Falls

Falls are a common, but often overlooked, cause of injury. Around 1 in 3 adults over 65 who live at home will have at least one fall a year, and about half of these will have more frequent falls.

Most falls do not result in serious injury. But there’s always a risk that a fall could lead to broken bones, loss of confidence and independence.

Falls in older people should be taken very seriously because of the huge consequences they can have for the health and wellbeing of this group.

Osteoporosis

Osteoporosis is a condition that weakens bones, it is a fairly common problem and can make falls problematic due to the increased chance of breaking bones.

It can develop in both men and women, particularly in people who smoke, drink excessive amounts of alcohol, take steroid medication, have a family history of hip fractures or women who have completed menopause.

Why do we fall?

Ageing

The natural ageing process means that older people have an increased risk of falling, particularly the over 75s. This is mainly due to;

balance problems and muscle weakness
poor vision
a long-term health condition, such as heart disease
dementia
or low blood pressure (hypotension) which can lead to dizziness and a brief loss of consciousness

Hazards

Wet floors in bathrooms, or recently polished floors
Poor or low lighting
Loose rugs or carpets or thresholds between rooms
Cluttered walkways or excessive furniture
Poor footwear, loose slippers or smooth soled shoes
Reaching for items in high or low storage areas
Completing DIY on step ladders
Going up or down stairs without support
Rushing to the toilet during the day or at night

Fear of falling

Having a fear of falling, particularly in later life is very common and often distressing. It can be very limiting, preventing you from having an active and fulfilling life, avoiding daily tasks and resulting in further immobility, loss of confidence and further health conditions.

Being anxious about falling can increase your risk due to the way it affects your body such as feeling dizzy or lightheaded, racing heartbeat, shortness of breath, shaky legs and pain or tightness in your muscles. This is completely normal reaction and you should not be embarrassed but should speak to your GP or local therapy team about this.

What should I do if I fall?

Stay calm. It is important to stay calm and assess if you are hurt. If you are not hurt, you can get up if you are strong enough:

How to get up

Roll onto your knees and use a stable piece of furniture, such as a chair, and slowly bring yourself back to your feet. Ensure you sit for a short time before returning to normal activities.

Always call to inform someone you have fallen.

What to do after an incident

If you are in pain or cannot get up:

Call for Help. Call 111 or 999.

Call out for attention, bang on the wall/floor, press your call aid button if you have one.

Crawl to a phone, call 999 for an ambulance.

Stay warm & comfortable. Cover yourself in a blanket or dressing gown. Try and keep changing position until help arrives.

Telecare

Telecare is the use of discreet equipment used in an emergency or if you are having difficulties in your home. As well as peace of mind for you, your family and your carers, telecare may give you more freedom to live independently knowing you can call for help by simply pressing a button when needed.

How do you know if you are at risk of falling?

Take this simple test to identify if you are at risk.

The test can help uncover any health issues that might make you more likely to fall, which you can discuss with your GP.

Fall risk test

1. Have you had a fall in the last 12 months?

You are more likely to have another fall if you have fallen in the last year.

2. Are you on 4 or more medications a day?

Taking 4 or more medications significantly increases the risk for falling because of the side effects associated with multiple medication use.

3. Do you have Parkinson’s disease or have you had a stroke?

Falls are common after a stroke mainly because of leg weakness, sensory loss, and foot, eyesight and balance problems. If you have Parkinson’s, you may have poor balance, take small steps or walk too fast, or have involuntary movements affecting your balance.

4. Do you feel unsteady or have problems with balance? Can you walk while talking? Do you sway significantly while standing still? Get someone to observe you standing upright. Can you stand on one leg?

If you stop walking either immediately or as soon as you start to answer a question, you should answer “Yes” to question 4. If you raise your arms or adjust your foot placement for balance, you should answer “Yes” to question 4. If you struggle you should answer “Yes” to question 4.

