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Falls

Introduction

Everyone can be at risk of having a fall, but older adults are more vulnerable than others. This is mainly due to long-term health conditions that can increase the chances of a fall.

Other groups who are particularly at risk are young children and people whose job involves working at heights.

Falls are a common but often overlooked source of injury and sometimes death. In 2009 in England and Wales, there were 3,593 deaths as a result of falls.

Around 30% of adults who are over 65 and living at home will experience at least one fall a year. This rises to 50% of adults over 80 who are either at home or in residential care.

Most falls do not result in serious injury. However, 20% of older adults will require medical attention for a fall and 5% will experience a serious injury, such as a broken bone.

Falls can also have an adverse psychological impact on elderly people. For example, after having a fall a person can lose confidence, become withdrawn and may feel as if they have lost their independence.

What should I do if I have a fall?

If you have a fall, it is important to keep calm and remember what you need to do.

If you are not hurt and you feel strong enough to get up, do not get up quickly. Roll onto your hands and knees and look for a stable piece of furniture, such as a chair or bed. Hold on to the furniture with both hands to support yourself and when you feel ready, slowly get up. Sit down and rest for a while before carrying on with your daily activities.

If you are hurt or unable to get up, try to get someone’s attention by calling out for help, banging on the wall or floor or using your aid call button (if you have one). If possible, crawl to a telephone and dial 999 for an ambulance.

Try to reach something warm to put over you, particularly your legs and feet, such as a blanket or a dressing gown. Stay as comfortable as possible and try to change your position at least once every half an hour or so.

Read more about what to do if you fall.

If you are living with or caring for an elderly person, see accidents and first aid for information and advice about what to do after an accident.

What causes a fall?

The natural ageing process often places older adults at an increased risk of having a fall. In the UK, injuries that are caused by falls are the most common cause of death in people over the age of 75. There are three main reasons why older people are more likely to have a fall. These are:

Chronic health conditions, such as those listed above, can sometimes cause a loss of balance, a brief loss of consciousness (known as a drop attack) or a sudden feeling of dizziness, all of which could all contribute to a fall. Visual impairment or muscle weakness may also make it more difficult for an older person to prevent a fall.

Among older adults, the most common reasons for accidentally falling or slipping include:

  • wet or recently polished floors, such as in a bathroom
  • dim light
  • rugs or carpets that are not properly secured
  • reaching for storage areas, such as cupboards
  • stairs

Another common cause of falls, particularly among older men, is falling from a ladder while carrying out home maintenance work.

In older women, falls can be particularly troublesome because osteoporosis (thinning and weakening of the bones) is a widespread problem. Osteoporosis is caused by hormonal changes that occur during the menopause.

Preventing a fall

There are several measures that an older person can take to help prevent a fall. Simple, everyday measures around the home include:

  • using non-slip mats in the bathroom
  • mopping up spills to avoid wet floors
  • getting help lifting or moving items that are heavy or difficult to lift

Removing clutter and ensuring that all areas of the home are properly lit can also be useful measures in helping to prevent falls. The charity Age UK also provides advice about how to make tasks easier around the home.

Healthcare professionals take falls in older people very seriously because of the potentially serious impact that falls can have. As a result, there is a great deal of help and support available for older people and they should not feel worried to ask their GP about the various options.

You may want to have a medication review if medication that you are taking is causing side effects, such as dizziness, which is increasing your risk of having a fall. A sight test may also be beneficial if you are having problems with your vision. A home hazard assessment may also be available. It involves a healthcare professional visiting your home to identify potential hazards and to offer advice.

Strength and balance training can be particularly beneficial to older people, and many local community centres and gyms offer specialist courses. The Chinese martial art Tai Chi has also been shown to be very useful for older people because it involves slow, controlled movements and focuses on balance. To find out about the services that are available in your area, contact your local health board or use theNHS Direct Wales Health, Wellbeing and Support Directory .

Children

Young children have a natural tendency to play boisterously but they are often not very good at judging risk. Most children will have at least one fall during their childhood.

Thankfully, children rarely die from a fall, but they often require medical attention. Each year, in the UK, an estimated 390,000 children are taken to accident and emergency (A&E) departments following a fall.

Read about preventing accidents to children in the home.

Occupational falls

Falls from height are one of the most common causes of serious workplace injury and death.

During 2008/9, the Health and Safety Executive (HSE) reported that there were 35 deaths and 4,654 major injuries as a result of falls from height.

Read more about accidents and first aid.

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Prevention

Making small changes in your home, such as using non-slip rugs and mats and ensuring that rooms are well lit, can make a big difference in helping to prevent accidents.

For people over 65, other measures can be taken to help prevent a fall.

Avoiding falls at home

Tips for preventing falls in the home include:

  • mopping up spillages straight away
  • removing clutter, trailing wires and frayed carpet
  • using non-slip mats and rugs
  • using high-wattage light bulbs in lamps and torches so that you can see clearly
  • organising your home so that climbing, stretching and bending are kept to a minimum and to avoid bumping into things
  • getting help to do things that you are unable to do safely on your own
  • not walking on slippery floors in socks or tights
  • not wearing loose-fitting, trailing clothes that might trip you up
  • wearing well-fitting shoes that are in good condition and support the ankle
  • taking care of your feet by trimming toenails regularly, using moisturiser and seeing a GP or chiropodist about any foot problems

Advice for older people

Some older people may be reluctant to seek help and advice about fall prevention from their GP and other support services because they believe that their concerns will not be taken seriously.

However, all healthcare professionals take falls in older people very seriously because of the serious impact that falls can have. As a result, a great deal of help and support towards preventing falls is available for older people.

If you are caring for an older person, you may find the information and advice about equipment and alarms useful for making their home safer. The charity Age UK provides information and advice about ways to make household tasks easier and safer.

