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A MEMBER OF

Your Guide to

Falls Prevention

Geriatric Medicine

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Don’t fall for itWhile it is true that falling down is a common occurrence in life and the risk increases as we get older, falls are not a natural part of ageing and can be prevented.

Why is fall prevention important? This is because:

1. Falls that happen in the older age group have a greater risk of causing injury.2. The injuries sustained can also be long lasting and reduce the ability to walk and move, affecting confidence and independence.3. A large number of falls in seniors can result in long hospital stays and expensive surgeries.

Don’t let falls affect your life, read this booklet and say no to falls today!

Get a QR code reader app from your smartphone’s app store (“search QR reader”) and scan this code using the app, or visit : www.cgh.com.sg/nofalls to read more about how to prevent falls.

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Why we fallThere are many reasons why falls happen. Some of the factors which can cause falls are listed below:

Contents

4 Why we fall

5 Ageing and falls: Our changing bodies

7 Fall proof your environment

9 Fall proof your bedroom

11 Fall proof your kitchen

13 Fall proof your bathroom & toilet area

14 Walk safe: Proper footwear and walking aids

15 Useful fall prevention products

17 Getting up from a fall: What to do if you are alone

19 Getting up from a fall: How to help someone who has fallen

21 Getting help: Your action plan

22 When to call an ambulance

1. Physical factors – these are usually a result of changes due to ageing or some medical conditions

• Muscle weakness or pain• Slow reaction time• Poor balance• Reduced vision• Poor memory

or concentration• Dizziness

2. Medical conditions which can pre-dispose to falls

• Parkinson’s disease • Stroke• Dementia• Arthritis• Rheumatism• Incontinence• Diabetes

3. Lifestyle reasons • Lack of exercise• Poor diet• Unsuitable footwear or attire

4. Environmental factors • Poor lighting and visibility• Cluttered spaces, narrow walkways,

physical obstacles• Staircases, steps, steep inclines and

curbs• Slippery surfaces such as wet floors

To manage and reduce your risk of falling due to medical conditions or use of medications, you need to ensure that your medical conditions are optimally treated. Visit your doctor for regular review.

Understanding these fall risk factors is the first step in preventing falls. In the next few pages, we will explain how some of these factors contribute to the risk of falling – and more importantly, how to do away with these hazards.

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Keep an eye out for poor visionGood vision is important for identifying and avoiding obstacles, sharp corners, steps and curbs. Good vision in both eyes is also crucial in judging distances and depth to help navigate stairs and uneven terrain.

Here are some tips to maintain good vision:

• Have your eyes checked every year by an eye doctor or optometrist• Wear only a single-lens pair of glasses (i.e. no bifocals, trifocals or multifocals)

when walking, especially when outside the home. Wear bifocals, trifocals or multifocals with caution as these vision aids blur obstacles on the ground, creating a ‘blind spot’ that can cause tripping

• Always wear your glasses and keep them near you• Wear a hat and/or sunglasses when outside, especially in bright and high

glare situations.• Avoid dimly lit areas if possible and turn the light on before walking in the

house at night• Put on your glasses if you get up in the night to go to the toilet.• If you have cataracts which are suitable for surgery, having the operation is

likely to improve your vision

Ageing and falls: Our changing bodiesAs we age, our bodies change – our eyesight may dim and we may not be as nimble as before. Stairs and curbs may become harder to manage as our balance becomes poorer. Moving around may take longer. We might become more forgetful. These changes are a natural part of growing older.

Ageing is normal – falling is not; understanding your personal risk factors can help you remain active and independent safely.

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Fall proof your environmentSixty per cent of falls happen in the home. In order to continue to live safely and independently, our homes have to ‘grow’ with us. Making simple modifications to our environment, especially at home, can go a long way in reducing the risk of falls.

There are two main ways to reduce fall hazards in the home:1. Adapt your environment to increase safety2. Increase your perception and awareness of your environment

General PrinciplesTake note of these general principles to ensure that they don’t cause a fall. These apply to ALL areas of the home:

Floor and walkway safety• Ensure floors and walking areas are clear and clutter-free.• Remove trip hazards such as loose mats and rugs, stray wiring, furniture that

blocks walkways, standing fans and toys.• If using mats or rugs, make sure they are secured to the ground.• Wipe up spills as soon as they occur. • If you have pets, be wary in case they get underfoot.

Keep things within reach• Ensure that heavy items or items used frequently are within easy reach.

You should not need to climb, bend or reach too far for these items.• Only if absolutely necessary, use a broad based sturdy and secure ladder

to reach high places. Do not stand on stools and chairs to reach the high shelves.• Place your telephone within easy reach; cordless telephones are recommended.

