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Falling - and why you should love your Physiotherapist

I rarely post openly but I think this subject matter requires it. If you have an older relative/friend or are concerned about ageing then please read on.  If you don't, aren't and are immortal with perfect health then you can stop here.

Unless you have had injuries that cause you to learn to walk again on unsteady joints or an illness that affects your ability to walk, you probably haven't thought about how terrifying it is to fall.  Due to old injuries I still hesitate at stairs and prefer to walk slowly beside the handrail and I am still under 40.  The thought terrifies me and I hate the winter.  I recently started working on the strategic implementation of improvements in Older People's Care in an NHS Trust.  The material I've be working with on falls has been startling.

An elderly person falling and breaking their hip has a 30% chance of being dead within a year and a 10% chance of being dead in a month. Source BMJ 2014 .  The reasons for this are various; you're already frail and small ailments hit you hard, let alone a break and major surgery, you end up in a hospital which is an unfamiliar place where you can catch infections, are surrounded by strangers, possibly fall again, the place frightens you, it's difficult to sleep and the food is not what you are used to and you use a strange and shared bathroom.  The single biggest risk factor for a fall is that you have already fallen.

If you have concerns please consider the following:
Know that most fire services will do free fire safety checks on older people's homes
Check the house for trip hazards (rugs on landings are a nasty one)
Check their shoes/slippers fit properly.
If they are unable to wear shoes recommend socks with rubberised grips (these are standard issue in hospitals)
If they report diziness ensure any medications are checked for any cross-reactions.
Make sure the lighting is adequate for someone perhaps with failing eyesight
Immediately fix any worn carpet on the stairs.
Consider bathroom handrails.
An important but often overlooked one is if you notice they are wearing a long dressing gown or nighty that has perhaps grown to big as they have lost weight or have a dressing gown belt on which trails on the ground - sort it by safety pinning the belt to the loops and offer to buy better fitting night clothes.  Also look for mens trouser hems that trail the ground.
All of these things can help prevent a fall.

Most of all - if you notice that an elderly relative has started to have difficulty walking please do not assume it is part of ageing - ask them to see the doctor and ask for a referral to a Physiotherapist.  They really can help with quite a few problems.  Some tremors of the head can be dealt with through exercises to strengthen muscles.  Showing someone how to get up and down from the floor, especially following a fall can help to minimise or prevent injury.  And the Physio can do some basic gait analysis and look at exercises that counter the under or over use of a particular joint/limb.  Physios also run balance class for people who have fallen which concentrate on gentle exercises to improve balance and are vastly sucessfull - so much so that participants love the classes and won't leave.

If you're interested and want to know more about the subject there is currently an excellent free short course on the OU's Futurelearn platform which I can't recommend strongly enough.  It's through the University of Newcastle and is excellent - you can find it here.
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This is great info - thank you! Now the tricky thing is persuading my 74 year old mother to maybe consider wearing heels a little lower than her usual 4 inches with added platform!

On a more serious note, dad had a couple of nasty falls and while he didn't break anything, getting him up off the floor was terrifying.

Thanks - I was really surprised when I started reading into the subject.

On a different note - I honestly didn't think about platform shoes!

All such good points. I think the under 60s normally don't have a clue about these things. The practicalities of aging are normally hidden behind media narratives which divide older people into a) in a home senile and immobile b) completely independent sprightly and "marvellous for their age". The huge middle ground is ignored or treated with contempt.

I had never considered it until I started to see my parents age and I started to do the job I am currently in.

I had medic friends who introduced me as a young man to the Off Their Legs category - basically elderly folk who'd been hospitalised after a fall and just never made it out of bed again. And, as you say, tended to die quite soon thereafter.

Which causes me to pause once more to be grateful for the intrepidity of my mother, who broke her pelvis in a fall in her 70s (she was standing on a chair to hang curtains), and was in hospital for weeks'n'weeks, but nevertheless. Today is her 95th birthday, and she's still up and about and living independently.

That's excellent news about your mother - the longer someone remains in their own home, happy and independent the better the quality of life.

Interesting comment over on my link to that, talking about Tai-Chi, and how much it can help.

Absolutely agree re Tai chi and balance. Anything that gets people moving and hopefully socialising.

As you get older, remaining mobile is extremely important. Part of a new way of treating fractured hips is to get people on their feet within 24 hours of the op. The more mobile you are the better your recovery, prevention of sores and lung infections etc etc.

That's a really good post, thank you. We're continually worried about MiL falling, as she remains (understandably) very resistant to moving out of her home, even though the stairs are completely unsuitable for a frail woman in her 90s. She really needs to downsize to a flat, and briefly agreed, when she was really ill and in hospital - the only place, ironically, where she's actually had a fall so far (desperately crossing fingers as I say this). At which point financially overstretched council couldn't offer anything. Now that she's got some mobility back, she's determined to stay put. It's very worrying. We already do some of the things on your list - again, with some difficulty as MiL doesn't want anything in her house changed, even the things - like bathroom layout - that we try to convince her are dangerous. I can understand: from her point of view it must be infuriating to have your own kids interfering and nagging, and assuming they know better than you do. But oh dear...

You can only do what you are allowed to. And sometimes knowing what that is can be more difficult and frustrating. You could try talking to AgeUK to see if they had anyone who could perhaps advise your mum - mainly because a change of messenger may change the reaction.

Thanks for suggestion of Age UK. Unfortunately MiL is even more reluctant to hear messages from people outside the family, than from us. Example being her bathroom. Which is tiny, very old, not adapted to MiL's needs, and frankly dangerous to use. M and his brother have repeatedly offered to work on it and got the "too much bother" response. So Sister in Law (who has spent a lot of time and energy caring for MiL, and is the person she trusts most) contacted the Council (it's their house), asking them to sort it out. But when Council worker came round, MiL dug heels in, and basically refused to talk to the poor woman, declaring that she 'didn't like her' afterwards. MiL is not an articulate person, and very much what we used to call a "home body". The biggest problem that has arrived with old age is her aversion to meeting new people. She tends to clam up when meeting strangers, and ignores their messages: "too much bother" again. At least she's starting to get used to the people who come to do her daily 'personal care' visits.

Edited at 2015-09-11 12:15 pm (UTC)

Very helpful - thank you. My mother is very arthritic and finds the handholds useful, also a raised lavatory seat. I will check out the physic recommendations, too. I have too many elderly relatives who died after a fall, including my uncle who fell out of a hospital bed (no handrail because they were afraid he might get stuck under it, apparently).

Also, getting them to wear a 'help pendant' which is linked into the phone line. My mother, who is compos mantis and sensible, does this, but numerous examples elsewhere of people who have one but 'forgot' it or couldn't be bothered, because the things can be activated by heat or cold and cause a panic - but omitting it led one friend's mum to be trapped under an overturned wheelchair in the garden for 5 hours.

I think that more and more the technology of this will get better. There are currently sensors you can put round an older person's house so that with the click of an app you can see if they have turned the kettle on, opened the bedroom door or flushed the toilet. This will take time to get better but I think it's a good step forward and over time hopefully it will be less burdensome than a pendant although they are a very good idea.

Thanks - as I learn more about the subject I will post more that I think is relevant.

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