Falls

Falls are a common but often overlooked source of injury and, in many cases, death. In Ireland ,approximately 250 older people die each year from falls.Three quarters of falls related deaths occur among those aged over 65.

Groups at risk

Everyone is potentially at risk of having a fall, but certain groups of people are more vulnerable than others. These groups are:

  • adults who are over 65
  • children
  • people whose jobs involve working at heights

Older adults

Some older adults have a combination of health-related factors that increase their risk of having a fall, such as:

  • muscle weakness
  • problems with balance and mobility
  • poor eyesight

Around 30% of adults who are over 65 and who are living in the community will experience at least one fall a year. This figure rises to 50% for those who are living in nursing homes or residential care.

Not all falls will result in injury, but a significant minority do. For example, 20% of older adults will require medical attention for a fall, and 5% will experience a serious injury, such as a fracture.

Falls can also have an adverse psychological impact, particularly on elderly people. A fall can sometimes result in a person losing confidence, becoming withdrawn and feeling like they have lost their independence.

Children

Due to the natural impulse to play and take part in risky behaviour, most children will experience a fall at least once during childhood. Thankfully, falls in children are seldom fatal, but they often require medical attention.

For more information about accidents see Health A-Z: Accidents and first aid.

Occupational falls

For information on falls at work in Ireland go to www.hsa.ie

Falls from a height are one of the most common reasons for serious workplace injury and death.For further information go to www.hsa.ie

Common causes of falls

Common causes of slips, trips and falls include:

  • unsafe ladders
  • unsafe stairs, steep stairs or slopes
  • slippery surfaces
  • obstructions 
  • poor footwear
  • untidy areas
  • running
  • low lighting
  • hurried or careless movements
  • distractions
  • poor manual handling, carrying large objects incorrectly and not having your hands free to break your fall

Older adults

The natural process of ageing can often place older adults at an increased risk of having a fall. There are three reasons for this, which are outlined below.

  • Older people are more likely to have chronic health conditions, such as heart disease, dementia or low blood pressure (hypotension). Dizziness is a common symptom of low blood pressure. These conditions can increase the risk of a fall.
  • Older people are more likely to have impairments, such as poor vision or muscle weakness.
  • Older people are more likely to have disabilities that can affect their balance.

Among older adults, some of the most common reasons for accidental falls include:

  • falling or slipping in the bathroom
  • falling or slipping due to dim light
  • falling or slipping on rugs or carpets that are not properly secured, or on floors that are wet or recently polished
  • falling or slipping when reaching for storage areas, such as cupboards
  • falling or slipping down the stairs

Another common cause, particularly among older men, is falling from a ladder while carrying out home maintenance work.

As mentioned above, falls can also sometimes occur as a result of health reasons. Some common health reasons linked to falling include:

  • loss of balance due to disability or muscle weakness
  • a sudden episode of dizziness
  • a sudden brief loss of consciousness due to an underlying health condition, such as a heart condition or low blood sugar (a brief loss of consciousness is known as a drop attack)
  • low blood pressure (hypotension)
  • visual impairment

Falls can be particularly troublesome for older women, as osteoporosis (thinning and weakening of the bones) is a common problem among older women. Having osteoporosis increases the risk of fracture following a fall.Osteoporosis is caused by hormonal changes that occur during the menopause.

Children

Falls in children usually occur for one of two reasons:

  • an accidental fall from height, which usually occurs in younger children and toddlers
  • falling during a sporting activity, which usually occurs in older children and teenagers

Common reasons children fall from height include:

  • falling down stairs
  • falling from playground equipment
  • falling out of bed
  • falling from a shopping trolley
  • falling from a pram or pushchair

Common sporting activities that can lead to children or teenagers falling include:

  • football
  • rollerblading
  • cycling
  • netball
  • basketball
  • rugby
  • ice-skating
  • gymnastics

Occupational falls.

