Falls, and injuries related to falls, are common among the elderly.

 

In Singapore, falls are a leading cause of injury among older adults. One in three people over 65 experience a fall each year, risking severe injury and even death.

 

According to the Health Promotion Board, about a third of Singaporeans aged 65 and above have recurring falls and the incidence rate increases sharply with age.

 

Falls among senior citizens also reduce overall everyday functions and result in early admission to long-term facilities.

Falls among the elderly can cause physical and pyschological issues, so it is important to nip the problem in the bud.

Explains Mr Vimal Raman, 31, senior physiotherapist at Orange Valley: “As we grow older, our bodily functions change or deteriorate. Changes include reduced sense of balance, slower reaction or response time, weaker leg muscles and impaired vision. Chronic medical conditions with the use of four or more drugs also increases the risk of falls.”

 

At Orange Valley, one of Singapore’s largest private nursing home operators, some of the residents are admitted for reduced independence due to falls.

 

Mr Vimal, who has seven years’ experience as a physiotherapist, says falls involving the elderly can lead to severe physical and psychological consequences. “Physical consequences include head injury, fractures and soft tissue injuries to the body and the common fracture sites are the wrist, hip and spine,” he says.

 

According to the American Academy of Orthopaedic Surgeons:

• 20 per cent of elderly hip fracture patients die within one year after their fall;
• 50 per cent become dependent on a cane or walker;
• 40 per cent needs to be admitted to a nursing home due to an inability to perform daily activities such as eating, bathing, getting dressed and toileting; and bathing, getting dressed and toileting; and
• Only 25 per cent of older adults who suffer a hip fracture from a fall make a complete recovery.

On top of that, the elderly victim of falls will also develop psychological fear, Mr Vimal says.

 

And this fear of falling again often leads to self-imposed idleness, which, in turn, can result in functional decline and higher risk of falls.

 

The psychological impact includes:

• Loss of autonomy and confidence when an elderly person becomes dependent on help to get around; and
• Developing a fear of falling that could lead to withdrawal from social activities like visiting friends and relatives, attending religious gatherings or going on trips. “Distress and frustration due to injury and loss of independence can also lead to depression and social avoidance,” Mr Vimal adds.

Causes of falls

 

Studies have shown that many of these falls involving the elderly often happen at home. These are often caused by clutter, poor lighting, loose mats and cables, as well as slippery floors, especially in the bathroom.

 

“Tripping can also be due to shuffling, a usual gait change due to medical conditions such as Parkinson’s disease. Seniors with medical conditions such as  diabetes,  stroke, dementia and arthritis should also be monitored closely. Seniors can experience giddiness due to a drop in blood pressure when getting up from lying down or sitting position too quickly. ,” Mr Vimal says.

 

Some medications — such as sedatives, diuretics, anti-depressant and blood pressure drugs — may affect balance, vision or alertness, thus indirectly being the cause of falls, he adds.

 

It is important to reduce the risk of falls in older adults, and factors that cause a person to fall should be removed.

 

Interventions include:

• Home modifications: This includes installing rails as well as reorganising and reducing clutter. Studies have shown that home modifications are the most useful in preventing falls — at least for people who already had a history of falling. In one study participants with a previous history of falls were 37 per cent less likely to experience a second fall after home modification, while another showed that it cuts fall rates by 25 per cent among patients who had already experienced a fall.
• Vitamin D3 supplements: These are given to strengthen the bones and decrease the risk of fracture should a fall occur.
• Exercise: Programmes include strategies to build muscles and improve balance.

“Ways to prevent falling include ensuring that the elderly goes for regular medical check-ups and takes medication as prescribed, is aware of the side-effects of these medications and to use prescribed walking aids as advised by the physiotherapist,” Mr Vimal says.

 

Helping fall victims regain strength and confidence

 

He adds that the elderly’s fear of falling should not be ignored. In fact, it is important to acknowledge the validity of the fears about falling “as these fears are not unfounded; they are very real to the elderly”.

 

“The physiotherapist can then come up with individualised exercise programmes to help strengthen weaker muscles, improve the sense of balance and coordination, and conduct mobility training. They may also incorporate strategies to recover balance and educate on falls prevention,” he says.

 

“At Orange Valley, we also advocate strong family involvement in our rehab programme, as the rehab journey may not be all smooth sailing, and their emotional and moral support is crucial to keep confidence level consistently high.”