Read more about what to do in the event of a fall.

Strength and balance training

Research has shown that older people who take part in regular strenagth and balance training are less likely to have a fall.

Many community centres and local gyms offer specialist training programmes for older people. Exercise programmes that can be carried out at home are also available.

There is also evidence that taking part in regular sessions of tai chi can help to reduce the risk of falls. Tai chi is a Chinese martial art that places special emphasis on balance, co-ordination and movement. However, unlike other martial arts, tai chi does not involve physical contact or rapid physical movements, making it an ideal activity for older people.

Read more about  physical activity guidance for older adults.

Medication review

Your doctor will need to review your medicines every year, or sooner if you've had a fall, especially if you take four or more medicines a day, to make sure they are still right for you. If you have not had your medicines reviewed for more than one year, please go and see your doctor or practice nurse.

If you are concerned that the side effects of medication that you or your relative is taking may increase the risk of having a fall, you can ask your GP for a medication review.

There may be alternative medications that you or they can use, or the current dose could be lowered. In some cases, it may be possible for the medication to be stopped.

Some types of medication that are used to treat sleep problemsanxiety or depression may also increase the chance of a fall and your GP may recommend gradually stopping them.

Sight tests

If you are concerned that poor vision is increasing your risk of falling, make an appointment to have a sight test. Find an optician near you.

Not all causes of visual impairment can be treated, but some can. For example, cataracts (cloudy patches in the lens of the eye) can be surgically removed.

Home hazard assessment

If you are concerned that you or a relative may be at risk of having a fall, or if you know someone who has recently had a fall, you can request a home hazard assessment.

The assessment will involve a healthcare professional with experience in fall prevention visiting your home, or your relative’s, to identify potential hazards and to give advice about how to deal with them.

For example, as the bathroom is a common place where falls occur, many older people can benefit from having bars fitted to the inside of their bath to make it easier for them to get in and out.

The healthcare professional who carries out the assessment may also recommend getting a personal alarm system so that you or your relative can signal for help in the event of a fall. An alternative would be to keep a mobile phone in close reach so that it is possible to phone for help after having a fall.

Contact your local authority or your GP to find out what help is available in your local area. See the Directgov website for the contact details of your local authority.

Vitamin D and calcium

Vitamin D is used to strengthen muscles and bones and has been shown to help to prevent falls in people who are 65 and over.

Foods high in vitamin D include:

  • liver
  • oily fish
  • wholegrain fortified breakfast
  • cereals
  • margarines and spreads
  • well-cooked eggs
  • evaporated milk

Sunlight is also a natural source of vitamin D so spending half an hour each day outside between April and September can also help.

There is some evidence to show that taking daily vitamin D and calcium supplements may help prevent falls in those who have a low level of vitamin D in their blood.

However, the vitamin D and calcium supplements that are found in supermarkets often do not contain a high enough amount to provide full protection. Speak to your GP if you think that you would benefit from having daily supplements. They will be able to prescribe stronger supplements.

Young people with a long-term (chronic) condition that increases their risk of having a fall, such as multiple sclerosis, may also benefit from taking vitamin D and calcium supplements.

Alcohol

Drinking alcohol can increase the risk of a fall. Older people are more susceptible to the effects of alcohol.

The effects of alcohol include:

  • loss of co-ordination and memory, which can lead to falls and general confusion
  • causing the effects of some drugs to be exaggerated, such as diazepam (Valium)
  • thinning of the bones, which can occur with heavy drinking

Children

Preventing falls in children can be somewhat of a balancing act. It is natural for parents to want to protect their children, but most parents don't want to stop their children from having fun and taking part in normal childhood activities.

Although it is impossible to prevent all falls, there are steps that you can take to minimise the risk of a fall or to avoid serious damage in the event of a fall.

Read more information and advice about preventing accidents to children in the home.

Workplace advice

Only use ladders in a workplace environment for short-term, light work. Any work that requires spending a considerable amount of time at height, or involves heavy lifting, should be carried out on scaffolding or another suitable platform.

The Health and Safety Executive (HSE) provides more information about the correct use of ladders in the workplace, including a list of common tasks that involve working at height.

Any work that involves going up onto a roof should also be considered high-risk and therefore high standards of safety are essential.

Read more about carrying out minor roof work, including tips for safe working.

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What to do

Try not to panic if you have a fall. It is likely that you will feel shocked and a bit shaken, but staying calm will help you to gather your thoughts and remember what to do.

When you are calm, ask yourself whether you feel able to get up. If you are not hurt and you feel strong enough to get up, follow the steps listed below.

  • Do not get up quickly. Roll onto your hands and knees and look for a stable piece of furniture, such as a chair or bed.
  • Crawl over to the piece of furniture and, if possible, put something soft under your knees.
  • Hold on to the furniture with both hands to support yourself.
  • Place one foot flat on the floor, with your knee bent in front of your body.
  • When you feel ready, slowly get up.
  • Sit down and rest for a while before carrying on with your daily activities.

If you are hurt or unable to get up, follow the steps listed below.

  • Try to get someone’s attention by calling out for help, banging on the wall or floor (if there is someone on the floor below you) or using your aid call button (if you have one). If possible, crawl to a telephone and dial 999 to request an ambulance.
  • While you are waiting for help to arrive, try to get as comfortable and as warm as you can by moving to a carpeted area. Try to reach something warm to put over you (particularly your legs and feet), such as a blanket or a dressing gown.
  • Try to move regularly to avoid getting pressure sores and to help you keep comfortable. Change your position regularly (at least once every half an hour).

See accidents and first aid for information and advice about what to do after an accident if you are living with, or caring for, an elderly person.

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