unsteady furniture should never support brittle bones.
7. Long, trailing gowns and sarongs
Long trailing gowns may look glamorous, until you trip and unceremoniously fall down the stairway. Shorten them to provide a good clearance.
After a fall
Lastly, be prepared and plan on how to call for help if you should fall. Nothing could be more frustrating than not being able to reach the phone that is placed too high when you are unable to stand as a result of injury.
Also strengthen your bones with calcium or vitamins from your healthcare provider.
These are some simple but effective interventions you could act on to reduce your risk of falls. For falls, prevention is the key word.
Dr Lee Fatt Soon is a consultant geriatrician. This article is contributed by The Star Health & Ageing Panel, which comprises a group of panelists 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 starhealth@thestar.com.my.
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.
| 