Keep dangers in sight• Highlight the edges of obstacles or changes in floor height by sticking

brightly coloured tape on these edges.• Furniture colours that contrast with the walls and the floor can help you to

be more aware of your surroundings.• Avoid installing heavily patterned floor coverings and furniture.

Let there be light• Ensure lights are just bright enough for you to see clearly, but not too bright

to cause glare or eye strain.• Ensure light switches are easy to reach and near each doorway.• Provide adequate lighting, particularly at night. Options such as plug-in

nightlights, or motion sensor lights are worth considering.• Allow time for your eyes to adjust when walking from light to dark areas and

vice versa.

Fall proof your wardrobe• Check that clothing ends are above the ankle to avoid tripping.• Sit down rather than stand when dressing.• Avoid walking around in your socks.

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Install a night light.

Consider placing a commode or urinal next to the bed at night to avoid the need to walk when sleepy.

Place walking aids close to the bed.

Fall proof your bedroom

Ensure that the bed is of a correct height. You should be able to place your feet flat on the floor when you sit at the edge of the bed.

Use a cordless phone to help you make phone calls without getting out of bed. A cordless door bell may be used to call for help.

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Fall proof your kitchen

Place utensils and commonly used items within easy reach at chest or waist level.

Reduce glare by using shades or indirect lighting.Install additional lighting if needed.

Have good, non-glaring lighting over the counter top and stove, especially when food is being sliced or cut.

Do not stand on stools and chairs to reach the high shelves.Clean up spills immediately.

Turn in long handledutensils when cooking.

Store heavy items or frequently used items within easy reach or in lower cabinets.

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Fall proof your bathroom & toilet area• Showersaresaferthanbathtubs.• Sit on a stable shower chair with back support to make

showertimesafer.• Ensure that soaps, shampoos and towels arewithin easy

reachintheshower.• Installgrabbarstohelpyouget inandoutoftheshower

safelyifneeded**.• Wherepossible,removetheraisededgeoftheshowerstall

topreventtrips.• Avoidsquattingtoiletsoruseacommodechairinstead.• Installgrabbarsand/orusearaisedtoiletseatifyouhave

difficultygettingonandoffthetoilet.• Makesurelightswitchesarewithinreach.• Installslipresistantflooringorusenon-slipmats.• Consideradistressalarmorphoneinthebathroomincase

ofemergencies.

** For installation of grab bars, please seek professional advicefromanOccupationalTherapist.

Walk safe: Proper footwear and walking aidsWith age, our feet may change shape, be prone to swelling or loss of feeling. Combined with other changes in muscle strength and balance, the risk of falls increases. Hence, it is important to wear appropriate shoes.

Safe shoesThe ideal shoe should fit well, be flat, broad-based and have non-slip soles.

Unsafe shoes• Slippers and thongs do not have laces/buckles to hold firmly onto your foot• Shoes with slippery or worn soles are a balance hazard, especially in wet

weather• Shoes with high or narrow heels make you unstable when walking and can

cause ankle sprains• Shoes without heel counter/support such as slippers or mules, do not provide

support and your feet can slide out of the shoes

• Heel cup should be low, wide and have a rounded edge. Ensure that they provide adequate support

• Soles should be non-slip and of the correct thickness to allow you to ‘feel’ the ground

• Buckles, Velcro straps, and laces help to ensure a snug and safe fit. Be mindful of laces when walking

• The front of the shoe (known as the toe box) should be wide and deep so that it fits snugly (not too loose nor too tight)

• Buy shoes at the end of the day and try on both sides to ensure a proper fit

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• Night lightsNight lights in the bedroom, bathroom and living space can help increase safety in the night time.

• Arm chairChoose stable chairs with arm rests to help you. The seat should be firm because a seat that’s too soft makes it hard to get up after sitting down. When seated, you should be able to place your feet flat on the ground. Chairs should be of the correct height for you. When you are seated, you should be able to place your feet flat on the ground.

• Grab barGrab bars act as useful handholds. An occupational therapist should be consulted for advice on appropriate installation of grab bars.

• Neon stripsPlace strips on high risk areas such as edges of stairs, raised curbs and uneven floor areas in the house.

Useful fall prevention products• Personal alarm

A personal alarm can help alert family members or neighbours to your situation if you fall or needhelp. This can be a pendant or wrist tag with an activation button, whistle or a cordless door bell. A cordless phone may be helpful if it is placed atan appropriate location

• Rubber mattingNon-slip floor coverings such as rubber mats may be placed in toilets, kitchen and under floor mats to reduce slips.

• Shower chairA sturdy chair in the shower can help make shower time safer.

• Commode chairA commode chair may make night time visits to the toilet more convenient and safer.

