Why is falls prevention so important as we age and what can we do to reduce our risk of a fall?
In Australia, falls are responsible for over 80 per cent of hospital admissions for people over 65.
And while people can recover from injuries sustained in a fall, they also have to contend with the emotional and psychological impacts of a fall, which can affect confidence and social connectedness.
Registered nurse, Fatimah Lesiguez, is one of the facilitators of integratedliving’s newest Wellness for Independence® program, Falls Prevention Wellness and in this podcast, she shares key insights on the many ways people can reduce their risk of a fall as they age.
This podcast covers the reasons people are more at risk of a fall when they are older, what people can do to manage their risk of a fall (hint: there are lots of things you can do), how you can make your home safer and utilise allied health such as occupational therapy, exercise physiology, and dietitian to further safeguard against a fall.
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Transcript
Jo
Hello and welcome to the Live Well Podcast. I'm Jo Isaac, Senior Manager, Communications at integratedliving Australia and I'm speaking to you from Awabakal Country in Newcastle. integratedliving acknowledges Aboriginal and Torres Strait Islander peoples as the traditional owners and custodians of this land, we pay our respect to them, their cultures and customs, and to elders both past, present and emerging. Today I'm very pleased to be joined by one of integratedliving’s wonderful registered nurses, Fatimah Lesiguez to talk about falls prevention. Welcome, Fatimah.
Fatimah
Hi, Jo. It's very nice to be back again.
Jo
So today, as I said, we are talking about falls prevention. Can you tell us why falls prevention is so important?
Fatimah
So falls prevention is very important as it is one of the leading causes of injury and death. According to the World Health Organisation Jo, an estimated of 646,000 individuals die from falls each year worldwide, and in Australia, falls are responsible for over 80% of hospital admissions for people over 65 years of age. And just another thing as well is that one in three Australian adults have experienced falls in the last 12 months. And if you have fallen more than once in the last six months, your chance of falling again is higher.
Jo
It's amazing statistics there that it affects so many people and it has quite a cost in terms of the economy and hospital admissions, as you said. So why are people more at risk of falling as they age?
Fatimah
We can categorise the risk of falls as we age in two categories. So we have what we call the personal or intrinsic factors. This could be poor vision, muscle weakness, medications, chronic health conditions, and then of course you have the environmental factors to consider, or the external factors for example, of poor lighting, slippery or uneven surfaces. We also have to remember that as we mature, we typically lose muscle mass and strength as well. And up to 40 per cent of our muscle mass is lost between 20s and 80s. So, by the time we're 20 to 80, we're starting to lose our muscle mass. And this loss of muscle mass and strength can contribute to significant falls. Also, another thing is our joints are less flexible now, so as we age our joints tend to stiffen and restricting our ability to move freely and quickly, thus increasing the possibility of falling. So, as we become mature, our reflexes and muscle reaction time tend to slow down. So, this means that the messages that are being passed from the brain to our muscle asking them to move are slower resulting in delayed reaction. So this can contribute to falling as the message the brain sends to our bodies to grab onto, let's say a piece of furniture, or to avoid the hole in the pathway, it takes longer.
Our balance also decreases as we mature, so muscle wasting, muscle loss, joint stiffness, diminished reflexes can also make it harder to perform things to stabilise our movements. That's why it's a bit harder to reorient our bodies when we misstep or we trip, or when we're reaching too far. Our vision also becomes very poor as we mature, so low vision may cause us to trip or stumble and as we fail to see hazards or have difficulty with depth perception. Falls can also be caused by the hazards in and around the home. As we age, reacting to avoiding these hazards become more difficult. So, what are the hazards? For example, oh my favourite, the carpets, the rugs that our lovely mature clients have around the home. That's another tripping hazard. Even pets, small pets or slippery surfaces and even pathways, all of that.
Jo
There's really so many things that contributing to falls for more mature people and anyone can fall, obviously, but as you say, the risks just get more pronounced as we age. So what can people do to avoid falls in terms of exercise and understanding medication, making their home safer, nutrition. What are all the things that kind of counteract those things you've just addressed? What can people do?
