Tackling falls and fractures in older adults

Wherever possible, it is helpful for everyone involved to understand the circumstances and nature of the fall because it helps to identify any contributory causes. What happened? Where? When? Has it happened before?

If the hospital team is not involved, then you should notify a GP.

Telling a GP about a fall is important – they can make a physical examination, review medication, and arrange a falls risk assessment. The assessment will explore any contributory factors (as listed above) and identify what can be done to prevent any further falls.

Typical actions include – strength and balance training, changes to medication, identifying and treating osteoporosis, and a home hazard assessment with modifications to promote safety. Some older people who experience unexplained falls actually have a circulation problem and need a pacemaker.

Be sure to ask whether any medication should be stopped or reduced, and whether any incontinence, poor balance, dizziness, confusion or suspected memory problems need further assessment or treatment.

Ageing can decrease contrast sensitivity (making it harder to see the edge of steps and kerbs), alter depth- perception and cause visual field disturbances – all of which increase the risk of falling. (see our article on sight problems in older age)

Removing hazards and adding supports such as hand rails can help to improve home safety.

Often the GP or Local Authority Adult Social Care Service will arrange a home hazard assessment leading to the installation of helpful equipment such as grab rails. An occupational therapist is likely to perform this assessment and arrange help. Typical measures include:

• Keeping pathways, stairs and walkways clear of objects that you could trip over.
• Removing throw rugs or using a rug gripper to secure them to the floor. If you can move a rug easily, you could also slip on it.
• Storing frequently used items close by to avoid unnecessary reaching or bending which can cause you to lose balance.
• Installing bright lights with switches at both ends of stairways, and night lights to light the path from bedroom to bathroom. Light switches that glow are easier to see in the dark.
• Adding supports in the bathroom where things are more likely to be wet and slippy. Grab bars near the toilet and in the shower and non-skid strips in the bathtub can all help.
• Installing handrails on both sides of the stairs.

Sometimes an older person can find all of these changes to their private home rather disruptive and intrusive and might not readily welcome the flurry of help.

Personal alarms and monitoring systems (telecare) enable help in the event of a fall or other problem.

There is a huge range of sophisticated technology available these days – from basic alarms to advanced monitoring systems that allow family members to see who’s knocking at the door.

The most basic alarms are triggered by the wearer and send a signal to a relative(s) or care team. Typically, these alarms are either buttons or pull cords installed around the home or they can be in the form of a wearable pendant. Some mobile phones include an alarm button which can trigger text messages to an appropriate “response team” (eg the family).

More sophisticated devices include a fall detector and even GPS tracking systems.

Many local councils provide basic alarm devices often linked with 24 hour monitoring services which provide an appropriate intervention in response to an incident. You can find out more by contacting adult social services at your council and, if they do, you can arrange a home assessment.

With any of these devices you will need to consider how others can access the home in an emergency. Whilst a relative might have a key, typically, emergency doctors and ambulances will not. A key safe can be the simplest and most commonly used solution. It is a small box fixed to the outdoor wall which holds the door key and which can only be accessed with the correct security code. You can buy a key safe privately (prices vary £20-£150 depending on how robust they are) but local councils will often provide and arrange installation as part of their alarm service.

Assistive equipment can help make getting around more comfortable and safe.

Typical examples include: walking sticks, and all sorts of walking frames. If used properly, this equipment can help with mobility and balance and also help to ease any pain and increase confidence. All of which can go a long way to promoting independence.

Although it may seem easiest to buy this equipment, experts emphasise how important it is to ensure that the product is fitted to the individual and his or her needs.

As with home adaptations, a GP or health or social care team can arrange a suitable occupational therapist or physiotherapist to explore what kind of support would be most helpful.

Make sure everyone involved knows how to summon help after a fall so that there is no possibility of your loved one being left lying on the floor for any prolonged period. A long lie is known to be dangerous and should be avoided at all costs.

The ageing process naturally impairs balance, muscles and joints and this is compounded by long periods spent sitting down. Regular activity can help to offset the effects of ageing. This does not have to entail running a marathon running or completing an iron man competition, simple actions such as housework or regular low impact exercises can build or maintain balance, strength and flexibility whilst limiting periods of inactivity. Specific advice about exercise is available in the “find out more” section below.

Eat well for healthy bones – a healthy diet can ensure you get enough calcium to maintain bone strength. Older people can also benefit from a Vitamin D supplement which helps the body absorb calcium – this is something to discuss with a GP.

Reduce alcohol intake – ageing is associated with bodily changes which means we cannot tolerate the same amount of alcohol. Older people are also more likely to experience unsteadiness after drinking alcohol making them more susceptible to falls.