Why are falls a problem?

A fall at any age can be dangerous, but falls become increasingly common and far more likely to cause injury after the age of 55. Approximately one in three people over the age of 65 will fall in any one year, and 4% of these ‘fallers’ end up in hospital and 1% suffer a hip fracture. This adds up to a significant number of people every year. Hip fractures in particular can be disabling and impact on your mobility and independence.

What is the fall cycle?

Some people, especially those who have had a fall, restrict what they do because of a fear of falling. While this sounds sensible, in fact, reduced activity actually puts you at a greater risk of falling because you will lose muscle strength and coordination. So it is important to keep up activities you enjoy, as safely as possible – ‘The more you do, the more you can do’. 

Why are falls more common with age?

Factors involved in why falls occur include:

• poor leg strength and impaired balance
• side effects from your medications
• other medical conditions
• eyesight problems
• nutritional deficiencies
• hazards around the home environment.

Health conditions that can increase your risk of falling may be hard to notice by yourself, so regular check-ups with your doctor are a good way to spot them.

Poor leg strength and balance

It is common to lose leg strength as you age, and particularly if illness has kept you ‘out of action’ for a while. This can also affect your balance and coordination. Your doctor, practice nurse or physiotherapist can perform simple tests of your muscle strength and balance. Your doctor may also be able to refer you to exercise classes or programmes in your area, targeted at reducing your risk of falls (more info further below).

Side effects of medications

Many commonly used medications (and non-prescription products and natural remedies) can cause you to have balance problems. These include some antihistamines for allergies, sedative sleeping tablets, antidepressants, diuretics (‘water tablets’) and medications used to control blood pressure. Certain medications can cause balance problems if they are taken wrongly or with alcohol. If you tell your doctor about all the prescription and non-prescription products you are using, he or she will be able to advise you of any problems they might cause – sometimes it is the combination of products that is the problem.

Other problems with your health

Some health problems can increase your risk of falls.

• Heart problems or low blood pressure (particularly on standing) can cause dizziness.
• Previous stroke or Parkinson’s disease can impair coordination and strength.
• Diabetic nephropathy (numbness of the foot) can make foot placements unsteady.
• Meniere’s disease disrupts your sense of balance.
• Infection can also affect balance and strength.

Poor eyesight

The older you get the more light you need to see. Most people also become more sensitive to glare and less able to judge distances. To minimise the risk of falls caused by not seeing obstacles or uneven ground you should get your eyes checked every year by your doctor or optometrist. If you have more than one pair of glasses, make sure you wear the right ones for the right task. And if you have new ones, take care while you get used to them.

Diet and nutrition

You should eat a balanced, nutritious diet for energy, and make sure you get enough calcium for bone strength. Getting out into the sun most days allows your skin to make vitamin D, which also strengthens your bone and muscles. However, quite often, older people who are frail and housebound or who have chronic conditions or those in long term care are unable to generate enough vitamin D to keep their bones and muscles strong. Vitamin D supplements may be recommended, so speak to your GP if you are concerned. It is also important to drink enough fluids – being very dehydrated can cause balance problems.

Home hazards

There are many falls hazards that can be removed from the home – ACC provides detailed lists of safety tips, eg:

• Your home should be well lit (inside and out) and uncluttered, with cords and cables safely positioned or powerpoints repositioned to avoid lengthy cables.
• Rails on stairs, outside steps and alongside baths and showers should be considered.
• Remove, or secure rugs and mats with tape/velcro.

If you are at risk for falls it is important to wear well-fitting, flat shoes with thin, non-slip soles for increased stability around the house. If you have problems with shoes or painful or swollen feet, your doctor or podiatrist can help.

Personal medical alarms

People at risk of falls or those who have had a fall in the past may find it useful to have a medical alarm. These can make it easier to remain independent and continue living in your own home, especially if you live alone. Medical alarms are usually worn as a pendant or wristband which can be activated to call for assistance if you have a fall and are unable to get to the phone or require medical help. This is a safeguard for people wanting to continue with everyday life around the home and garden, and can also offer peace of mind for family members, about your ongoing safety.

What to do if you have a fall

IF YOU HAVE A FALL AT HOME…

• Stay calm and decide whether to try to get up.

IF YOU CAN GET UP…

• Bend your knees up, roll onto your side, then push up onto all-fours.
• Crawl towards a sturdy chair.
• Use this support to help get yourself seated.
• Rest at any time, if necessary, and then try again.

Medical alarms, keeping the phone near ground level and giving friends a spare key are useful precautions you can make in case one day you cannot get up from a fall.

Exercises to prevent falls

Regular exercise is important in preventing falls. Benefits include improved balance, muscle strength and flexibility; stronger bones; more energy; better sleep; and better control of blood pressure, blood sugar and weight. General fitness can be improved by walking for 30 minutes most days of the week (or three 10-minute walks). It should make you breathe harder, but you should still be able to speak easily.

Programmes designed specifically for balance and muscle strength have been shown to reduce the number of falls and injuries resulting from falls by between 30% and 50%. Modified Tai Chi classes are some of the most common ones. Tai Chi is a gentle, controlled series of movements that help you develop strength, flexibility and balance. Once-a-week classes for 16 weeks are available in most regions and are funded by ACC, provided you are eligible and have first been assessed by your doctor.

Whatever you do to prevent falls, a positive approach will account for much of the progress.

Further information and support

Request the ACC booklet ‘Standing up to falls’ and ask about ACC-funded Tai Chi classes in your area. Freephone 0800 844 657, website www.acc.co.nz

Adapted from material provided by ACC and edited by everybody. Reviewed November 2011.