Fatimah
So yes, exercise regularly, including strength and balance training, can really decrease our chances of falling. Having a regular GP review is also a must and understanding how to manage the medication because some medication can cause dizziness and have other side effects. For example, some sleeping tablets if you take it after the time it's been suggested to you by your doctor, you can be very groggy the next day. Blood pressure medication, if you are also in insulin or medication to control your blood sugar. So, you have to understand that this actually, how is it, influences as well your chances of falling. For example, blood pressure medication, it means that if your blood pressure plummeted you can also become dizzy and you could fall. Same with blood sugar medication. If you also take it and your blood sugar level drops that could also lead you to fall. So, there's plenty of things that we need to discuss with your GP when we see him and one of them is the medication review. The pharmacy can actually do that and it's great to know that they offer this service. If you don't have access to your GP regularly have a medication review with your pharmacy every six months.
Also making the home safer. For example, removing trip hazards, maintaining good lighting, that's actually important. Having a hallway light because as we mature we tend to go to the toilet in the evening and having good proper lighting in the hallways is really helpful, especially with all the changes we've mentioned a while ago. Also, installing handrails and grab bars in areas such as the bathroom, or in the shower or using a shower chair or even a handheld shower, that could actually minimise. Ensuring proper good nutrition including vitamin D and calcium intake for bone health as we are also at higher risk of osteoporosis and that would make our bones brittle and when our bones are brittle that makes us susceptible as well for falling.
Having regular vision and hearing checks. People don't realise how important hearing and vision is, especially for our mature clients. They have always said to me, Fatima, it's really different when you have problems with your hearing and your vision, it can affect you in a lot of ways. So, make sure that we actually get reviewed regularly. Wear appropriate footwear. That's sounds a bit simple, but it does play a major role as well. Gone are the days we can wear all of those platforms shoes, those high heeled shoes. We need to have good proper fitted shoes that would provide us support as we mature because remember we're already predisposed to a lot of risk once we mature so we have to make sure we also minimise that. Staying hydrated. Make sure you drink plenty of water. When you stay hydrated, it helps you prevent dizziness and light headedness.
And of course, use assistive devices. So, if you are asked to use your walker or your walking stick, by all means we have to use it at all times as it is for our safety as well. And be mindful of the environmental factors such as weather, slippery surfaces and even sidewalks and for lighting. And also understanding how our house is set up and what we can do, making sure there's more room for us to move around, less traffic as well. If we have to move and get rid of some of the furniture that we actually don't need, by all means do that. Make sure that there's enough space for us to walk and mobilise and that would actually lessen our chance of falling.
Jo
Creating that space is a huge thing, isn't it? Because we do tend to have accumulated a lot of things by the time we mature. Having a spring clean would be a great idea to help minimise the risks as well. Can you tell us how occupational therapists can help make people's homes fall safe? OT’s can play a huge role here, can't they?
Fatimah
They do. It's highly recommended that mature client talks to an occupational therapist before they make any major changes in their home. And also, an occupational therapist will prescribe adaptations that would meet your personal needs as well as of course meeting Australian safety and regulatory standards. They will carefully consider measurement, room design, location of equipment or modification, correct slope or incline and ease of access for yourself and a carer. And also with OT’s, they would assist you with what is the equipment that would make your life a bit easier. For example, a tipping kettle. Simple as that. Or those little raised dots that you can put into let's say a remote control or to the tap so you know this is hot, this is cold or this is the on, this is the off buttons. I have a beautiful, lovely client that her husband bought this recliner. It was not according to her height and her needs. She actually had a fall as a result. So yes, even with that an OT can help you make sure that you choose the right chair, the right height for your walker. And I love how some of my clients would say, “Yes, guess how much I paid for this walker. It's five dollars from the garage sale.” Yes, it is five dollars, but then again, it's not specifically measured and set up for their needs and that's no good as well. So an OT can help with that, Jo.
Jo
That's right. And hopefully in many cases the OT can, through their aged care funding, help them purchase things that are fit for purpose, isn't that right?
