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What causes a fall?

Anyone can have a fall, but older people are more vulnerable and likely to fall, especially if they have a long-term health condition. Falls are a common, but often overlooked cause of injury. Most falls don't result in serious injury. However, there's always a risk that a fall could lead to broken bones. A fall can also cause the person to lose confidence, become withdrawn and feel as if they've lost their independence.

What causes a fall?

The natural ageing process means that older people have an increased risk of having a fall. 

Older people are more likely to have a fall because they may have:

  • balance problems and muscle weakness 
  • poor vision
  • impaired sensation (particularly in the feet) or foot pain 
  • vitamin D deficiency 
  • been using medicines that affect attention (e.g. opioid analgesics, antianxiety drugs, and some anti-depressant drugs) or lower blood pressure (e.g. antihypertensive, diuretic, and some heart drugs) can also increase the risk of falling. Even some over-the-counter medicines can affect balance and steadiness
  • poor safety awareness 
  • a long-term health condition, such as heart disease, dementia or low blood pressure (hypotension), which can lead to dizziness and a brief loss of consciousness

Falls can also be caused by physical conditions that impair mobility or balance, hazards in the environment, or potentially hazardous situations. A fall is also more likely to happen when:

  • the floor is wet or has been recently polished, such as in the bathroom
  • the lighting in the room is dim
  • rugs or carpets aren't properly secured
  • reaching for storage areas, such as a cupboard, or going down stairs
  • rushing to get to the toilet
  • there are electrical or extension cords or objects that are in the way of walking
  • there are uneven sidewalks and broken curbs
  • the person is unfamiliar with his/her surroundings

Most falls occur when several causes interact. For example, people with Parkinson's disease and impaired vision (physical conditions) may trip on an extension cord (an environmental hazard) while rushing to answer the telephone (a potentially hazardous situation). The more risk factors a person has, the greater their chances of falling.

What are the symptoms before a fall?

Often before falling, people have no symptoms. When an environmental hazard or a hazardous situation results in a fall, there is little or no warning. 

However, if a fall is partly or completely due to a person's physical condition, symptoms may be noticed before falling. Symptoms may include:

  • dizziness
  • light-headedness
  • irregular or rapid, pounding heartbeats (palpitations)

After a fall, injuries are common and tend to be more severe as people age. Falls can result in at least a slight injury, such as a bruise, sprained ligament, or strained muscle. More serious injuries include broken bones, torn ligaments, deep cuts, and damage to organs such as a kidney or the liver. Some falls result in loss of consciousness or a head injury.

Falls can cause even more problems if the person cannot get up right away or summon help. Such a situation may be frightening and may make the person feel helpless. Remaining on the floor, even for a few hours, can lead to problems such as dehydration, or muscle breakdown that can lead to kidney damage or failure.

What can happen after a fall?

Falls can cause broken bones, like wrist, arm, ankle, and hip fractures. These injuries can make it hard for a person to get around, do everyday activities, or live on their own.

Falls can cause head injuries. These can be very serious, especially if the person is taking certain medicines (e.g. blood thinners). An older person who falls and hits his/her head should see a doctor right away to make sure they don't have a brain injury.

Some falls can be serious and result in death. 

The effects of a fall may last a long time. Many people who fall, even if uninjured, become afraid of falling again. This fear may cause a person to cut down on their everyday activities. When a person is less active, they become weaker, which increases their chances of falling.

Should I tell my doctor if I have fallen? 

It is vitally important for people to tell their doctor if they have fallen, even if the doctor has not asked, so that the doctor can uncover treatable reasons behind the fall.

People who have fallen may be reluctant to tell their doctor because they think falling is just part of getting older, especially if they have not been injured. Even people who have been seriously injured during a fall and have been treated in an emergency department may be reluctant to admit they have fallen.

Some older people may be reluctant to seek help and advice from their GP and other support services about preventing falls, because they believe their concerns won't be taken seriously. However, all healthcare professionals take falls in older people very seriously because of the significant impact they can have on a person's health.

How are falls treated? 

The first priority is treatment of injuries, such as head injuries, fractures, sprained ligaments, and strained muscles.

The next priority is to prevent subsequent falls by treating disorders that may have contributed to the fall. Physical and occupational therapists can help improve people's walking and balance as well as their self-confidence after a fall. They can provide tips on how to avoid falling. Therapists can also encourage people to remain active. Physical therapy and supervised balance training and stretching can help reduce the risk of falling.

How can you prevent falls?

These are some simple things you can do to keep yourself from falling.

  • Talk to your doctor
    • Evaluate your risk for falling and talk with them about specific things you can do.
    • Review your medicines to see if any might make you dizzy or sleepy. These may include both prescription medicines and over-the-counter medicines. Your doctor may recommend alternative medication or lower doses if they feel the side effects increase your chances of having a fall. In some cases, it may be necessary to stop taking certain medications.
  • Do strength and balance exercises
    • Do exercises that make your legs stronger and improve your balance. This can take the form of simple activities such as walking and dancing, or training programmes. Tai Chi is a good example of such an exercise.
  • Wear proper clothes and footwear
    • Avoid loose-fitting, trailing clothes that might trip you.
    • Wear well-fitting shoes that are in good condition and support the ankle
    • Take care of your feet by trimming your toenails regularly and seeing a doctor about any foot problems.
  • Have your eyes checked
    • Have your eyes checked by an eye doctor at least once a year, and be sure to update your eyeglasses if needed.
    • If you have bifocal or progressive lenses, you may want to get a pair of glasses with only your distance prescription for outdoor activities, such as walking. Sometimes these types of lenses can make things seem closer or farther away than they really are.
    • Not all visual problems can be treated. However, some problems, such as cataracts, can be surgically removed with surgery.
  • Make your home safer
    • Add grab bars inside and outside your bathroom 
    • Use non-slip mats in the bathroom
    • Mop up spills to prevent wet, slippery floors
    • Get help lifting or moving items that are heavy or awkward to lift
    • Remove clutter that you could trip over 
    • Ensure all areas of the home are well lit 
  • Avoid alcohol

o   Drinking alcohol can lead to loss of co-ordination and exaggerate the effects of some medicines. This can significantly increase the risk of falls, particularly in older people.

o   Excessive drinking can also contribute to the development of osteoporosis

o   Avoiding alcohol or reducing the amount you drink can reduce your fall risk.

If you've fallen in the past, making changes to reduce your chances of falling can also help you overcome any fear of falling.

What should you do if you fall?

If you have a fall, it's important to keep calm.

If you're not hurt and you feel strong enough to get up, don't get up quickly. Roll onto your hands and knees and look for a stable piece of furniture, such as a chair or bed. Hold on to the furniture with both hands to support yourself and, when you feel ready, slowly get up. Sit down and rest for a while before carrying on with your daily activities. 

If you're hurt or unable to get up, try to get someone's attention by calling out for help, banging on the wall or floor, or using your aid call button (if you have one). If possible, crawl to a telephone and dial 995 to request an ambulance. Try to reach something warm, such as a blanket or dressing gown, to put over you, particularly your legs and feet. Stay as comfortable as possible and try to change your position at least once every half an hour or so.

You should also have a good way to call for help. People who have fallen several times may keep a telephone in a place that can be reached from the floor. Another option is installing a personal emergency response system (a medical alert device) that signals someone to check in on you. 

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