Some of the most common activities that lead to falls in the workplace include:

  • working on scaffolding
  • working on a ladder
  • working on a roof
  • cleaning gutters
  • cleaning windows
  • stacking shelves
  • putting up displays
  • unloading vehicles
  • maintaining machines

For information on falls at work in Ireland go to www.hsa.ie

Useful Links

General advice

Making small changes in and around your home can make a big difference in reducing accidents. Some general advice for preventing falls includes:

  • mop up spills straight away
  • remove clutter, trailing wires and frayed carpet
  • use non-slip mats and rugs
  • use high wattage bulbs in lights and torches so you can see clearly
  • organise your home so that climbing, stretching and bending are kept to a minimum, and so you do not bump into things
  • get help to do things that you can't do safely
  • do not walk on slippery floors in socks or tights
  • avoid wearing loose-fitting trailing clothes that might trip you up

Advice for older people

Some older people are reluctant to seek advice about fall prevention from their GP and other support services because they believe that their concerns will not be taken seriously.

The reality is that all health professionals take the issue of fall prevention in older people very seriously because they know the potentially serious impact that falls can have. As a result, a great deal of help and support is available for older people.

Strength and balance training

Research has shown that older people who take part in regular strength and balance training are less likely to have a fall.

Many community centres and local gyms offer specialised training programmes for older people. Alternatively, there is also evidence that taking part in regular sessions of t'ai chi can help reduce the risk of falls. T'ai chi is a Chinese martial art that places special emphasis on balance and movement. However, unlike other martial arts, t'ai chi does not involve physical contact or rapid physical movements, so it is ideal for older people.

Vitamin D and calcium

Research that was carried out in 2009 found that taking daily vitamin D and calcium supplements can strengthen muscles and bones, helping to prevent falls in people who are 65 and over.

Young people with a chronic (long-term) condition such as multiple sclerosis that increases their risk of having a fall may also benefit from taking vitamin D and calcium supplements.

However, the vitamin D and calcium supplements that are found in supermarkets often do not contain a high enough amount to provide full protection. Therefore, if you think that you would benefit from having daily supplements, you should speak to your GP who will be able to prescribe stronger supplements.

Home hazard assessment

If you are concerned that you or a relative may be at risk of having a fall, or if you know someone who has recently had a fall, you may wish to request a home hazard assessment.

During a home hazard assessment a health professional with experience in fall prevention visits a person's home to identify potential hazards and provide advice about how to deal with them.

For example, as the bathroom is a common place where falls occur, many older people can benefit from having bars placed inside their bath to make it easier to get in and out.

The health professional carrying out the assessment may also recommend getting a personal alarm system so that you or your relative can signal for help in the event of a fall. Alternatively, it is a good idea to keep a mobile phone in close reach so you can phone for help in the event of a fall.

Contact your local public health nurse and/or your GP to see what help is available in your local area.

Medication review

If you are concerned that the side effects of any medication that you or your relative are taking may increase your risk of having a fall, you can request a medication review with your GP.

There may be alternative medications that you can use, or the dose of your current medication could be lowered. In some cases it may be stopped altogether.

Sight tests

If you are concerned that poor vision is increasing your risk of having a fall, you should make an appointment with an optician to have a sight test so that your vision can be assessed.

Although not all causes of age-related visual impairment can be treated, a number can. For example, surgery is an effective treatment for cataracts.

Advice for children

Preventing falls in children can be somewhat of a balancing act. It is natural for parents to want to protect their children from harm, but most parents would not want to restrict their children from having fun and taking part in normal childhood activities.

While it is true that taking part in sporting activities increases the risk of falling, such activities also have important health benefits and can help boost a child's self-esteem and confidence.

It is impossible to prevent all falls from occurring, but you can take steps to minimise the risk, or prevent serious damage in the event of a fall.

You may find the advice below helpful.

