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How to prevent falls – how to reduce the consequences

Falls are the leading cause of injury related emergency department visits for older adults and the major cause of hip fractures. Every year, several thousands of people will suffer a hip fracture.

The consequences are painful lengthy treatment, as well as a need for nursing care. This is often a threat to the independence and the quality of life of the older adult.

With the right efforts, falls can be prevented, but if they do occur, a hip protector can reduce the consequences significantly. We have collected the most important information about fall prevention and hip protection in the below article.

 

According to the U.S. Centers for Disease Control and Prevention, an older adult is seen in an emergency department for a fall-related injury every 11 seconds. Every 19 minutes, an older adult dies from a fall. In 2014, the total cost of fall injuries was $31 billion only in the US[1], and according to WHO, approximately 28-35% of people aged 65 and over fall each year[2]. The risk of sustaining a hip fracture from a fall increases with age. More than 95% of hip fractures are caused by falling, usually by falling sideways[3]. A hip fracture carries numerous and often fatal and disabling consequences as a result.

A multi-faceted approach to fall prevention most successful

The most successful fall prevention initiatives are those that use a multi-faceted approach.

Numerous articles, reports, practices and guides have been written on the subject over the years. Here is a digest of the most important information:

Fall risk assessment

A fall risk assessment tool could be useful for health care settings caring for the adult at risk, but in a busy workday, it has to be quick and easy to use. You could use the Morse Fall Scale (MFS). The MFS is used widely in acute care settings, both in the hospital and in long-term care inpatient settings. 

The Morse Fall Scale (MFS) is a rapid and simple method of assessing a patient’s likelihood of falling. It consists of six variables that are quick and easy to score, and it has been shown to have predictive validity and interrater reliability.[4] Press the link to access the Scale http://www.networkofcare.org/library/Morse%20Fall%20Scale.pdf.

Fall prevention

Steps to prevent the fall must be taken. Those steps could engage both the adult at risk, relatives, an occupational therapist as well as a physiotherapist and should also focus on the home environment.

Home environment
To prevent falls from happening at home, the following interventions can be done:

  • Remove doorsteps
  • Repair loose and uneven surfaces
  • Provide better and brighter lightning
  • Move frequently used items to lower shelves
  • Raise the toilet seat
  • Install a bath bench
  • Install grab bars for tub or shower

For a complete home environmental assessment list, go to this webpage:
http://stopfalls.org/service-providers/environment/

When purchasing equipment for the adult at risk's home, like grab bars, ramps, etc., it is important to keep in mind that not every toilet, doorway, etc. is identical. It is not always as simple as going to the local hardware store or pharmacy asking a clerk for assistance. Sometimes an expert is needed, and that is where an occupational therapist can help[5].

Occupational therapist
Occupational therapists work with the older adults and caregivers to review the home environment for hazards and evaluate the individual for limitations that contribute to falls. Recommendations often include a combination of interventions that aim at improving physical abilities to safely perform activities of daily living (ADL), modifying the home, and changing activity patterns and behaviors.

Fear of falling can be both a risk factor and a consequence of falling. Lasting concern about falling may lead an individual to avoid activities that he or she remains capable of doing and that are necessary in order to remain as independent as possible. As a consequence of these self-limiting behaviors, older adults experience decreased physical functioning, which then contributes to an increased risk for falls.

In general, occupational therapists assist in breaking the fear, the cycle of inactivity and sedentary lifestyle that increase the risk of falling. Staying active and safe are common goals of older adults. By helping them reach these goals, occupational therapy practitioners empower older adults to maximize their ability to live life to its fullest[6].

Physiotherapist
Physiotherapists work with older adults in interdisciplinary teams and with other agencies in community, hospital and care settings often as an integral part of local falls care pathways. They have specialist skills in assessment and re-ablement and provide evidence-based exercise, education and advice programmes aimed to prevent falls, improve balance, increase self confidence and promote active and healthy lifestyles. Physiotherapy led group exercise programmes have been shown to be effective and to reduce falls by 29% and the risk of falling by 15% and individual exercise programmes by 32% and 22% respectively. Exercise-based falls prevention programmes targeting older adults - particularly older women - can be highly cost effective due to the fact that  they reduce hospitalisation rates significantly[7]

In close cooperation with the person at risk of falling, a physiotherapist can help break the fall by designing a personalised exercise based “fall prevention programme”. This programme may consist of home-based sessions over an agreed period of time. During this time, the physiotherapist will work with the person at risk of falling to achieve the following benefits:

  • Greater muscle strength
  • Improved balance
  • Improved reaction time
  • Improved posture and gait
  • Increased flexibility
  • Improved confidence
  • Improved independence[8]

Person at risk and relatives
Older adults at risk of falling and their relatives also play a significant role in terms of fall prevention and initiatives.

