Falls: Is it something to be afraid of?

Madam Chan, who is a healthy 65-year-old woman without any chronic illness, enjoys her daily Tai Chi session with a group of friends. One day, she went to the coffee shop downstairs and unfortunately fell on a slippery floor. She was diagnosed with Right Hip Fracture and admitted to the Rehabilitation Centre for two months. After that incident, she was afraid to go outdoors, nor even her Tai Chi session. As time passed, she found that she lacked capabilities in performing some daily tasks and also felt tired all the time. She was quite depressed and anxious about her changes...

Fall

Fear of falling will make a person worried about moving in case falls will occur and hurt themselves. As a result, they will restrict their daily activities, eventually leading to a decline in functional performance or just causing further falls.

A fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or other lower level. Fall-related injuries may be fatal or non-fatal such as abrasion, soft tissue injury, fracture, traumatic brain and also spinal cord injury, etc.

According to the National Registry of Diseases Office (NRDO) of Singapore, the crude incidence rate of unintentional falls in 2012 was 277.7 per 100,000 for adults aged 60 years and older. The incidence rate increases sharply with age. In comparison to the past, fall has been the major leading cause of injury among our silver generation. A series of strategies should be applied to help them to face their fear of falling with more confidence and courage.

Reasons for falling

Here are some main reasons that may cause a person to fall:


1. Vision: A sensory input that receives changes from the environment, and sends it to the brain for processing, then reacts to it. Some common eye problems like cataract, glaucoma, age related macular degeneration will impair their vision (difficulty in interpreting the surrounding) and increase the risk of fall.


2. Environment: Include some hazards with the potential to cause someone to fall and get injured such as slippery floor, uneven stepping surface, messy or disorganized area, poor lighting and others.


3. Footwears: At the time of in-home falls, 51.9% of people were barefoot, wearing socks without shoes, or wearing slippers; the adjusted odds ratio for a serious injury among those who were shoeless or wearing slippers compared to those who were wearing other shoes at the time of the fall was 2.27 [3].


4. Long Term Health Condition: Chronic illness will indirectly increase the chances of falling. Medications they consume daily may cause some undesired side effects like dizziness, drowsiness, whole body weakness/ pain, slow down in reaction time which will expose them to higher fall risk.


5. Unsteadiness: Loss of BALANCE associated with the feeling of almost falling and it can be attributed to multiple factors. For further understanding, click the link: Home Based Training.

Let’s do a test

Short Falls Efficacy Scale International

Short FES-I is a 7 items questionnaire which the participants tried to score their concern about falling while performing this activity. 1- Not at all concerned 2- Somewhat concerned 3-Fairly concerned 4-Very concerned 1. Getting dressed or undressed 2. Taking a bath or shower 3. Getting in or out of a chair 4. Going up or down stairs 5. Reaching for something above your head or on the ground 6. Walking up or down a slope 7. Going out to a social event (e.g. religious service, family gathering or club meeting) Scoring: Low Concern: 7-8; Moderate Concern: 9-13; High Concern: 14-28

Prevention

If you scored more than 14 in the questionnaire above, fear of falling has become a serious concern in your daily life. Don’t let fear rule your life, consider these strategies- PACE.

I. Physical Exercise

An updated review provides high-certainty evidence that well-designed exercise programs reduce the rate of falls among older people living in the community by approximately 25%. [5] Regular physical activities not only improve muscular strength, cardiopulmonary fitness but also your confidence in performing daily tasks.

II. Be Alert

Be aware of your surroundings anytime and anywhere. Looking for any possible hazards before you start to move. Make some adjustment if needed like brighter light, staircase railings, cozy space to create a safer environment for walking.

III. Don’t Forget Your Check-Up

Medical check-ups (include your eyes) done at regular intervals give you insight into current health status. It can help to identify any risk factors that may contribute to falling. Take note of the medication you are currently consuming and enquire about possible side effects from your doctor-in-charge.

IV. Equip Yourself

Equip yourself with suitable walking aids if you have a tendency to be unstable while standing or experienced multiple falls recently. Don’t let the aid become a decoration. Remember my tips: “ Don’t rush! Move the aid first and ONLY THEN the legs follow.” Check your other equipment: shoes and spectacles monthly also. Wear the most appropriate one when you go outdoors, even at home.

Take home messages

Fast is not always good.

Try to perform your daily tasks including getting up from bed, sitting up from a chair, and walking in a slow controlled manner.
You will gradually become more steady.

Looking, thinking and moving.

Don't just look downwards or at your phone. Screen for possible hazards around, often have an idea how to create a safer place for walking.

Say YES to exercise!

Fall is not scary, the scariest part is the physical deconditioning due to fear of falling. and let's see what we can do to help you.

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