Taking positive steps to prevent falls
Ann Murray, National Falls Programme Manager
Most of us will have experienced a fall at some time in our lives. For many, this will have resulted in little more than embarrassment. Think Madonna at the Brits. However, as we get older, falls are more common and the consequences of falls tend to become much more serious.
For AHPs not already actively involved in falls prevention and management, there are some falls facts that are worth knowing:
- Around one third of people aged over 65 fall each year – the cost to health and social care services of managing the consequences is substantial. In Scotland, this amounts to well over £471m annually. Less easy to quantify is the personal cost to the person, their family and friends.
- A fall is a symptom not a diagnosis; it can often be the first sign of a new or worsening health problem or a decline in a person’s functioning. A fall can also be the first indication that someone is becoming frail – although not everyone who falls is frail.
- Whether or not an injury is sustained, a fall can be a ‘tipping point’ in a person’s life, triggering a downward spiral of loss of confidence, inactivity, isolation and dependence.
In other words, falls matter.
Falls are not an inevitable part of getting older
Most people over 65 don’t fall. So falls should never be considered ‘normal’.
Risk factors for falls have long since been identified, and can be personal (such as muscle weakness, poor balance, dizziness, visual, cognitive and foot problems) and/or environmental (such as poor lighting, low temperature, clutter and uneven surfaces). Falls will often be the result of an interaction of several risk factors.
How can falls be prevented?
In short, falls prevention is about:
- identifying then addressing factors that are likely to be contributing to a person’s risk of falls.
- taking steps to minimise potential harm from falls – such as optimising bone health and putting strategies in place to summon help quickly in the event of a fall.
- minimising risk while enabling a physically active, meaningful and independent life – arbitrarily restricting activity to prevent falls will only serve to weaken muscles and bone, increasing the risk of falls and harm.
The good news
In Scotland, there is more going on than ever to prevent falls and the resultant distress and harm. We’ve had a National Falls Programme for a number of years, co-created a vision for falls prevention and management and fracture prevention – the ‘Up and About Pathway’ – and our first Framework for Action was published in 2014. Locally, Falls Leads are driving improvement. There are numerous examples of successful and innovative falls prevention initiatives across Scotland, many of which are AHP-led.
The Up and About Pathway (QIS 2010) Framework for Action, 2014-16 (SG, 2014)
However, there’s more to do – falls continue to be a growing challenge as our population ages.
What can we do as AHPs?
Talk about falls
Because a fall can signal a decline in a person’s functioning or health, it presents an opportunity to identify and address underlying problems that might not otherwise have come to attention. If a person you’re in contact with reports…
- a fall
- an injury due to a fall
- problems with daily activities or new care needs since a fall
… have a conversation about falls every time, to identify people who could benefit from either self management information and/or multifactorial falls risk screening and interventions. In fact, any contact with an older person potentially provides an opportunity for a conversation about falls prevention.
To support self management, you can sign post people to a range of useful resources, such as NHS inform’s Falls Information Zone, Smartcare’s Falls Assistant online tool and the Chartered Society of Physiotherapy/Saga booklet, Get Up and Go.
Take action to prevent and manage falls
Multifactorial falls risk screening and interventions involve working with a person, their family or carers to systematically check for and act on falls-related risks factors that can be treated, modified or better managed. Identified risk factors should be linked to interventions in an individualised and outcomes based plan.
AHPs are involved in delivering interventions to tackle a number of risk factors, including those relating to muscle strength, balance, mobility, environmental hazards, activities of daily living, fear of falling, cognitive impairment, foot pain and deformity, nutrition, hydration and bone health.
If you’re unable to carry out screening and the relevant interventions yourself, find the teams or services in your area that can help with this, and agree how you can work together to provide the information, interventions, support or care that may be required to prevent falls.
Work with partners to prevent and manage falls
Of course, falls prevention and management isn’t the preserve of AHPs; work with health and social care, third, independent, community safety and housing sector partners to support self management, identify people at high risk and take an integrated and co-ordinated approach to prevention and management.
And finally, a positive approach…
With reason, people who fall and professionals can view falls as a threat to a person’s identity and independence. Overemphasising risks and focusing only on safety may inadvertently stigmatise falls or cause people to restrict their activities. Asking about falls need not reinforce negative assumptions about old age – setting meaningful goals to preserve or restore a person’s function, independence and quality of life is both positive and enabling.