Here are six easy steps that an older adult and a relative can take to help reduce the risk of a fall:

  1. Enlist steps to stay safe
    Discuss with the person at risk if he or she is concerned about falling. If there is a concern about falling, dizziness or balance, consider a consultation with a health care provider who can assess the risk and suggest programs or services that could help.
     
  2. Discuss current health conditions
    Find out if the person at risk is experiencing any problems with managing own health and if so, agree to discuss it openly with a health care provider.
     
  3. Talk about the last eye check-up
    For those already struggling with low vision, consult a low-vision specialist for ways to make the most of the eyesight. If the person at risk wears glasses, make sure they are used as advised by the eye specialist.
     
  4. Notice if the person at risk grabs for support
    Notice if the person at risk is holding onto walls, furniture, or someone else when walking or if he/she appears to have difficulty getting up from a chair. These are all signs that it might be time to see a physical therapist who can help the person at risk improve balance, strength, and gait through exercise. They might also suggest a cane or walker and provide guidance on use.
     
  5. Talk about medications
    If the person at risk is having a hard time keeping track of medicines or is experiencing side effects, encourage this person to discuss the concerns with a doctor and pharmacist. Suggest that medications are reviewed each time a prescription is renewed.
     
  6. Do a walk-through safety assessment of the home
    There are many simple and inexpensive ways to make a home safer. For professional assistance, consult an occupational therapist[9].
     

Hip protectors as a supplement to fall prevention programmes

It is a fact that no matter how many steps are taken to prevent falls, they occur anyway. It is therefore recommendable that the person at risk of falling wears a hip protector day and night so that in the unfortunate event of a fall, the person is protected. A hip protector cannot prevent the fall, but it can reduce the consequences of a fall. Hence, hip protectors should be seen as a product that contributes to personal safety at the same level as seat belts, lifejackets and helmets.

Furthermore, they improve the quality of life, because they give a feeling of safety, which influences gait and encourages a higher level of activity.

Hip protectors also reduce the health economic costs related to hip fractures. Purchasing a hip protector is definitely worth the investment compared to costs related to several days of hospitalisation, rehabilitation and a possible admission to a nursing home. Human costs such as pain, inactivity, loss of independency etc. must not be forgotten either.

These are the reasons why a hip protector is an important and essential element in a fall prevention programme, as fall prevention initiatives will not prevent all falls. Hip protectors have been widely discussed though. Some studies show that they are clinically proven, some show that they are not. Unfortunately, these studies cause confusion around hip protectors and their clinical potential.

It is Tytex's experience that in studies where hip protectors have not been proven effective, uncomfortable hip protectors that carry no substantial clinical evidence have been used. If a hip protector is uncomfortable to wear, it lowers compliance level, which has a negative influence on the study outcome.

SAFEHIP® - clinically proven hip protector

The best hip protector available is clinically proven while being very comfortable to wear both day and night. SAFEHIP® is such a hip protector. It has been tested on more than 7,000 users in clinical trials in Scandinavia, Holland, Germany, Japan and Australia. It is the most clinically proven hip protector in the world, and the results are unequivocal:
SAFEHIP® has a significant effect in reducing the number of hip fractures

SAFEHIP® hip protectors can effectively and inexpensively reduce the risk of hip fracture by around 60%.

SAFEHIP® is the only hip protector in the world using the patented horseshoe shaped shields that bring outstanding force reduction capabilities. Horseshoe shaped shields have been proven to both absorb and disperse the force away from the critical area on the thigh bone. Standard shaped hip protector shields merely absorb the force from a fall.

For increased comfort and compliance, SAFEHIP® AirX hip protector is the only 100% breathable textile-based hip protector in the world – soft and flexible when walking, standing, sitting or lying down.

See extracts of all the clinical studies here

If you want to know more about the benefits of hip protectors in long-term care facilities, Fraser Health Authority in Canada has made a very informative video on this - click to watch it.


Get more information on fall prevention

Contact our Medical Product Manager for further data and information on this article and fall prevention.

Nurse & Medical Product Manager

Heidi Vang Hagelskjær Tel. +45 4099 2017 E-mail: hvh@tytex.dk

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