Preventing falls and fall-related injuries

Statistics on falls

• 1 in 3 people over 65 years have a substantial fall in any given year.¹
• Falls are the leading cause of injury-related hospital admissions in people aged 65 years and over.²
• 1 in 5 falls may require medical attention.³
• A person who falls more than once in 6 months is more likely to fall again.⁴
• 60% of falls occur at home and most are associated with going to the toilet or getting out of a bed or chair.²
• Falls account for about a third of all hospitalised injury cases and a fifth of all fatal injury in Australia.⁵
• The estimated average total hospital stay due to an injurious fall by an older person is 15 days.⁶

What is 'falls prevention'?

The term 'falls prevention' is usually associated with physical interventions that aim to minimise the risk of a fall. Some common falls prevention strategies include:

• Exercise programs: Falls prevention exercise programs can aim at building strength, balance, flexibility or endurance. Programs that target at least two of these components have been shown to be most effective at reducing both the rate of falls and the number of people who fall.³
• Household modification: For example, fitting handrails in and around the house in high risk areas, such as beside external steps and in the bathroom.
• Use of walking aids: This includes walking sticks and frames as well as assisted shopping trolleys.
• Changing footwear: Slip-on shoes are preferred because they are not only easier to put on and take off but there is no risk of tripping over laces that may come undone.
• Improving vision: One of the more easily overlooked strategies is that many older people need glasses or a new prescription for their glasses to correct their poor vision that puts them at risk.

Why is falls prevention so important?

• Falls are often preventable and are not inevitable.
• Nearly a third of hospitalised fall-related injuries for older Australians in 2005-06 involved the hip or thigh. Other injuries include bruises, lacerations and brain injuries.⁵
• Psychologically, falls can cause a sufferer to experience increased fear which can then result in reduced activity, diminished functionality and increased social isolation.⁷

Who's at risk of falling?

Older people are at increased risk of falling because normal aging often involves: poorer eyesight, worse balance, less feeling in the feet and legs, poorer muscle tone and slower reaction times.⁴

What can I do to prevent falling?

Exercise

• Be physically active almost every day. Aim to do at least 30 minutes of appropriate activity at least 5 times a week.⁴
• Physical activity is very important in maintaining and improving health and wellbeing in older age groups, particularly for preventing falls and broken bones. ⁵
• Exercising in supervised groups, participating in Tai Chi, and carrying out individually prescribed exercise programs at home are all effective ways to prevent falling. ³
• Wear comfortable, firm fitting flat shoes with a low broad heel, with gripped shoe soles.

Fall prevention programs

• Speak to your doctor about a falls prevention program.

Do you know about your bone health - whether you might have osteoporosis?

• Osteoporosis is a weakening of the bones and affects both women and men, although women are at even greater risk. People with osteoporosis are at greater risk of suffering a broken bone if they fall, so the need to prevent falls is even greater. Your doctor can help with the diagnosis and as well as exercise and diet, you may be advised to supplement your diet with vitamin (D) and mineral (calcium) supplements. Some people will also be prescribed medication.

Eat a healthy, balanced diet

• Eat a wide variety of foods and drink plenty of water, especially in hot weather.⁴ Vitamin and mineral supplements may be suggested (see above).

Manage your medication and medical conditions

• Some medications can increase the risk of falling. Reviewing and adjusting medications may be effective in reducing falls.³ Have regular check-ups with your Doctor and discuss any concerns you have.
• Be especially careful when you are ill, for example if you have the flu: Stand up slowly after lying down or sitting, take care when bending down and make sure you are steady before walking. ⁴
• This same advice regarding standing up slowly (or carefully) is just as relevant if you have a condition such as "postural hypotension" when your blood pressure drops when you stand up, if you are on certain medications, or for some middle ear problems that cause you to momentarily feel giddy. If you are at all unsteady when you stand up, or stand up quickly, then take note of your body and learn to get up more slowly and safely.
• Have your eyesight checked yearly by your doctor and at least once every 2 years by an optometrist - your eyes let you both see obstacles and help you to keep your balance.⁴

Make an emergency plan for yourself

A good emergency plan will involve how to raise the alarm for help and how the help will get access to you. Some devices and programs that may help you raise alarm include⁴:

