Falls

Every year, many old people suffer from falls. These falls in older adults are a significant cause of morbidity and mortality and can have a serious after effect due to the fall. The risk of falling increases with age and is greater for women than for men. According to stats, two-thirds of those who experience a fall may fall again within six months. A decrease in bone density contributes to falls and resultant injuries.
Falls can be caused by many reasons and often the cause is multi-factorial, and requires a multi-disciplinary approach to treat any injuries sustained during the fall and to prevent any future falls. Some people believe that falls are a normal part of aging, and as such are not preventable. Lack of knowledge leads to lack of preventive action, resulting in falls.

Falls info on IEC

< Soft tissue injuries
< Inflammation of joints
< Hypotension
< Auditory and visual abnormalities
< Trauma
< Tremor
< Illness
< Fractures or dislocations

1. Physical Exercise
Physical strength is particularly important to stay mobile and prevent falls and injury. Exercise is good for heart and circulation as well as for bones, muscles and balance. It also helps to maintain a healthy weight and mental well being. Include balance and exercises as a part of regular exercise routine. For older people, walking groups, exercise and dancing groups are recommended. Group exercises makes the session interesting and active. Plan the physical activity with a health professional before beginning an exercise program.

2. Healthy Nutrition
Eat or drink sufficient calcium. Postmenopausal women need 1,500 mg of calcium daily. Calcium-rich foods include milk, yogurt, cheese, fish and shellfish, selected vegetables such as broccoli, soybeans, collards and turnip greens, tofu and almonds. It’s also important to keep hydrating the body with water or fluids.

3. Better Vision
Have regular checkups by an ophthalmologist to discern the extent of age-related eye diseases such as cataracts and glaucoma. Keep the glasses handy at all times. Avoid wearing reading glasses when walking. Use colour and contrast to define balance-aiding objects at home (e.g., grab bars and handrails). Reduce the outdoor glare by wearing a hat or sunglasses and eliminate glare inside the house by using light shades curtains.

4. Keeping Track of Medication
Know the common side effects of all medications taken. Talk with the physician about ways to reduce the chances of falling by using the lowest effective dosage, regularly assessing the need for continued medication, and the need for walking aids while taking medications that affect balance. Limit intake of alcohol as it may interfere with the medications.

5. Personal care
Get sufficient vitamin D in order to enhance the absorption of calcium into the bloodstream. Vitamin D is formed naturally in the body after exposure to sunlight, but some older adults may need a supplement. However, do not get exposed to direct sun for long duration.

Fear of falling or loss of confidence sometimes occurs after a fall, this may lead to vicious cycle stopping activities, which in turn reduces muscle mass and strength. If there is a fear of falling, discuss that with family members and health professionals and take necessary steps for fall prevention.

If alone at home, use personal alarm or cordless, personal alarms can be worn as pendants around the neck. Hip protectors are protective shields and can be effective in reducing the hip fractures. Ill fitting footwear and foot wear with worn soles increase the risk of fall. Foot problems like in-grown nails, fallen arches, badly-shaped toes and decreased sensation with age or from diabetes can also contribute to falls.

Garments that hang below ankle level are trip hazards. Wear walking shoes for daily activities and make sure the shoes are firm and supportive around the heels and the instep of feet. Shoes should provide enough room for toes. Shoes with Velcro fasteners are best. Do not wear socks without shoes. Avoid slip on shoes and unsupportive slippers.

Having short term illness like UTI, diarrhea and chest infection can increase the risk of falls.

6. Environment
Few modifications in the home environment can significantly reduce the risk of falls:

Stairs:
< Well lit, free of clutter and non skid surface
< Edges should be marked with contrasting colored non skid tape

Kitchen:
< Place the frequently used and heavy items in an easy to reach location
< Use stable step stool with side rails for reaching high places
< Wipe the spills immediately
< Living room
< Should be clutter free, non glaring light, non slip surfaces

Bedroom:
< Light switch should be at the entrance
< Place a cordless phone and lamp near bed
< Use night lights in the halls, bathroom in order to avoid darkness while getting up in the middle of the night
< Take a few moments to sit at the bedside before standing up after resting or before getting up in the morning

Bathroom:
< Use grab bars inside the bathroom
< Keep the absorbent towel handy to wipe up moisture or spills immediately
< Talk to the health care professional about the correct placement of assistive devices
< Always maintain the assistive devices in good condition. For example, check for the worn out rubber bushes and handles.
< Always use the assistive devices of appropriate height suitable for the patient

Outdoors:
< Always use foot paths, avoid damaged footpaths or rough ground with loose or uneven surfaces
< Be aware of curbs, changing levels and slopes, especially at entrances to buildings
< Take time and cross the road slowly
< When using public transport take time and keep one hand free to hold the rail and always look at the step while getting up and down.

