How common are falls and balance problems in older persons?

Each year, falls occur in over a third of people over the age of 65, and in over half of people aged 75 and over.

Many of my patients are at risk of falling and have even fallen. They attribute the cause of their fall to external factors such as uneven footpaths. They do not believe that they will fall (again), and state that they will ‘take more care’. It is hard to convince them to do anything about it.

It is generally not useful to encourage older people to accept their risk of falling to motivate them to change their falls prevention behaviour. It is very common for older people to believe that taking more care will prevent further falls but there is no evidence to suggest that this is effective. It could be distressing or embarrassing for older people to admit that they could fall for reasons about themselves. Instead frame any suggestions you have such as attending strength and balance training towards the positive (help to keep up with your grandchildren; help to maintain or improve your level of independence) rather than towards the negative (help to prevent falls).

It is often the case that your patients may have fallen but will not tell you because they feel embarrassed or because they do not want to waste your time (health professional)?

Ask your patients aged 65 years and over at least once a year if they have fallen. “In the past 12 months, have you had any fall including a slip, trip or stumble in which you lost your balance and landed on the floor or ground or lower level?”

I am planning on running a falls education program, what topics should I include?

There are a range of topics that you should include, but first you should decide if the education program is going to be run just by yourself or if a multi-disciplinary team will contribute such as Physiotherapist, Occupational Therapist, Dietician, Podiatrist and Optometrist.

The following topics could be considered for inclusion – falls risk factors and how these can be reduced, balance and safe walking, vision, medications, healthy diet, safe footwear, how to get up off the floor once you have fallen and summoning help.

I am having difficulty recruiting people to attend the falls education sessions that our organisation runs, what should I do?

You may need to revisit what you have named your program and how you are promoting it. Recent research has shown that those at risk of falls do not generally think they are, nor do they think a fall will happen to them. Also if they have fallen, they tend to think it was just an accident and it won’t happen again.

Therefore it may be best to not call your program, Falls Prevention or Preventing Falls, rather terms such as Staying Healthy, Staying Independent & Safe at Home, are considered more acceptable to people as they age.

Another strategy may be to consult with your local hospital or GP practice and promote the sessions to the staff and also to the people who visit these services.

Where are the falls clinics that I can refer my patients to assess them at risk of falling and for prevention?

The ‘Professional Services Directory for Falls Prevention: South Australia Metropolitan Region’ has a comprehensive listing of the falls prevention services that exist, including an individual listing of all of the programs and services that are provided by that organisation. These services may include day therapy centres, home care services, or hospital or rehabilitation facilities. The directory is available to be downloaded via the link above.

What are the resources available that I can suggest to my patients or their carers?

There are many resources available. If you refer to the ‘How do I reduce falls risk in my patients’ section of the website you will be able to find a range of resources that cover most areas that are fall-related. One very good resource is “Don’t fall for it. Falls can be prevented! A guide to preventing falls for older people”. Copies of this resource can be obtained through the Department of Health and Ageing by emailing PHD Publications.

Is there a list of physiotherapy and occupational therapy services in both the public and private sector that have an interest or specialty in falls prevention?

Physiotherapy has a listing of private therapists atwww.physiotherapy.asn.au and Occupational Therapy has a listing atwww.otsa.org.au however neither specify therapists with an interest in falls prevention.

Where do I refer my patients for assessment for walking aids or home modifications?

It is usually best to have an assessment for walking aids completed by a Physiotherapist and the need for home modifications to be assessed by an Occupational Therapist. Referrals for these services can be made to community services such as Domiciliary Care SA (ph 8193 1234), Day Therapy Centres (contact Commonwealth Carelink for your closest centre –http://www9.health.gov.au/ccsd/usr_general/gen_home.cfm or 1800 052 222) or private therapists – for Physiotherapists seewww.physiotherapy.asn.au or (08) 8362 1355 and for Occupational Therapists look at www.otsa.org.au or (08) 8239 1422. Another useful resource for information on equipment is the Independent Living Centre which can be contacted on 1800 800 523 or www.ilc.asn.au