Preventing Falls

1. Introduction

Falling, or worrying about falling, can be a great concern and anxiety for those who are getting older or who have illnesses or disabilities which may make them more vulnerable to falls.

Many people may not worry about having a fall until it actually happens. Straight after the fall, the main concerns will probably be about the physical impact and whether they need to see a doctor, go the the Accident and Emergency Department or even be admitted to hospital.

But, after the physical effects have faded, a fall can affect someone’s confidence, self-esteem and impact on the activities they enjoy, particularly if they are frightened it might happen again. A fall does not have to result in broken bones or bad bruising to seriously impact on a person’s mental well-being; 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 families, there is also an impact on health and social care services. For example, a person may need to be admitted to hospital for an operation to repair a broken hip or other significant injuries; a 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 to 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 in relation 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 in relation to falls, and summaries actions that can be taken to reduce the likelihood of a person having a fall. Issues raised in relation 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 their 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 had any impact on their physical and mental health or 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 the risk of someone having a fall; for example by making them feel dizzy.

2.1.2 Doing strength and balance exercises

Doing regular exercise can improve a person’s strength and balance and in turn 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 designed 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 coordination. It does not involve physical contact or rapid physical movements, so is a good exercise for older people.

See also Physical Activity Guidelines for Older Adults (NHS)

When someone 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, and they will 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 this 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 a loss of co-ordination. Alcohol can also make the effects of some medicines worse. This can significantly increase the risk of falls.

Avoiding alcohol or illegal drugs or reducing the amount of alcohol 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.

See also:

Alcohol Misuse (NHS)

Drug Addiction: Getting Help (NHS)

2.1.6 Footcare

People should take care of their feet by trimming toenails regularly, and seeing a GP or podiatrist (footcare 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 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 drink plenty. Not having enough fluids may result in someone feeling light-headed, which may increase their risk of a fall. People should drink about six to eight glasses of fluid (non alcoholic) a day.

2.1.9 Bone health

Bones can become weaker as people get older, and weak bones are more likely to break if a person 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 lights that come on as needed – are useful;
• organising the home so that climbing, stretching and bending are kept to a minimum, and making sure that drawers and cupboards are closed immediately after use so they are not bumped into;
• the adult getting help from other people to do things they cannot safely do 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 at all times, or have other technology aids which will alert a 24 hour response centre. The staff at the response centre will contact friends or family on the adult’s pre-decided list of contacts or contact the emergency services.

See also Tips on Adapting Your Home as You get Older (Age UK)

2.2.2 Avoiding a fall outside

Falls do not just happen in the home, they can also 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 around, as these can make it harder to see.  They may need to slow down to reduce the 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 their balance, as can dogs who jump up;
• take extra care in icy, snowy and wet weather – wet leaves and mud can also be very slippery. See also What to do when the Weather is Particularly Bad (Age UK)