The effects of falls, particularly in the elderly, can be very serious. Each year, approximately 30-40% of people over 65 years of age have a fall. This can result in fractures, loss of the ability to live independently (and the potential need for admission to a nursing home) and increased mortality. Additionally, older people can often underestimate their risk of falling.

Many falls are multifactorial (i.e. have both environmental and patient-specific risk factors), so what are the risk factors for falling?

• Older age (sensory decline, cognitive impairment and increased difficulty walking steadily and maintaining balance)
• Previous history of falls
• Lack of regular exercise
• Certain medical conditions (e.g. visual impairment, vertigo, cancer, delirium, dementia, ischaemic stroke)
• Medication changes
• Unfamiliar/unsafe environments (e.g. a crowded room with furniture that could cause someone to trip, or improper toilet seat/bed heights)
• Foot pain
• Having just had an operation (post-operative period)
• Malnourishment

How nurses and doctors can help to reduce falls risk in patients

• Assess their past history of falls. This may provide a clue as to why they fall and how to stop it from happening again.

• Have a good knowledge of their medical history, perform a cognitive and functional assessment, and regularly review their general health (including their hearing, eyesight, and muscle strength).

• Performing a screening test for deficits in balance, such as the Timed Up and Go Test. This involves asking a sitting patient to stand up, walk forwards for 3 metres, turn, return to their seat and sit back down. Taking 15 seconds or longer to do this indicates a higher risk of falling.

• Review their medications. Certain medications, particularly sleeping tablets and psychotropic medications may increase falls risk. A placebo-controlled trial found that slow reduction of psychotropic medications resulted in a decreased rate of falls. Check if any medications are making the patient dizzy or lightheaded. Also, adding new medications or changing medication doses can affect falls risk.

• Education. Ensure patients are educated on the ways in which they can prevent falls (see below).

• Refer patients to a podiatrist to discuss footwear advice, orthoses and foot/ankle exercises, particularly for patients with disabling foot pain.

• Assess for the likelihood of osteoporosis and provide good treatment to reduce the risk of fractures in falls.

How patients can reduce their own falls risk

• Create a safe home environment. Tidy up loose electrical cords, get rid of clutter, ensure the rooms are well lit, avoid storing items in high places out of reach, and move any furniture or loose rugs that might get in the way. Put non-slip mats in the shower. An occupational therapist may be able to conduct a home visit and make some recommendations to make your house safer – this may even include installing safety rails in the shower.

• Have good footwear. Avoid slippery soles and high heels, and ensure the shoes are a good fit. Also note that wearing socks without shoes can increase the risk of falls.

• Exercise regularly. This will improve balance, flexibility, endurance, strength and confidence. Tai Chi, swimming and walking are good options for the elderly. Multiple randomised clinical trials have shown that exercise can reduce the risk of falls. Exercise can also reduce injuries that occur as a result of falls.

• Take vitamin D (cholecalciferol) supplements to help increase muscle strength, and also increase bone mineral density (thus decreasing the risk of fractures from falls).

• Take oral nutritional supplements if recommended.

• Use walking aids, as long as they are recommended by a doctor or physiotherapist. Each individual patient would need a walking aid of the correct size, and have been taught how to use it properly.

Things that may reduce falls risk in the nursing home/hospital setting

• Falls risk assessment when the patient is first admitted.

• Regular exercise programs and physiotherapy assessments.

• Medication reviews by either a doctor or clinical pharmacist. Studies suggest that around 43% of residents in aged care facilities are taking at least one medication that is inappropriate for their needs.

• Regular vitamin D supplementation. An estimated 89% of residents in Australian aged care facilities have vitamin D deficiency, with vitamin D levels of <60nmol/L.

• Toileting interventions/assistance. Many falls occur whilst toileting or walking to the bathroom.

• Hip protectors – these may decrease incidence of hip fractures in falls.

• NOT using physical restraints or bedrails. Studies have shown an increased risk in falls in people who were physically restrained, as well as an increase in pressure ulcers.

Extra safety measure

For those at high risk of falls, consider getting a personal alarm that can be worn around the neck, like a necklace. These alarms can be pressed when the person has fallen and is unable to get up, summoning help from an emergency service. Silver Chain is one organisation that offers this service.