After the treatment of injuries, the person is assessed to identify the reason for falling and risk factors to avoid future falls and fall-related injuries. The diagnosis of fall is usually dependent on the reason for the fall. An ECG or X-Ray could be taken in case of serious injuries.

Elderly patients are questioned about falls on a periodic basis because there are high chances of recurring falls. The risk of getting injured by a fall depends on the likeliness of a person and other environmental hazards.

Below is a list of drugs that may increase the risk of falling:

< Sedative-hypnotic and anxiolytic drugs
< Tricyclic antidepressants
< Major tranquilizers
< Antihypertensive drugs
< Cardiac medications

Diagnosis of hypothyroidism is based on the symptoms experienced and the results of blood tests that measure the level of TSH and sometimes the level of the thyroid hormone thyroxin in the body.

Hypothyroidism can be treated by replacing the missing hormone that is essential to the body’s key functions. This can be accomplished by taking thyroid hormone replacement medicine prescribed by the physician. The other types of treatments are:

< Antithyroid drugsalso known as thionamides are most often used to treat an overactive thyroid (hyperthyroidism) caused by Graves’ disease.
< Radioactive iodine treatment (RAI) also known as radioiodine ablation is a type of internal radiotherapy for thyroid cancer.
< Surgical removal of the whole thyroid gland or part of the gland known as thyroidectomy.

Some controversial, cutting-edge therapies for treatment include block/replace therapy (BRT), and thyroid arterial embolization. Generally the approach used for treatment depends on the severity of the condition, whether or not the patient is a child or a pregnant woman, and in some cases, the preference or perspective of the treating physician.


Clean up clutter:
 The easiest method for preventing falls is to keep your home neat and tidy. Remove all clutter, such as stacks of old newspapers and magazines, especially from hallways and staircases.

 Repair or remove tripping hazards: Sometimes home fixtures can contribute to falls, which can then lead to back pain and other injuries. Examine every room and hallway, looking for items such as loose carpet, slippery throw rugs, or wood floorboards that stick up. Then repair, remove, or replace those items for more effective fall prevention.

Install grab bars and handrails: These safety devices are crucial for going up and down stairs, getting on and off the toilet, and stepping in and out of the bathtub without injuring yourself. Gary Kaplan, DO, founder and medical director of the Kaplan Center for Integrative Medicine in McLean, Virginia, suggests installing grab bars by toilets and bathtubs and handrails in stairways and hallways. Have a handyman or family member help with this if necessary.

Avoid wearing loose clothing: You want to feel comfortable at home, but baggy clothes can sometimes make you more likely to fall. Opt for better-fitting and properly hemmed clothing that doesn’t bunch up or drag on the ground.

Light it right: Inadequate lighting is another major hazard. To create a home that’s more suitable for the elderly, install brighter light bulbs where needed, particularly in stairways and narrow hallways. Robert Bunning, MD, associate medical director of inpatient services at MedStar National Rehabilitation Hospital in Washington, D.C., also recommends adding night-lights in bedrooms and bathrooms for better guidance at night.

Wear shoes: Socks may be comfortable, but they present a slipping risk. Preventing falls at home can be as simple as wearing shoes. You can also purchase non-slip socks that have grips on the soles of the feet if shoes are too uncomfortable.

Make it nonslip: Bathtubs and showers, as well as floors in kitchens, bathrooms, and porches, can become extremely dangerous when wet. To prevent falls on slick surfaces, Dr. Kaplan recommends nonslip mats.

Live on one level: Even with precautions like guardrails, stairs can present a significant falling hazard. “If possible, live on one level,” says Kaplan. “Otherwise be extra-careful when you negotiate stairs.” If it’s not possible to live on one level, try to limit the trips you take up and down the stairs.

Move more carefully. Many people fall at home by moving too quickly from a sitting to a standing position and vice versa. Preventing falls like this is as easy as taking your time. “All you have to do is pause after going from lying down to sitting and from sitting to standing.Also take a pause before using the railing on stairs, whether going up or down.”
For the elderly, fall prevention means injury prevention. Ask your loved ones to help you ensure that your rooms and stairways are clutter-free and well-equipped with lighting, handrails, grab bars, and nonslip mats to help you avoid falling — all of which can go a long way toward keeping you safe in your home.

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