Fatimah
That is right too.
Jo
So, the grab bars and the reaches so people don't have to bend over to pick things up. There are so many wonderful assistive devices, isn't there? I can’t believe how many there are. And people just don't even realise how many things can make their lives a little bit easier as they get older. It is really worth investigating it an appointment with an occupational therapist. We talked a little bit about exercise and how that can help reduce the risk of falls and fractures. There are specific exercises people can do, aren't there to help them improve their balance, which is really important. So, they could have an appointment with an exercise physiologist, or they could attend one of our Wellness Centres and they have very specific exercises to help build that strength and balance, which is wonderful too. I was going to ask, you spoke a little bit about nutrition and hydration, can you give us some extra information about that and how your nutrition and hydration can minimise the risk of falls?
Fatimah
Yes, so good nutrition and hydration could reduce the risk of falls in several ways. First of all, strong bones. Remember osteoporosis. As we mature our bones become a little brittle. With that one it should be adequate intake of calcium and vitamin D can help promote healthy bones. And this, like I said, reduce the risk of osteoporosis and fractures, which can in turn of course help decrease the risk of falls as well. But also good nutrition and hydration can help with improving balance. So good nutrition can help maintain good muscle mass and strength, which is important for balance and coordination. Good hydration also helps lower the risk of dehydration, dizziness, light headedness that can of course increase the risk of falls. Also, a healthy diet, including protein and iron, is essential for good health, staying active on your feet. Iron carries oxygen to the body cells and provides energy to the muscles. That's why it's very important. A lack of iron can lead to anaemia characterised by fatigue, weakness, irregular heartbeat, light headedness, headache and shortness of breath.
Protein is needed to build and strengthen muscle and repair cells and develop a strong immune system. The right amount of protein in your diet can actually help prevent muscle wasting and fatigue, and will assist you with tissue repair after an injury. Preventing a nutrient deficiency, like poor nutrition can lead to malnourishment or nutrient deficiency that can result in decreased muscle strength, poor balance and impaired cognitive function, all of which can actually raise the risk of falls. Therefore, when we maintain balanced diet, stay hydrated, it can be an effective way to improve overall health, reduce inflammation in the body, maintain strong bones, improve muscle strength and balance, and of course lower the risk of falls Jo.
Jo
How can people plan for a fall so they know what to do if one happens? Because obviously we can talk about prevention, but as you said one in three, was it one in three? Yes. So obviously many people will have a full no matter what they do to prevent it because accidents happen. So, if someone has a full, what should their plan be?
Fatimah
Yeah, so especially for people who live on their own, it's very important to have an emergency plan. As we know planning for an event of a fall will give the mature clients or us confidence that if ever these things would happen, touch wood they never happen. At least we have something in place that we can do to follow if ever this incident happens. So, an emergency plan may involve a family, a neighbour or an ambulance or having a personal alarm and it's a self-help strategy such as learning how to get up after a fall. So, a sample of an emergency plan could be as simple as, for example, having a like a safety check in procedure in place. For example, I have my lovely gentleman before Jeffrey. He would open his curtains and that's actually a signal to his neighbour in front of him saying, “Oh, Jeffrey is up, Jeffrey is okay because his curtain is open.” Simple thing as that. Or giving your neighbours your phone number and a house key. How most of our clients really recommend them to have a lock box with a spare key in it and you give your neighbour the code for that one, just in case they're worried about you or they haven't seen you. They know that they can have access to your house by using the lock box and the spare key in there.
Carrying in your mobile with you at all times or have a phone within reach is also another way for a safety falls plan. Also wearing a personal alarm Jo. Yeah, it's very important. Most of the time my beautiful clients I walk into their house and I would say what's your personal alarm? Oh, it's in the kitchen, oh, so the kitchen is now using it or it's in their bedroom or it's in the walker. Having this is actually very important. Or give a trusted family member or a friend a house key. Or let them know where the spare key is located, just in case, because at the end of the day, we wanted to make sure that all of our lovely clients are safe. That's why even a simple thing, like I said, curtains opening as a sign that they're okay. That's simple but it's amazing. It does work. And it's one way for us to actually also look after our mature clients in our community, isn't it, Jo?