5. Do you struggle to get up from a chair?

You should be able to stand up from a chair of knee height without using your arms. If you cannot, or you feel dizzy or unsteady, answer “Yes”.

6. The “Timed Up and Go” test: Does it take you more than 12 seconds to do the following?

Stand up from the chair
Walk 3 metres (10 feet) at your normal pace
Turn
Walk back to the chair at your normal pace
Sit down again

Score

If you have had a fall in the last 12 months or answered “Yes” to two or more questions then you should contact your GP or single point of access teams for further support – number at the bottom of the page.

Preventing a fall

Reducing environmental hazards

Having a home / environmental assessment by a health care professional
Clear clutter, reduce furniture and clear walkways
Ensure rooms, passages and staircases are well lit
Remove rugs and mats or use non-slip matting

Vision assessment

You should have your eyes tested every 2 years (or more if advised by an opthalmic professional) to ensure your vision is optimised. Find your nearest NHS optician.

Exercise

Physical activity and exercise is important for older adults to maintain muscle strength, balance and co-ordination
You should aim to complete 150 minutes of moderate exercise per week
Strength exercises; (weights, yoga) 2-3 times per week
Balance exercises; watch this video to find out more

Six exercises to look after your muscle strength

There is an underlying myth that falls are an inevitable part of getting old.
The surprising truth is that our risk of a fall decreases with this one simple thing: exercise.
You see, starting at 30, our muscles can loose 8% of there strength every decade.
So, by the time we are 80, we have potentially lost 40% of our strength.
We can help reverse this trend though, with six simple exercises, widely used by physiotherapists, to keep us mobile and independent as we age.
All you need is a steady support, sensible shoes and a little time each day.
Exercise 1. Heel raises
Stand tall and hold your support, then raise your heels off the floor. Taking your weight through the front part of your feet.
Hold this position for three seconds. Then slowly lower your heels to the floor. Repeat this ten times.
Exercise 2. Toe raises
Stand tall and hold your support again. This time raise your toes.
Taking your weight in your heels. Keep upright and don’t stick your bottom out.
Hold this position for three seconds then slowly lower your toes. Repeat this ten times.
Exercise 3. Heel toe stand
Stand tall sideways on your support. With one hand on your support.
Now put one foot directly in front of the other, to make a straight line, as shown.
While looking ahead, take your hand off the support if you can, and balance for ten seconds.
Take your front foot back, to hip width apart and place the other foot in front instead. Balance again for ten seconds.
Exercise 4. One leg stand
Stand close to your support and hold it with one hand. Now balance on one leg and keep the support knee soft and your posture upright. Hold this for ten seconds.
Now repeat on the other leg.
Exercise 5. Heel toe walking
We’ll be walking forwards for this one. So use a support, like a sideboard.
Stand tall with one hand on your support. While looking ahead place one foot directly in front of the other, so your feet form a straight line. Then move the back front in front of the other.
Continue a steady walking action for ten steps. Then take the feet back to hip width apart. Then turn around and repeat the steps in the other direction.
Exercise 6. Sit to stand
Grab a sturdy chair. Then sit tall towards the front with your feet tucked slightly back.
Now lean forwards slightly and stand up. If you need to, place your hands on the chair for extra support.
Carefully step back until your legs touch the chair, then slowly lower yourself back into the chair.
Repeat this ten times.
And that’s it, keep these up and you’ll help your muscles stay strong.
If you’d like to keep these exercises handy, download our PDF.
This advice is brought to you by The Chartered Institute of Physiotherapy.

Balance exercises need to be challenging and progressive. Chair based exercises will not improve your balance.
Our community therapy or falls team, can create a program suited to your needs
Learning how to get up and down from the floor is an important skill to have

Continence Assessment

Reducing your need to rush to the toilet due to urgency, improving your mobility to the toilet, or wearing pads to reduce your worries about incontinence can help to reduce falls.