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Dr Duncan

Falls prevention

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We saw lots of them during the winter Olympics when speed-skaters, downhill slalom skiers, bobsleigh teams and ice skaters all came spectacular “croppers”!

falling skater
We saw lots of them during the winter Olympics when speed-skaters, downhill slalom skiers, bobsleigh teams and ice skaters all came spectacular “croppers”! And these were people who were at the top of their game and had practiced for years at their particular skill and activity. So it’s not really surprising that we lesser mortals succumb to falls - even when we’re not on snow, ice or moving at great speeds!

All of us will have tripped over a step, a carpet or even our own feet. And though we think of joggers as being fit and healthy, they too can fall over and injure themselves. For those who think walking or jogging are the only ways to fall over, then think again: cyclist are at even more risk of serious injury if they fall off their bikes. In fact, cyclists account for a significant number of weekly admissions to the emergency departments of our hospitals. So it’s not just the old and frail, or the young and clumsy who should be the focus of falls prevention, we should all prepare for it, because one day it’s going to happen to us all. And forewarned is forearmed!

But it’s once you cross the 75 year old mark - often described as old age unless you happen to be 75 yourself - that the rate of falls begins to rapidly escalate. For Australians aged 65 years and over the rate is 2,516 injuries per 100,000. At ages 85 years and over, unintentional falls account for about 7 times the number of injury incidents attributed to all other external causes combined. The fall rate is higher amongst older women than it is for older men: but for both genders, falling can not only injure, but it can also be a killer. Deaths following falls rapidly increases with age too.

falling woman 
In this older age group, the more common injuries leading to hospitalisation are fractures of the femur, the hip, the wrist and the shoulder. Interestingly, we males of the species tend to hit our heads more, which is probably a wise move because older males who fracture their hips are more likely to die as a result of their injuries. And even more interesting is the fact that residents of aged care facilities tend to fall more frequently than those who live at home!

Fractures of this sort at an advanced age have both financial and social costs. The cost of the acute care of falls in older people in the period 2006-2007 was $600 million, but the overall costs would have been considerably higher when inpatient and ongoing rehabilitation were taken into account. The social impact can be even more devastating for those who 
suffer a fall. It can lead to loss of confidence in their ability to live independently, and place financial and emotional burdens on both them and their families during this very stressful time.

Like all of us we can take steps to reduce the risks of suffering an accidental  fall - which, by definition, always happen at the most unexpected times. A patient of mine was about to embark on a long distance walk in Europe and had been in training for months for the adventure of a lifetime. Whilst walking around the shops on the day prior to setting off, he slipped on wet cobble stones and landed heavily on his backside! Luckily he only suffered severe bruising to his buttocks as well as his ego! However, if he had not been fit and prepared, there is little doubt that he would have broken some bones! 

The lesson from his experience is that being fit and strong will not prevent a fall, but it does allow your muscles to REDUCE THE IMPACT of a fall. If you think of your arm and leg muscles as shock absorbers, then when you do slip or trip, then your muscles won’t always stop the fall, but they will let you down more easily. And as my patient discovered, being badly bruised is far better than having a broken bone!

Here’s a check list of things that we need to review in order to help prevent falls :
  1. Activity - are my muscles weak through lack of exercise or physical activity? (A)
  2. Footwear and clothing / Foot – am I wearing unsuitable footwear? (F)
  3. Eyes – Vision problems: reduced vision - especially at night - or wearing the wrong glasses can cause problems (E)
  4. Balance – Do I have balance problems? (B)
  5. Medications – Do any of my medications have an unwanted side-effects on balance or strength? (M)
  6. Health factors – Do I suffer from: memory loss, arthritis, incontinence, Parkinson’s disease, poor nutrition and low confidence? (fear of falling) (H)
  7. Environment – Home safety hazards in and around the home and in public places - loose carpets, cables across the floor etc (E)
And all of us have a part to play - even those fit individuals who walk, jog, swim or ride daily. They too should check their environment, and before they head should go through a quick pre-exercise check list to think what they would do if they slipped over or fell off their bike. And for older folk and their families it’s a timely reminder to regularly review this check list to make sure that you don’t end up flat on your back in a place that you don’t want to be!
falling cyclist



Article written by Dr. Duncan Jefferson. More articles here. For more information on health care and private health cover, visit HBF Insurance at www.hbf.com.au.

The content of these articles is not tailored for any particular individual's circumstances. The author does not take into account your physical condition, medical history or any medication you may be taking. Any advice or information provided by the author cannot replace the advice of your health care professional. The views expressed in this article are those of the author and do not represent those of HBF unless clearly indicated.

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