Jo
That's definitely true. My mother-in-law has just recently moved in with us and I do have to remind her to put her necklace on. But she's doing it. I think if you only have to push a button, if you have a fall and then you're going to have help within a very short period of time, there's so valuable to have a personal alarm. Can someone learn how to safely get up after having a fall? Is that possible? Or especially if obviously they've broken a bone or they're in a lot of pain, how can somebody do that? If they need to get to their phone and aren't wearing a personal alarm, what can they do?
Fatimah
So, we always recommend that they seek a professional advice from let's say from a physiotherapist or an exercise physio in learning the technique of getting out safely after they have a fall. But always assess the situation but, like you said, if they felt like they have broken their bone, definitely do not try to get up. You can practise once, let's say for example in a physiotherapist and an exercise physio will show you the technique on how to safely get out from the floor if you have a fall. Then practise it because practise does make it better and practise each week as this will give you more confidence to perform this. But remember when you're doing it, try to do it with someone, that's another thing. And make sure that you are with someone where you are trying to practise the technique from getting out from the floor once you have a fall. But you learn it from a physiotherapist or an exercise physio.
Jo
And so yes, you need that expert advice to do it safely. But it's great to know that you can get that advice from a physiotherapist or an exercise physiologist, both of whom you can contact through integratedliving, as well as a dietitian who can help you with meals plan and how important nutrition is for this as well.
Fatimah, something exciting is happening at integratedliving? You're about to launch a new Wellness for Independence program called the Falls Prevention Wellness Program. Can you tell us a little bit about that and why someone might enrol in that to learn more about these things we've been talking about today?
Fatimah
That is right Jo. We are actually launching the Falls Prevention program for our Wellness for Independence® programs. Also, why it's very important, like we said, statistics, as one in every three over 65-year-old mature Australians have a fall.
So, why should we consider enrolling to the falls program? We wanted to help our lovely clients to stay at home safely, like there's no place like home Jo, and enjoy social and life activities for as long as possible. And that's one of the main purpose and goal of our program. With the falls program, it will give them a better understanding about what is our risk of falling as we mature? How can we actually prevent or lessen this risk and also gain a better understanding? We will talk about what are the factors and why it's important and what we can do to prevent this. Also, it will help them develop strategies to reduce your falls and also help gain confidence and knowledge on how to get assistance for let's say and OT or let's say a nutritionist. We can do that through the program.
And with a Wellness for Independence® program, we do one-on-one assessment. So, they get a registered nurse or an allied health professional at the beginning of the program and at the end of the program and if there's anything outside the norm or their normal parameters, we would be in touch with their doctors. And we can give recommendation as well for, let's say, an OT and exercise physio, a physiotherapist or nutritionist, if ever they needed that.
Jo
That's fantastic, yes. And what else? They get a full program as part of it. And they can borrow an iPad for the period of time that they're doing the program as well, can't they?
Fatimah
Yes, they will be loaned an iPad for 16 weeks with unlimited internet, which they can be using for, let's say, browsing the YouTube, searching for their favourite Tom Jones song or playing their games. And also, they get a book that they can actually read. And if let's say they wanted to review what they have discussed in the session, the book is there. And in the first four weeks of the program we'll teach them how to use the iPad. So, no need to be scared if you're not tech savvy, it's all good. We have your lovely nurses and allied health professionals who will be helping you set it up and also guide you as well in the process. So, this programme is really amazing Jo. And just like all the other wonderful programs from the Wellness for Independence® suite, I am pretty sure it's going to be a big hit and it will be an important program to assist our clients to empower them to stay home longer, to make health and lifestyle choices to improve their overall wellbeing and like we said to support them, to stay at home because like we like they always say that's where they want to be. There's no place like home Jo.
