This chapter was added to the APPP in February 2022.
Falling, or worrying about falling, can be a great concern and anxiety for those who are getting older or who have illnesses or disabilities that may make them more vulnerable to falls.
Many people may not worry about having a fall until it actually happens. Straight after a fall, the main concerns will probably be about the physical impact and whether they need to see a doctor, go to Accident and Emergency or even be admitted to hospital.
However, after the physical effects have faded, a fall can continue to affect someone’s confidence, self-esteem and impact on the activities they enjoy, especially if they are frightened it will happen again. A fall does not have to result in broken bones and bad bruising to seriously impact on a person’s mental wellbeing; even trips and small falls can have a significant effect.
As well as the physical and psychological effects of a fall for adults and their family, there is also an impact on health and social care services. For example, they may need to be admitted to hospital for an operation to repair a broken hip, or other significant injuries; referral for home care services may be needed for support at home, or they may not be able to return home and need to move into permanent residential or nursing care. As well as the psychological impact on the adult and their family and friends, this puts additional pressure on hospital beds (particularly related to delayed discharge), hospital and social care staff and domiciliary and residential care services.
For a number of reasons therefore, reducing the possibility of someone having a fall is vital. This chapter outlines some of the main issues to consider about falls and actions that can be taken to reduce the possibility of people having a fall. Issues raised that relate to preventing falls may be considered as part of a strengths based assessment.
2. Preventing Falls
There are a number of ways that people can reduce their risk of having a fall. These can be divided into actions for the person and also to their environment.
2.1 Actions for the person
2.1.1 Contacting the GP
The adult should discuss any falls they have had with their GP and let them know if it has had any impact on their physical and mental health and wellbeing.
The GP can carry out some easy balance tests, to see if they are likely to have another fall in the future. They can also refer them to appropriate services in the local area. They may also need to review any medication the adult is taking as the side effects of some prescription drugs may increase someone’s risk of having a fall; if it is making them feel dizzy for example.
2.1.2 Strength and balance exercises
Doing regular strength exercises and balance exercises can improve people’s strength and balance and reduce their risk of having a fall. These can be:
- simple exercises such as walking or dancing (community centres and local gyms often offer training programmes specifically for older people);
- exercises that can be carried out at home;
- tai chi can reduce the risk of falls. This is a Chinese martial art that focuses on movement, balance and co-ordination. It does not involve physical contact or rapid physical movements, so it is a good exercise for older people.
When someone has had a fall, strength and balance training programmes should be personalised for that individual person and monitored by an appropriately trained professional. In such circumstances, a GP should be consulted, who should make a referral to other services and professionals as appropriate.
2.1.3 Eye tests
Eyesight changes as people get older and can lead to a trip or loss of balance. People should make sure they have eye tests at least every two years and wear the right glasses for them, as problems with vision can increase the risk of having a fall. They should also get a test if they think their vision has got worse, even if it is before two years.
Not all vision problems can be cured, but some can be treated with surgery, for example cataracts can be removed which will improve a person’s sight.
See also Look after your eyes (RNIB)
2.1.4 Hearing tests
Hearing also changes as people get older. Adults should get a hearing test if they think their hearing has got worse. They should also talk to their doctor, as ear problems can affect balance. It may be something which is easily treated, such as a build-up of ear wax or an ear infection, or they may need a hearing aid.
See also Hearing loss (NHS)
2.1.5 Alcohol and drugs, including prescription drugs
Drinking alcohol or taking drugs – including some prescription drugs – can lead to loss of co-ordination. Alcohol can also make the effects of some medicines worse. This can significantly increase the risk of a falls.
Avoiding alcohol or illegal drugs or reducing the amount a person drinks can reduce their risk of having a fall. People should see their GP if they think their dizziness or lack of coordination may be related to prescription medication.
People should take care of their feet by trimming toenails regularly and seeing a GP or podiatrist (foot health professional) about any foot problems. If someone has foot pain it may cause them to walk differently or limp, which may affect balance. Wearing well-fitting shoes and slippers that are in good condition and support the ankle can also reduce the risk of having a fall:
- footwear should fit well and not slip off;
- sandals with little support and shoes with high heels should be avoided;#
- slippers should have a good grip and stay on properly;
- people should always wear shoes or slippers and not walk in bare feet, socks or tights.
2.1.7 Eating well
Having food that is nutritious, as well as tasty, helps people stay well. If people do not have a good appetite, it is better to eat little and often instead of three main meals, if they prefer. Having enough energy is important in keeping up strength and preventing falls.
See also Eat Well (NHS)
2.1.8 Drinking fluids
In addition to eating well, people should make sure they are drinking plenty. Not having enough fluids may result in someone feeling light-headed, which will increase their risk of a fall. People should drink about six to eight glasses of (non alcoholic) fluid a day.
2.1.9 Bone health
Bones can become weaker as people get older, and weak bones are more likely to break if someone falls. Bones can be kept healthier and stronger by eating food rich in calcium, getting enough vitamin D from sunlight and doing some weight-bearing exercises, as mentioned above.
2.2 Environment issues
2.2.1 Avoiding falls at home
Tips for preventing falls in the home include:
- wiping up anything that has been spilt on the floor;
- removing clutter, trailing wires and repairing or replacing frayed carpet;
- using non-slip mats and rugs;
- making sure all rooms, passages and stairs are well lit, especially when it is dark. A night light near the bed so people can see where they are going if they wake up in the night – including motion-activated light that come on as needed – are useful;
- organising the home so that climbing, stretching and bending are kept to a minimum, and avoid bumping into things so drawers and cupboards are shut immediately after use;
- the adult getting help from other people to do things they cannot safely by themselves;
- not wearing loose-fitting, trailing clothes that might catch on door handles or trip the person up
Mobile phones or alarms should always be carried, even around the house.
Personal alarms and telecare allow people to call for help, if they are unwell or have a fall and cannot reach the phone. People can wear a button on a pendant or wristband all the time, or have other technology aids, which will alert a 24-hour response centre. The staff at the centre call friends and family on the adult’s pre-decided list of contacts, or contact the emergency services.
2.2 Avoiding a fall outside
Falls do not just happen in the home, they can occur in the garden, in the street and on outings, particularly if places are not familiar. The following should be considered to reduce risk:
- if people are wearing a mask or face covering, they should be extra careful about moving about as it can make it harder to see. They may need to slow down to reduce their risk of falling;
- people should use a walking stick, walking frame or walk with others for support if this helps them feel more confident;
- walking on uneven ground in gardens may make some people more vulnerable to losing their balance, as can reaching and stretching to do gardening jobs. Mobile phones should always be carried, especially in the garden;
- walking dogs who may pull, even if they are small dogs, can cause people to lose balance as can dogs jumping up onto people;
- take extra care in icy, snowy and wet weather – wet leaves and mud can also be very slippery;