2. Introduction
• What is a fall
•Falls and Aging
• Scope of the Problem
• Risk Factors for Falls
•Role of the Physiotherapist - Predicting Falls
•What Can be done (PREVENTING FALLS)
• Exercises To Prevent Falls * PRACTICAL*
• Getting up off the Floor – I’ve fallen, Now what?
*PRACTICAL*
• What can be done Right now
•Identifying Hazards/Exercise
• Services available
3. WHAT IS A FALL?
A sudden, unintentional change in position causing an
individual to land at a lower level of an object, the floor, or
the ground, other than as a consequence of sudden onset of
paralysis, epileptic seizure or overwhelming force.
4. FALLS
• Common in people aged 65 years and older
• 1 in 3 community dwellers over 65 years old fall at least one each
year
• 1 in 2 people living residential aged care fall at least once each year
• 1 in 4 Australians will be over 65years by 2051
• The cost of falls is increasing exponentially
• Rate of falls and severity of resulting complications increase
dramatically with age
• By 2051 Australia will require an additional; 3320 nursing places &
2500 hospital beds permanently allocated to falls injury treatment
• The total health cost attributable to fall related injury is $1357 million
per annum
•It used to be thought that falls were an inevitable part of ageing.
Luckily, it is now clear that falls can be prevented with well-designed
exercise programs.
5. FALLS AND AGING
Why does our risk of falling increase as we age?
•As we age, our muscle mass, vision, reaction time and
reflexes tend to diminish.
•Our stride length decreases and our gait tends to slow
6. SCOPE OF THE PROBLEM
•A number of injuries could occur after a fall, including bone
fractures or soft tissue injury.
•Most prevalent fall related injuries are fractures (10%) –
•Hip, spine, upper arm, forearm and bones of the pelvis,
hand and ankle
•Most serious injury is hip fracture
•Up to 80% of admissions for
hip injury occur in woman
7. RISK FACTORS FOR FALLS
Physical
•Decreased strength, balance, vision, sensation and
reaction time.
•People with better balance may also tend to put
themselves in more challenging situations. A
combination of these factors will lead to an even
greater risk of falls.
Behavioural:
•risk taking vs. cautious
Psychoactive medication use
•Example sleeping pills
Environmental factors
•Clutter, objects, loose mats etc
•Likely interactions between these factors: consider a
careful person with good balance in a dangerous
environment.
8. RISK FACTORS FOR FALLS
Fear of Falling
Once a person has fallen once they are more likely to be admitted to a NH-
develop a fear of falling and therefore limit activities and become more frail
and de-conditioned. Again increasing the chance of falling
Habits
Lack of exercise
Getting out of bed or a chair immediately
Not putting on glasses in the middle of the night
Alcohol abuse
Standing in chairs to reach high places
Equipment/Assistive Devices
Failing to use a prescribed, necessary assistive
device may result in a fall
Inappropriate shoes
9.
10. FALLS - MYTHS Vs REALITY
• Myth: If I stay seated most of the time, • Reality: Inactivity leads to muscle and
I reduce my risk of falling. joint weakness which may lead to a fall
• Myth: Falling is just something normal • Reality: Problems in later life are not
that happens as I get older. part of ―normal‖ aging. Falling is no
more ―normal‖ than memory loss and
may be prevented through things like
strengthening exercises for the body
or changes in your environment to
eliminate fall risks, a fall may be
prevented.
• Myth: Taking just one medication • Reality: Taking any medication may
cannot increase my risk of falling. increase your risk of falling.
Medications affect people in many
different ways. One of the common
problems is that the initial dose of the
medication is too high. Be very careful
when starting a new medication and
take extra care until you see what
affect it is going to have on you.
11. Role of the Physiotherapist
PREDICTING FALLS
The Fall Screen Test – The fall risks calculator
Contrast Sensitivity „Melbourne edge test‟:
20 circular patches containing edges with reducing contrast. Correct
identification of the orientation of the edges gives a measure of CS.
12. PREDICTING FALLS
The Fall Screen Test
Proprioception:
Ability to determine themselves in space and match their toes on either side on
the platform.
Any difference in matching the great toes is measured in degrees.
13. PREDICTING FALLS
The Fall Screen Test
Quadriceps Strength:
The strength of three leg muscle groups (knee flexors and extensors and
ankle dorsiflexors) is measured while subjects are seated. In each test,
there are three trials and the greatest force is recorded.
14. PREDICTING FALLS
The Fall Screen Test
Reaction time:
Measures the time it takes the person to click the mouse when a light
appears. You can also test the LL by using your feet to turn off
something or step onto something.
15. PREDICTING FALLS
The Fall Screen Test
Postural Sway
The amount the person moves when trying to stay still (can use eyes
open, eyes closed on floor or foam).