• Cordless or mobile phones that are carried on your belt clip or in your pocket with pre-programmed phone numbers
• Auto diallers - a pendant worn around the neck, and linked to the telephone. When activated, it automatically dials certain pre-programmed numbers until it gets an answer
• Intercom systems - baby monitors or two-way intercoms between houses
• Telstra delayed hotline - automatic connection to a relative's or friend's number when the telephone receiver is removed (costs involved)
• Telecross - a daily phone call from a Red Cross volunteer
• The person who comes to help you needs to be able to get into your house - Leave a spare key with a friend, neighbour or relative who lives nearby. Some people leave a spare key in a box outside with a combination lock.

What do I do if I fall?

If you do fall, don't panic - if you don't think you have sustained a serious injury, stay still for a few minutes and try to keep calm. If you are in a lot of pain, check to see whether you think you might have broken a bone or cut yourself. If you think you can, try to get up slowly without causing yourself too much pain: although you don't want to suspect the worst, it is advisable not to make a broken bone worse by trying to stand on it. 

If you can't get up or feel you need assistance, call for help if you can. If there is no-one around, and you feel you've injured yourself badly, as an alternative dial triple zero (000) to telephone emergency services or call your local doctor for help. Always see your doctor to check for injuries and to assess whether there was a medical cause for the fall. There are many reasons other than simply getting older as to why someone might fall, and many of these can be made better with simple medical treatment.

If you think you can get up yourself

• Roll over onto your stomach and try to get into a crawling position
• Crawl to a stable piece of furniture, like a lounge chair
• Try to get up onto your knees
• Push up, using your strongest leg and arms, still firmly holding onto the furniture
• Sit down on the furniture.

If you can't get up by yourself

• Try to crawl or drag yourself to somewhere on carpet and find anything that can keep you warm, such as bedclothes, a towel or clothing while you wait for help
• Use your personal alarm, if you have one
• If you don't have a personal alarm, use an object that you can bang to make a loud noise, like a walking stick against the wall, to alert a neighbour
• If you know no one will hear you, keep warm and try to get up again later.

Further information

• Talk to your GP.
• The Commonwealth Respite and Carelink Centre provides free and confidential information on community aged care, disability and other support services available in your area, as well as how to contact them and whether there are any costs involved with the service you are enquiring about. You can contact the Carelink Centre on 1800 052 222 or visit http://www9.health.gov.au/ccsd/
• For more information on Telstra's delayed hotline phone 13 22 00 or see http://www.telstra.com.au
• For more information on the Red Cross Telecross service, contact your nearest Red Cross office or visit http://www.redcross.org.au/telecross.aspx
• The Bupa Health Foundation is a proud partner of the Garvan Institute which has conducted research on osteoporosis and falls. Find out more at www.garvan.org.au/research/our-work/osteoporosis 
• The Garvan Institute has developed an online bone fracture risk calculator based on history of falls, history of personal fracture, gender, bone mineral density and age. You can access the calculator at www.fractureriskcalculator.com.au  

Sources

1. 'The Patient Who Falls', American Medical Association, Vol 303, No. 3, 2010.
2. 'Falls Prevention for Older People', Better Health Channel,
   http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Falls_prevention_for_older_people
3. 'Interventions for preventing falls in older people living in the community (Review)', Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH, The Cochrane Collaboration, Issue 4, 2009.
4. 'A Guide to Preventing Falls for Older People', Commonwealth of Australia, 2007.
5. 'Australia's health 2008', Australian Institute of Health and Welfare 2008, Cat. no. AUS 99 Canberra: AIHW.
6. 'Hospitalisations Due to Falls in Older People 2005-2006', Bradley C and Harrison JE (2007) 2003-04. Injury research and statistics series number 32, (AIHW cat. no. INJCAT 96) Adelaide: AIHW
   http://www.nisu.flinders.edu.au/pubs/reports/2007/injcat96.pdf (PDF 598kB)
7. 'Falls Prevention', Mary Jane Nottli , Encyclopedia of Aging and Public Health, 2008.

Last published: 25 April 2010

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