Get some supportIf you have a prior injury or condition that makes walking difficult, you may benefit from a walking aid. A quad stick, walking frame or walking stick may help enable you to become more mobile. Speak to a doctor, physiotherapist or occupational therapist; they will be able to recommend an appropriate walking aid that suits your needs.

• Glow in the dark stickersStick glow in the dark stickers on light switches.

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4. Bend one knee and use your supporting foot and arms to brace yourself.

5. Push yourself into a half-standing position and slowly turn yourself around to take a seat.

6. Sit or rest until you feel strong enough to call for help. Tell a family member or friend that you have fallen and seek medical help if needed.

Getting up from a fall: What to do if you are aloneFalling can be a distressing experience, especially if one is alone or if there is an injury sustained. In the event of a fall, it is important to get up or get help as soon as possible. Lying on the floor for long periods of time can lead to more problems. If you are alone when a fall occurs, follow these steps to get up safely and get help.

1. In the event of a fall, don’t panic. Take deep breaths and remain where you are. Assess the situation; can you move your body, arms and legs? If you are in pain and unable to get up, call for help. Sit or lie down on the floor in a comfort-able position till help arrives.

2. If you are not in too much pain, roll to your uninjured side. Rest in this position until you feel strong enough to move.

3. Get onto all fours and crawl towards the nearest support, such as a sturdy piece of furniture.

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Getting up from a fall: How to help someone who has fallenIf you are helping someone get up after a fall, it is important to let the fallen person get up on his or her own; you should only act as a guide.

1. Calm the person down and let him or her remain lying down while you check for injuries. Ask the person if he or she can move.

4. Guide the person to place both arms on the chair as support and prop himself or herself into a kneeling position.

2. If there is no significant injury and pain and if the person can move, help lightly roll him or her onto the his/her side and allow him/her to rest. Meanwhile, place two chairs nearby as shown in the illustration.

3. When the person feels strong enough, help him or her to get onto all fours and move towards the chairs.

5. Guide the person to push himself or herself into a half standing position and place second chair behind the person.

6. Guide the person to use his/her arms and legs to push up and sit back on the chair behind him/her. Guide the person to sit back into the seat. Remember not to lift the person as undetected injuries may be aggravated if you pull on him/her. Keep your back upright when assisting.

7. Allow the person to rest and check again for injuries. Seek medical help if needed.

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When to call an ambulanceSome falls may be minor and only result in bruises and cuts, but more severe falls are medical emergencies. Here is how to identify a severe fall:

• If the person who has fallen is unconscious• If there is severe pain• If the person is unable to move• If there is difficulty breathing. If breathing stops, start CPR if you are trained• If there is fluid or blood from the nose, ears or mouth• If the fall involves injury to the head, neck, back, hip or thighs

Call 995 if any of these situations should happen. While waiting for help, do not move the person but keep the person warm with a blanket or towel.

Getting help: Your action planIt is important to have a Help Action Plan in place so that in case of an emergency, you – and your family, helper, spouse and neighbours – know what to do and you can get help readily.

Your plan should be two-fold:1. Proactive – engaging your family, friends and neighbours about the importance

of fall safety Engage your support group • Speak to your family, friends and neighbours about how they can help

you in case of a fall and ask if they can be your emergency contact/help • Leave your emergency contact number with your neighbour/s so they can

contact your designated family member or friend • Leave a copy of your keys with family members or a trusted neighbour so

they can get into your house in an emergency

2. Reactive – knowing what to do in the event of a fall Help Action Plan: Raising the alarm • If someone is at home with you, call out for help • If you are alone, try crawling to a phone. Have phones placed in accessible

places in areas such as the bathroom, the kitchen or the bedroom • Activate your personal alarm, sound a help bell or similar device that can

alert your helper, family members or even neighbours to your situation

The publisher does not endorse the service providers listed here and does not accept responsibility or liability for the quality of the services listed here.

Medical service providers – Fall prevention/assessment

1. Alexandra Hospital Falls Service Tel: 6476 8828 www.alexhosp.com.sg

2. AgeWELL Seniors Clinic Tel :6258 9792 www.agewell.com.sg 3. Changi General Hospital Geriatric Centre Fall Assessment Clinic Tel : 6850 3333 www.cgh.com.sg

4. Hua Mei Seniors Clinic Tel: 6593-9530 www.tsaofoundation.org

5. National University of Singapore Falls and Balance Clinic Tel : 6772-5733 www.nuh.com.sg

6. Raffles Hospital Internal Medicine Centre (Geriatric Medicine) Tel : 6311 1111 www.rafflesmedicalgroup.com.sg

7. Singapore General Hospital Mobility and Falls Clinic Tel: 6321-4377 www.sgh.com.sg 8. Tan Tock Seng Hospital Geriatric Medicine Clinic/ Falls and

Balance Clinic Tel : 6357 8013 www.ttsh.com.sg