The score is then compared to the norm for the person’s age.
16. KNOWLEDGE
•EXERCISE
•WHAT TO DO ONCE FALLEN
•REMOVING HAZARDS
•SERVICES AVAILABLE
•WHAT CAN BE DONE NOW
17. Role of the Physiotherapist
Example Case Study - Mr C (aged 79) was referred to a falls clinic for
assessment after experiencing a number of falls.
Mr C had six falls in the past year, all as a result of losing his
balance on sloping ground in the garden and on the steep driveway.
He was grazed but had suffered no major injury. Mr C had limited
mobility as a result of angina and shortness of breath. He had
previous knee replacements. He had also recently been in hospital
and so was out of condition. Previously he had been walking 2 km
daily with regular stops every 100 m to rest. His medical assessment
showed some health problems which could contribute to falling, and
some of his medications were changed.
His physiotherapy assessment showed that he had weakness of the
hip muscles, and pain and muscle weakness of the right knee. He
scored only 50% on the balance test, his walking was abnormally
slow with small shuffling steps, and he limped due to knee pain. His
confidence was low and he was afraid of falling again.
18. Role of the Physiotherapist
Example Case Study
Mr C had home-based physiotherapy treatment to settle his knee
pain and improve his strength and balance. He was prescribed a
daily home exercise program. He improved his exercise capacity, his
pain settled, and he was then able to participate in a falls prevention
strength and balance exercise group, which he attended weekly for 6
weeks. He continued his daily home exercise program.
When reassessed three months later in the clinic, Mr C reported
feeling much more confident, and was back to walking 2 km daily
with less frequent need for rests. He had no further falls. He scored
100% on reassessment of his balance, his walking speed was
normal, and he was no longer shuffling.
19. WHY EXERCISE - MYTHS Vs REALITY
• Myth 1: There‟s no point to exercising. • Fact: Exercise and strength training helps
I‟m going to get old anyway. you look and feel younger and stay active
longer. Regular physical activity lowers your
risk for a variety of conditions, including
Alzheimer’s and dementia, heart disease,
diabetes, colon cancer, high blood pressure,
and obesity.
• Myth 2: Elderly people shouldn‟t • Fact: Research shows that a sedentary
exercise. They should save their strength lifestyle is unhealthy for the elderly. Period.
and rest. • Inactivity often causes seniors to lose the
ability to do things on their own and can lead
to more hospitalizations, doctor visits, and
use of medicines for illnesses.
• Myth 3: Exercise puts me at risk of falling • Fact: Regular exercise, by building strength
down. and stamina, prevents loss of bone mass
and improves balance, actually reducing
your risk of falling
• Fact: You’re never too old to exercise! If
• Myth 4: It‟s too late. I‟m already too old, you’ve never exercised before, or it’s been a
to start exercising while, start with light walking and other
gentle activities
• .Myth 5: I‟m disabled. I can‟t exercise • Fact: Chair-bound people face special
sitting down.. challenges but can lift light weights, stretch,
and do chair aerobics to increase range of
motion, improve muscle tone, and promote
cardiovascular health
45. What Happens When We Fall?
•DO NOT PANIC
• The way you react after a fall, can cause more
injuries than the fall would.
•Take several deep breaths and determine if you are
hurt.
•If you believe you are hurt, do not get up.
•Call 000, use your pendant alarm to call for help or
call for a family member
•While you wait for help, keep yourself warm the best
you can
46. What Happens When We Fall?
GETTING UP
STEP 1 ….
• LYING ON YOUR BACK
• ROLL ONTO YOUR SIDE
• TUCK ELBOW UNDER AND PUSH INTO
STRAIGHT ARMS
47. What Happens When We Fall?
GETTING UP
STEP 2 ….
• ON STRAIGHT ARMS, PUSH BOTTOM UP INTO 4
POINT KNEELING POSITION
• IN THIS POSITION YOU CAN CRAWL TO
SOMETHING CLOSE BY.
48. What Happens When We Fall?
GETTING UP
STEP 3 ….
•CRAWL TO FURNITURE CLOSE BY
•USE HANDS TO PULL YOURSELF UP
49. What Happens When We Fall?
GETTING UP
STEP 4 ….
• SLOWLY BEGIN TO RISE, USING STRONGEST
LEG FIRST, ONE LEG AT A TIME
• THEN OTHER LEG
50. What Happens When We Fall?
GETTING UP
•STEP 5 ….
• STAND UP
•SLOWLY, TWIST AROUND AND
SIT IN THE CHAIR
51. What Happens When We Fall?
I CAN‟T GET UP
CAN I ATTRACT ATTENTION?
