Are you at risk of falling?

By Dr TEH ROHAILA JAMIL

HAVE you ever fallen down or slipped? If you haven’t, you might know of others who have. Falls in older people is common and the risk increases with age.

Worldwide, it is estimated that around 35% of people who are over 65 fall every year. In Malaysia, a similar picture exists, in which around 28-47% of elderly people have had falls.

Some might think that falling is natural and occurs as you get older. Many even don’t see the harm in it and don’t think it is a serious matter.

Why must we be concerned with falls in the elderly? Though most falls don’t cause any injuries, around one in five of them result in serious consequences. Those injuries may range from just minor cuts and bruises to more serious ones such as bone fractures or even death.

What are the risk factors?

A person may often have more than one risk factor for falls. The more risk factors they have, the higher the chance of an elderly person having a fall.

Here are examples of these risk factors:

Biological factors

  • Increasing age – the older you get, the higher the risk of falling
  • Medical diseases – such as high blood pressure, diabetes, stroke, dementia
  • Vision problems
  • Gait or balance problems
  • Muscle weakness

Behavioural factors

  • Taking multiple medications
  • Lack of exercise
  • Inappropriate footwear – wearing ill-fitted shoes or slippers increases risk
  • Excessive alcohol intake
  • Fear of falling – elderly people who worry about falling increase their risk of falls. Worrying about falling may cause them to limit their activities, subsequently leading to muscle weakness and problems with their balance

Environmental factors

  • Slippery floors
  • Loose carpets or rugs
  • Stairs without railings
  • Slippery bathrooms
  • Inadequate lighting

Socio-economic factors

  • Living alone
  • Limited access to healthcare services

Awareness

Although older people are at higher risk of falls and it is common among them, sadly the majority are not aware they are at risk.

Some studies show that most of the elderly are especially not aware of certain risk factors such as medications and biological risk factors. Even though some have good knowledge of the risk factors, most are not able to relate it to themselves. This is quite worrying as this lack of awareness may lead to a higher risk of them falling. Awareness of fall risks empowers the elderly to take action to overcome these challenges.

Are you at risk?

Older people who have fallen more than once are at a higher risk of falling again. In fact, it has been shown that they are two to three times more likely to fall again within that same year.

If you have had a recent fall, regardless of whether there is any injury, you should inform your doctor. Your doctor would need to take a thorough medical history and perform an examination on you to determine any underlying cause that may have caused you to fall.

This is important to identify the cause of the fall and to prevent falls in future.

Apart from this, you should also inform your doctor if you think you have any balance or walking problems. Your doctor may then perform some tests to assess your balance and gait. Some simple and specific tests are available that can be performed by your doctor or a physiotherapist to assess this problem.

Furthermore, if you think you have any of the risk factors above, you may talk to your doctor and discuss measures that can be taken to prevent it.

What can be done about it?

It is important to understand that falls can be prevented. A number of different interventions can be done to address specific risk factors.

General measures to prevent falls include exercising, being more physically active and making your home safer. Examples of exercises that have been shown to reduce fall include tai chi, balance exercises and muscle strengthening exercises (see 10 Exercises to help prevent falls).

Specific measures include:

  • Letting your doctor adjust your medications if they cause any side effects such as dizziness;
  • Having good control of your medical conditions; and
  • Performing muscle-strengthening exercises.

These specific interventions can be tailored to the risk factors that you might have. Falls are mostly due to a number of co-existing problems. As such, the most effective method of prevention is multifactorial intervention programmes that address a number of different risk factors.

Intervention programmes that contain elements such as medical assessment, exercise programmes and home safety assessments have been shown to reduce falls in the elderly.

Preventing falls

The most important thing to understand is that falls are preventable. You should be aware of the risk factors and try to identify your own risks for falls.

Inform your doctor if you have suffered a fall or think that you are at risk of falling. Ultimately, working together with your healthcare professional will prevent you from falling and hopefully reduce its incidence.

Dr Teh Rohaila Jamil is a specialist and lecturer at the Universiti Kebangsaan Malaysia Medical Centre’s Family Medicine Department.

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