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Falls – The what, why and how to prevent

We have all heard of falls. Most of us know an older person that has recently had a fall.


Whether it be an old friend, the lady down the street or mom and dad. Falls are so common, it feels like they are simply a fact of life.


Falls are frequent and sometimes fatal, but they can be and must be foiled.



What is a fall?


"A fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or other lower level"

- World Health Organization (WHO)

That definition is worth reading again.


Anytime someone ends up on a lower surface without the intention to do so, they have had a fall.


Many people overlook instances of falls, particularly if they fell on the bed or sofa. While others even ignore a fall to the floor if they are able to get themselves up and walk away.



However, these falls need to be taken seriously as they may be a warning sign for a loss of balance.



Different types of falls


Falls are of different types. One way to classify a fall is based on what caused it:

  1. External force (I.e. being pushed, strong wind)

  2. No external influence (I.e. fainting, over balancing)

  3. Unexpected hazard (I.e. trip, slip on banana peel)

  4. No apparent cause



Understanding falls


Falls are important to understand for several reasons. Here are 2 big ones.


Falls are common

On average, 1 in 3 people aged over 65 will fall at least once a year (Lord et al. 2007). Of these, 40% are likely to fall again in 12 months (Ryynänen et al. 1992).


Falls have consequences

Needless to say, having a fall can have a dramatic impact on one's own life and the lives of those around them, particularly if the person is frail.


Falls also come at a cost to the community and the economy. Falls are one of the leading cause of death and disability worldwide. Falls are estimated to cost Australia's economy $50 billion every year (Florence et al. 2018).


The World Health Organization reported that falls are the second leading cause of unintentional injury death globally. In Australia, falls are one of the leading cause of injury-related hospitalisation and amongst the top 10 leading causes of death of older people.




Figure 1. The fall cycle. Falls often start a downward spiral towards physical inactivity and loss of independence. Education and exercise can help break the cycle.



Consequences of a fall

  • Fractures. More than 95% of hip fractures are due to falls

  • Internal or external bleeding (I.e. bruising, lacerations)

  • Most common cause of Traumatic Brain Injury

  • Reduced physical activity and confidence


Given the gravity of the issue, it is clear that we must tackle the issue of falls.



Can falls be prevented?


Yes!


It is important to seek expert advice from a health professional such as the doctor, physiotherapist or exercise physiologist.


The clinician will ask a number of questions to better understand what type of fall the client has had. Based on the falls history, the clinician will provide recommendations to reduce the risk of subsequent falls.


A tailored exercise program should be a key component of any falls prevention program. An exercise physiologist can assess the client's strength and balance and then prescribe exercise which are appropriate for them.





Quick tips to preventing falls

  • Wear good supportive shoes

  • Reduce clutter around the house

  • Ensure good lighting

  • Get vision check regularly

  • Do home modifications (hand railings etc)

  • Learn to manage activities (I.e activity pacing, substitution of risky activities)

  • Manage medications


Key references

  1. Ageing, W. H. O., and L. C. Unit. 2008. “WHO Global Report on Falls Prevention in Older Age.” World Health Organization.

  2. Florence, Curtis S., Gwen Bergen, Adam Atherly, Elizabeth Burns, Judy Stevens, and Cynthia Drake. 2018. “Medical Costs of Fatal and Nonfatal Falls in Older Adults.” Journal of the American Geriatrics Society 66 (4): 693–98.

  3. Fumio, E. 2001. “Causes of Falls in the Elderly.” JMAJ 44 (7): 299–305.

  4. Lord, Stephen R., Catherine Sherrington, Hylton B. Menz, and Jacqueline C. T. Close. 2007. Falls in Older People: Risk Factors and Strategies for Prevention. Cambridge University Press.

  5. Ryynänen, O. P., S. L. Kivelä, R. Honkanen, and P. Laippala. 1992. “Recurrent Elderly Fallers.” Scandinavian Journal of Primary Health Care 10 (4): 277–83.

  6. Terroso, Miguel, Natacha Rosa, Antonio Torres Marques, and Ricardo Simoes. 2014. “Physical Consequences of Falls in the Elderly: A Literature Review from 1995 to 2010.” European Review of Aging and Physical Activity 11 (1): 51–59.





ABOUT THE AUTHOR


Hassan Qureshi is the founder and owner of Holistic Exercise Physiology. He believes educating and communicating good science to the wider public is not only important but is the responsibility of every clinician. For this reason he started the Holistic blog. For more blog posts, subscribe now!

If you would like to see Hassan Qureshi, you can meet him online or visit him at a clinic.

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