Modifiable risk factors – how many changes will you make to lower your risk of falling?

Stuff everywhere

Did you know that more people die from falls every year than car accidents? Yet we have multiple health promotion campaigns in Australia about slowing down, wear your seat belt, don’t drink and drive or do drugs, the list goes on! But where are the constant and changing advertisements about preventing falls? Injury Matters in Western Australia do have their ‘Move, Improve, Remove’ campaign which has included mass media campaigns, but interestingly they have used very different messaging to get their point across, in particular they have been positive. Yet to reduce motor vehicle accidents, to stop smoking or reduce obesity all of these health promotion campaigns are viewed as doom and gloom and as such are portrayed that way in advertising campaigns. I wonder which makes people change more?

Rather than have the fancy headlines or campaigns that will shake you to your core I just thought I would give you the evidence and then it is up to you to see if you want to make some changes, be they big or small. We’ll start with some facts, one in three older adults living in the community will fall each year, often they won’t be hurt, which is a good thing, but there is always a chance that injury could happen. If we can avoid them, it would be ideal.

Falls risk factors

To make it easy to see the different risk factors I have placed them into three categories:

1) individual factors;

2) behavioural or lifestyle factors; and

3) environment factors.

Individual factors really are about you, and they include things like:

• Balance and mobility impairments: do you find you lose your balance easily, are you walking with a limp or waddle due to pain or maybe struggle to walk in a straight line in general or are you having trouble walking on uneven surfaces or started shuffling a bit more? Any of these could mean you have a balance or mobility impairment. That doesn’t mean it has to stay that way though, if you find a good physiotherapist or exercise physiologist they may be able to help you with this and get you back to living without these issues.

• Cognitive impairment: people who are living with a cognitive impairment are at greater risk of falling that those without a cognitive impairment. The risk factors for dementia have been updated and I will speak about these in an upcoming blog.

• Sensory deficits: poor vision or hearing loss. I’m as blind as a bat (are bats really blind??? Apparently not, myth busted!) and my optometrist even laughs at how blind I am without my glasses. Thankfully though I am able to wear glasses and because of this my body reacts like I have sound vision. If your vision is not great, please don’t put off seeing an optometrist, because it puts you at much greater risk of having a fall than those like me who go every year and make sure I have the correct prescription. Also, be aware if you have multifocal glasses you will be at higher risk of falling than those with single lens, it is thought this is due to the change in where someone looks through the lens when stepping up and down off curbs and walking up and down stairs, depth perception can be changed. Same with hearing loss, if you struggle with your hearing please see a professional to have yourself tested, I realise some people can’t wear hearing aids but for most people if they need them and they fit it will help to reduce your risk of falling over.

• Depression and psychological factors: having a fall can affect someone psychologically and may lead to having a fear of falling also. It is really important if you are feeling like this to speak with a health professional, we all want to live a full life and having this fear can become debilitating for some people, it’s good to try and get on top of it early.

• Chronic conditions: if you have conditions such as hypertension, diabetes, arthritis, Parkinson’s disease, dizziness, cardiovascular disease you may be at higher risk of falling. However, everyone is at different stages with these chronic conditions and the important thing is to be aware and especially try and do the things we know can help us to reduce our risks, such as improving our balance and physical function.

Spectacles

Now we are going to look at the behavioural or lifestyle factors, the things we REALLY CAN make changes in:

• Physical activity: those who are leading a sedentary lifestyle and not being active are at much higher risk of having a fall. Get out and move, improve your strength and most importantly for falls challenge your balance.

• Polypharmacy: Talk about an academic term or what!! Who made this up! It just means if you are taking numerous medications, particularly sedatives, antidepressants, cardiovascular or psychotropic drugs you are at higher risk. How do you know if you are? If you are taking a number of medications everyday the next time you see your doctor please ask them about all the medications you are on and if any increase your risk of falling, if they do, ask if there are any alternatives that are safe to change to. BUT, this is a big BUT, do not stop taking your medications without speaking with you GP or specialist, there is a reason they prescribed them and you need to speak with that practitioner before any changes are made.

• Footwear: How many of you own dodgy slippers or thongs (in Australia)/flip flops (everywhere else)? These are some of the major reasons why people fall and they also encourage people to shuffle when walking rather than picking up their feet. All in all, they are bad news, if you are wearing them now, please make the decision by the end of the blog to throw your dangerous slippers/shoes away and shout yourself a new pair, your feet will thank you.