• MAKE LOUD NOISES AND SCREAM
• USE YOUR PENDANT ALARM OR USE THE
TELEPHONE IF POSSIBLE
52. What Happens When We Fall?
I CAN‟T GET UP
CAN I GET COMFORTABLE?
• USE A NEARBY CUSHION OR USE A ROLLED UP
PIECE OF CLOTHING
53. What Happens When We Fall?
I CAN‟T GET UP
CAN I KEEP WARM?
• COVER YOURSELF WITH NEARBY CLOTHING,
BLANKET OR RUG
54. What Happens When We Fall?
I CAN‟T GET UP
CAN I KEEP MOVING?
•Move position to avoid getting pressure sores
•Move joints to avoid stiffness and help circulation
•Roll away from damp area if your bladder "lets go"
56. What Can be Done Right Now
It's never too late to start exercising! - balance is a skill you can keep or
recapture at any age.
Exercise regularly - this keeps the balance 'tuned up' and bones and muscles
strong.
Exercise within your limits - problems such as diabetes, arthritis or asthma
should not stop you exercising. Your physiotherapist can tailor a specific exercise
program for you.
Maintain good posture - good spinal care throughout your life will assist your
balance.
Walking aids such as sticks and frames should be correctly prescribed and
fitted - not borrowed from other people.
Choose proper footwear - firm fitting, flat shoes improve your stability.
Take extra care on uneven ground - surfaces such as gravel and grass are more
challenging to the balance.
Good vision helps your balance. Be careful if lighting is poor and avoid walking
in the dark.
Be aware of home hazards - slippery mats, dangling electrical cords and clutter
can turn your home into an obstacle course.
Have a 'Falls Emergency Plan' - know how to summon help if you do have a fall.
58. What Can be Done Right Now
IDENTIFYING HAZARDS
•Unsecured scatter mats and floor rugs •Uneven Footpaths
•Shower or bath •Water Spills
•Clutter •Poorly Lit places
•Stairs without
•Cords and cables
Handrails
•Garden Areas – free from moss & tools
•Stairs poorly lit
•Cane or walker that is the wrong height •Medications
•Unsafe – slippery footwear •Poor eyesight
59. What Can be Done Right Now
Make Your Home Safe
In Stairways,
• Handrails on both sides of the stairs, and make sure they are tightly
fastened.
•Hold the handrails when you use the stairs, going up or down.
•If you must carry something while you’re on the stairs, hold it in one hand
and use the handrail with the other.
•Don’t let what you’re carrying block your view of the steps.
•Make sure there is good lighting with light switches at the top and bottom
of stairs and on each end of a long hall. Remember to use the lights!
Hallways, And Pathways
•Keep areas where you walk tidy. Don’t leave books, papers, clothes, and
shoes on the floor or stairs.
•Check that all carpets are fixed firmly to the floor so they won’t slip. Put no-
slip strips on tile and wooden floors. You can buy these strips at the
hardware store.
•Don’t use throw rugs or small area rugs.
60. What Can be Done Right Now
Make Your Home Safe
In Bathrooms And Powder Rooms
•Mount grab bars near toilets and on both the inside and outside of
your tub and shower.
•Place non-skid mats, strips, or carpet on all surfaces that may get
wet.
•Remember to turn on night lights.
In Your Bedroom
•Put night lights and light switches close to your bed.
•Keep your telephone near your bed.
61. What Can be Done Right Now
Make Your Home Safe
In Other Living Areas
•Keep electric cords and telephone wires near walls and away from walking paths.
•Tack down all carpets and large area rugs firmly to the floor.
•Arrange your furniture (especially low coffee tables) and other objects so they are
not in your way when you walk.
•Make sure your sofas and chairs are the right height for you to get in and out of
them easily.
•Don’t walk on newly washed floors—they are slippery.
•Keep items you use often within easy reach.
•Don’t stand on a chair or table to reach something that’s too high—use a “reach
stick” instead or ask for help. Reach sticks are special grabbing tools that you can
buy at many hardware or medical-supply stores. If you use a step stool, make sure
it is steady and has a handrail on top. Have someone stand next to you.
•Don’t let your cat or dog trip you. Know where your pet is whenever you’re
standing or walking.
•Keep emergency numbers in large print near each telephone.
63. What is Available to Us?
•Gym programs
Movement for Life Physiotherapy
•Balance and Falls Prevention Classes
MASONIC TIWI GARDENS
•Hydrotherapy Sessions
In warm water, to decrease pain, increase
strength, flexibility, fitness and balance.
Clinical Pilates
Exercise regime using specific floor based exercises
and spring resisted equipment to train the body's deep
postural muscles..
To provide stability, strength and control to the lower
back, pelvic and hip joints, upper back, neck and
shoulder regions.