  • One of the most common causes of falls in toddlers is falling down the stairs. To prevent this, install protective stair guards both at the top and the bottom of your stairs.
  • If you have a toddler, make sure that your home is 'toddler-friendly'. Rugs should be secured with tape or rubber pads. Use padding to cushion the sharp edges of furniture, such as tables. Also, avoid leaving anything on the floor or stairs such as toys or a handbag.
  • If you have a young child, make sure that their bedroom windows are securely locked with a child-proof lock, but also make sure that the windows can be opened quickly in the event of a fire.
  • Young children playing on playground equipment should always be supervised.
  • Make sure that your child always wears a helmet when they are cycling, rollerblading, roller-skating or skateboarding. Children who do not wear a helmet are 14 times more likely to die if they are involved in an accident, compared with children who are wearing a helmet.

For more information about keeping young children safe, these booklets and more are available on www.healthpromotion.ie :

 

Workplace advice

Ladders

You should only use ladders in a workplace environment for short-term, light work. Any work that requires spending a considerable amount of time at height or involves heavy lifting should be carried out on scaffolding or another suitable platform.

Before using a ladder, you should inspect it carefully for any damage. If the ladder is damaged, do not attempt to repair it - buy a new ladder.

Before you go up a ladder, check that the base is secure. Ladders are only safe when they rest on a firm, level surface, not on loose bricks or packing. Ladders should always be secured with a rope or another suitable device.

Make sure that the ladder is properly angled to minimise the risk of it slipping out from beneath you. A good rule of thumb is 'one rung out for every four rungs up'. For example, if the ladder is 16 rungs up then it should be angled four rung lengths away from the wall.

Roof work

Any work that involves going up onto a roof should be considered high-risk, and therefore high standards of safety are essential.

Before starting the work, you should ask yourself whether it is absolutely necessary and, if it is, whether there is an easy way to complete the work, for example using a powered access platform such as a mechanical 'cherry picker'.

Getting on and off the roof is a major risk so securing the means of entry and exit is very important. At the very least, you will need a properly secured ladder.

If anyone working on the roof could fall more than two metres (6 foot), you will need to install a guard rail around the edge of the roof. You should also consider using a safety harness that is securely attached to an anchorage point.

Never work on a roof in rainy, windy or icy conditions. It is easy for you to be blown off the roof by a sudden gust of wind or to slip over on the wet or icy roof.

Many accidents occur when people fall through a roof because they underestimate how fragile the roof is. Therefore, you should always confirm how secure the roof is before beginning any work.

For information on falls at work in Ireland go to www.hsa.ie

If you have a fall try not to panic. After a fall, it is likely you will feel shocked and a bit shaken, but staying calm will help you to gather your thoughts and remember what you need to do. When you are calm, ask yourself whether you feel able to get up again.

If you are not hurt and you feel strong enough to get up, follow the steps listed below.

  • Do not get up quickly. Roll onto your hands and knees and look for a stable piece of furniture, such as a chair or bed.
  • Crawl over to the piece of furniture and, if possible, put something soft under your knees.
  • Hold onto the furniture with both hands to support yourself.
  • Place one foot flat on the floor, with your knee bent in front of your body.
  • When you feel ready, slowly get up.
  • Sit down and rest for a while before carrying on with your daily activities.

If you feel hurt and/or you are unable to get up, follow the steps listed below.

  • Try to get someone's attention by calling out for help, banging on the wall or floor (if there is someone on the floor below you), or using your aid call button (if you have one). If possible, crawl to a telephone and dial 112 or 999 to request an ambulance.
  • While you are waiting for help to arrive, get as comfortable and warm as you can by moving to a carpeted area, and try to reach something warm to put over you (particularly your legs and feet), such as a blanket or dressing gown.
  • Try to move regularly to avoid getting pressure sores and to help you keep comfortable. You should change your position at least every half an hour or so.

For information on falls at work in Ireland go to www.hsa.ie

 

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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