• Nutrition and hydration: did you know that having a poor diet and being Vitamin D deficient puts you at higher risk of having a fall? Make sure you are drinking enough fluids (water please) and getting enough nutrients, if you grow your own vegetables you’re ahead of the game and you know where they came from and what chemicals have been put on them (hopefully none), same thing with having chooks, there is nothing better than an organic egg (thanks Mum).

• Medication misuse: As I mentioned above it is really important that the medications you have been given you take as directed by your doctor. Taking them infrequently or too much can affect you also, if you are having trouble keeping up speak with your pharmacist, they have many ideas on how to help you take them correctly.

Old slippers

The last are environmental factors, these can be really easy wins because they can be changed quite quickly in some cases:

• Home hazards: clutter (commonly known as having lots of stuff everywhere) can increase your risk, perhaps have a clean up one room at a time. If you haven’t used something for a year or five years do you really need it still? Poor lighting, slippery surfaces, loose rugs are all hazards. There are people out in the community who are willing to help it’s often a matter of asking. A night light could be the difference between seeing where your sheets or doona are and tripping over them in the middle of the night. The light out the front needs a new globe, the neighbour might be willing to help change this if you feel you can’t. Loose rugs and mats! Don’t get me started…the number of Occupational Therapists to go into people’s homes and recommend a rug is removed because it is a tripping hazard only for them to drive out the driveway and the rug to go straight back down on the floor – does it sound familiar? If you love having a rug somewhere but the ends are frayed and the corners are sticking up, or it's really high and fluffy compared to the floor, can we compromise? Can you consider buying a new rug or mat that is not thick in texture, is as close to the ground and thin as possible, and has good grip on the underside so when you step on it it will stay in the one place and not slip and slide everywhere. These don’t cost a lot, Ikea has plenty (please note I have no deals or interests in Ikea) but it may just save you from having a fall, which is what we all want to avoid, me included.

• Unsafe neighbourhood: uneven paths, curbing at shopping centres that can be really high, poor drainage in some areas meaning walkways are slippery, steps that need maintenance. Just keep an eye out and be vigilant particularly in areas you haven’t been before. Fluids dropped in shopping centres or even fruit and vegetables in that section of the supermarket can make floors really slippery. If you drop a grape, please pick it up they can really do some damage, one of my participants slipped on a grape and broke her hip.

• Inappropriate use of aids: Often when we get a device to help us in living at home it might have been given by a neighbour or relative e.g. a walking stick previously owned by a great Aunt. It is incredibly thoughtful and generous for the family to pass it on but often the stick or walker won’t have been set up to the correct height for you or your family member or friend. Please do the right thing and get a health professional to help you choose what is right for you and for them to teach you how to use it properly, it’s such an easy way to keep yourself safe.

Not an ideal rug

• Did any of these resonate with you? Do you need to make any slight adjustments? Consider writing them down now and work your way through them, it doesn’t need to be getting through them all in one day, but as you go cross them off, it is so satisfying.

• Are you one of those people who wears dodgy slippers? Make a change today on this one and throw them away now and buy new ones that fit your feet correctly and allow you to pick your feet up when walking – this is for everyone regardless of age.

• Are you taking medications? If you are, first up are you taking them correctly? If yes great, if no, this is something you can change for the better. When you next see your GP have a chat to them about your medications and whether you need to be on them still and how they interact with each other, it’s always good to have better understanding of what we are doing with our own health.

• Do you have stuff everywhere? Set a goal to go through one room or even a section of a room each week, being organised and decluttering feels good for the soul.

• Lastly how are those rugs? Consider removing them, but if you just can’t, how about we compromise, and you upgrade them and buy ones that you are less likely to trip over because they sit flat on the ground.

Live the good life!

Reference:

Li, Y., Hou, L., Zhao, H., Xie, R., Yi, Y., & Ding, X. (2023). Risk factors for falls among community-dwelling older adults: A systematic review and meta-analysis. Frontiers in Medicine, 9, Article 1019094. https://doi.org/10.3389/fmed.2022.1019094

Lord, S. R., Sherrington, C., & Naganathan, V. (Eds.). (2021). Falls in older people: Risk factors, strategies for prevention and implications for practice (3rd ed.). Cambridge University Press.