Preventing Falls

Preventing falls may not be an exciting topic of conversation but it is absolutely essential. Life happens and everyone gets older which means physical changes occur and certain health conditions may arise. In some cases, even the medication used to treat certain conditions are often the cause of falls.

The fact is, falls are one of the leading causes of injury among older adults as each year a third of people over 65 will fall. That number only increases as people get older where half of people over 80 will suffer an injury from a fall.

The good news is that falls can be prevented and educating the public is the perfect place to start. Pharmacy teams can play a pivotal role in fall prevention as they come face to face with many patients across all age groups and with varying illnesses or conditions. Here is a handy guide on which medications increase the risk of falls the most.

Common Factors Leading To Falls

  • Balance and gait – As people get older, many may lose some of their coordination, flexibility, and balance. This is primarily as a result of inactivity which makes it easier to fall
  • Vision – Age is often unkind to our eyes as less light reaches the retina which makes it harder to see contrasts in the environment. This makes it much harder to identify edges, tripping hazards and obstacles
  • Medication – Some prescriptions and over-the-counter medication often cause dizziness, dehydration or interactions with one another that could lead to a fall
  • Environment – Most senior citizens have lived in their homes for a very long time and never thought it would be necessary to do simple modifications to improve their safety as they get older. A few simple changes can make all difference
  • Chronic conditions – Many older adults have at least one chronic condition such as diabetes, arthritis or suffered a stroke. These conditions often increase the risk of falling as they can result in impaired function, inactivity, depression or chronic pain

Common Injuries Associated With Falls

Falls are the number one reason many of the elderly are taken to the emergency department with varying degrees of injuries. While most falls don’t cause serious injury, they can leave people distressed and uncomfortable.

Besides death, fractures are the most serious consequence in the elderly. The most common fractures are to the hip, femur, pelvis and spine (vertebrae). An increasingly worrisome statistic is the number of people in the UK that die after suffering a fall, especially among the very old. The Office for National Statistics death registration data shows that between 2008 and 2016, deaths from falls in men over 85 increased by 177%.

Hip Fractures and Falls

Hip fractures are associated with diminished quality of life and survival rates are poor especially amongst the elderly. A study published in January 2017 in the Journal of Internal Medicine showed that even after 8 years, people with broken hips were at more than double the risk of dying. A more recent report by the Royal College of Physicians on hip fractures also states that a patients’ age and frailty means up to a third of patients die within a year.

Falls cost the country £4.4 billion and includes associated social care and often play a major part in emergency admissions due. Patients may require constant, close monitoring and support from healthcare staff and equipment. Falls may also result in post fall syndromes such as dependence, loss of autonomy, confusion, immobilisation and depression. All of these can lead to further restrictions in daily activities which results in a loss of independence and confidence.

The Effect Of Osteoporosis

Osteoporosis causes the weakening of bones and subsequently increases risks of fragility fractures. It currently affects more than 3 million people in the UK where women are more at risk due to hormone changes after menopause. Treatment of osteoporosis generally includes treating and preventing fractures as well as medication that help strengthen bones.

However, regular exercise is extremely important and applies to everyone of all ages. Exercise regimes do vary depending on age, level of mobility or health conditions but being active on a daily basis is hugely beneficial. For a detailed overview and helpful exercise tips and advice in the elderly, refer to the Government guidelines.

Following a healthy eating plan and ensuring that you get enough Vitamin D equally important. Not to mention that reducing alcohol consumption and giving up smoking can also help considerably. In fact, you can find out everything you need to know in the VirtualOutcomes training module on smoking.

Fall Prevention

Helping the elderly live independently in their own homes has long been a key objective for the Department of Health. A report in February 2018 recognises that although their housing needs may change as people get older, an appropriate comfortable well-located house can improve a person’s mental and physical health.

There are over 400 reasons identified as causes for falls and it includes intrinsic and extrinsic factors. Pharmacy teams can play a vital role in reducing the number of falls and should encourage people to use the risk self-assessment tool on the NHS website. The tool will help identify people who are at higher risk and includes questions such as:

  • Have you had a fall in the last 12 months?
  • Are you on 4 or more medications a day?
  • Do you have Parkinson’s disease or have you had a stroke?
  • Do you feel unsteady or have problems with balance?

Additionally, you can also use the ‘timed and go test’. Does it take you longer than 12 secs to stand up, walk 3 metres, turn, walk back and sit down again?

How To Help Reduce The Risk Of Falls

It’s important to discuss their health conditions in terms of medications and possible side effects. Do they often forget to take their medications? Are they experiencing side effects? Is it getting more difficult for them to do things they used to do easily? Encourage patients to speak openly with their health care provider about all of their concerns.

If people wear glasses, ask about their last eye check to make sure their prescription is still up to date. Bifocals can often be problematic on stairs so always promote caution. For anyone already struggling with low vision, recommend that they consult a specialist for ways to make the most of the eyesight they have.

People also need to know that making their homes safer can drastically reduce the risk of falling. A few simple ways are to add more lighting, especially at the top and bottom of stairs and making sure the lights are easily accessible. The stairs should have two handrails securely fitted. The bathroom should have support bars in the bath tub or shower and near the toilet. For added safety, recommend using a shower chair and hand-held shower.

VirtualOutcomes And Community Pharmacies

To support pharmacies, we have a host of online training courses and we recommend that pharmacy owners ensure that their staff are up to date with their training. We provide helpful, relevant and vital healthcare information on a number of topics including cancer screening, smoking, obesity, mental health, diabetes and fall prevention among others. Contact us to find out more about our courses and how you can register.