Jo
One hundred per cent! And with the risk of falls meaning that you could end up in hospital for an extended period of time and that you could have a lot of rehabilitation, it is really important to try and avoid them in the first place. And so over that 16-week period of the program, you're empowering whoever does that course to take ownership of managing that risk, isn't that right?
Fatimah
Yes, that's right. And I just also remembered, it says that the average days that a mature client stay in the hospital from a fall - 9.5 days.
Jo
Wow. Yes. And nobody wants to be in hospital for that long.
Fatimah
It’s not that we don't like the nurses! But the thing is that it's just, it's not our home, is it? And I always remember when my clients are in hospital, I mean, I look after them, the food is not what they wanted to eat. They're just sitting there and they want to be out. They want to do their ballroom dancing, they want to do bingo, they want to do their bowling. So that's why we are really encouraging everyone to attend the Falls Prevention program from the Wellness for Independence®.
It's also interesting though, that when a person has a fall it doesn't just affect them physically, it also affects them emotionally. And the thing is that they lose their confidence and that's what a fall can do. It makes them lose confidence and they start to withdraw slowly from the things they love.
Jo
Yes, because they're afraid of it happening again. And I think that's overlooked a lot while the physical is being repaired or improved it's that emotional and psychological impact that really is something that has a massive effect on people. As you say, it would be valuable for anyone to do this programme because it's a preventative programme. It's aim is to prevent you from falling and to keep you in really good health so that you reduce your risk dramatically and nobody wants to have a fall. I know quite a few more mature people who've had falls, even multiple falls and it does really have a big impact on their lives and so if you can avoid it for yourself, that's what you should aim to do. Absolutely.
Fatimah
With this program as well Jo, we will be discussing about the equipment, personal alarms available in the market and what's available in every region. Cause some regions could have different funding and they can have different personal alarms available for them. But we will be talking about that too. And we even set up goals, like in our very first session we will be setting up goals on what do we want to achieve in our program. And then we would look back at the end of our program, say, hey, did we achieve our goal of walking 30 minutes a day for at least five days a week. That would be also an extra motivation for our mature clients to achieve what they have set up as a goal. And like we said, it's all about prevention, Jo. We want to support them to stay at home. We want to empower them because these lovely clients of ours, they've been through a lot, and I really admire them. And I really believe that our program, our company has been very amazing in supporting them.
Jo
So, we actually have more programs in development, to help them. And also, the other wonderful benefit of doing one of the Wellness for Independence® programs is the fact that you do it with other people from around the country. And you’ve seen many times, haven't you, Fatima, that people build friendships within these programs and many people do a lot of the programs one after the other because they really enjoy that weekly social connection that they get as well. Isn't that right?
Fatimah
That is right. I have a group up in Port Stephens, after a program they go for a swim and a coffee.
Jo
Wonderful. And that's what I want to be doing when I'm retired is having fun with my friends and enjoying the time I have to relax and do the things I enjoy that you don't really get to do very much when you're raising a family and life is super busy. And so, I do look forward to enjoying that time. But in order to do that you need to stay well, you need to understand risk that may affect you and you're providing all that information through this program, which is wonderful. So, I'm sure it will, as you say, be a big hit because I think it's probably one of the things people fear the most as they get older is having a fall. And I think being able to reduce the risk and learn as much as you can about how to do that is a wonderful thing that you and the team have created.
Fatimah
I forgot to add as well. You know, in our program people get to share their experiences and people and even myself, I get to learn from all the stories that my lovely clients share in our group. And they feel like they have a common ground. They would say, “Oh yeah, I had to fall and this happened to me.” “Yes, this happened to me too.” And they get to share their story and then that way they're able to know that, hey, I'm not alone. It's alright. And this is what we can do to avoid it next time. And you feel supported. They feel safe to share.
Jo
Thank you very much for sharing your expertise with us, Fatima. I know that you do absolutely amazing work in the community and all your clients are very lucky to have you in their life.
Thank you so much for being with us today and sharing all this information. We really appreciate it and you.
Fatimah
Thank you. I'm more than happy as well and thank you for giving me the opportunity to share about the Wellness for Independence program and our services.
Jo
Thank you, Fatimah.