Preventing falls amongst seniors

By: Steve Kyaw

An accidental stumble could result in a minor cut or bruise for most people. However, in seniors, a fall could result in far more serious damage, such as a hip fracture, head trauma or long-lasting psychological fear of physical activity. More worryingly, a fall may cascade into various negative consequences, such as subsequent falls, reduced mobility, loss of independence and even premature death. Falls are one of the leading causes of injuries in seniors. In Singapore’s Emergency Departments, 85 percent of all trauma in seniors are falls.

In addition to the physical suffering caused by a fall, patients and their caregivers will also be hit by the financial cost. Overseas studies suggest each fall by a senior costs S$12,250. There is also the cost of reduced income, should a family member decide to stop work to care for their loved one.

Fall Prevention Awareness Week 2017 occurs in the US from September 22 to 28 as a week-long campaign to help prevent falls amongst seniors. The campaign’s main message is that falls are preventable, and everyone – from healthcare professionals to caregivers and families – can take certain steps to reduce the risk seniors falling.

Here are some tips to prevent such falls at home:

• Be aware of the intrinsic risks – These involve the senior’s health and mobility levels. As people age, we lose muscle strength, coordination, joint flexibility and balance. Together with reduced vision, this increases the chances of a fall. A number of chronic age-related diseases increase the risk of a fall, such as diabetes, stroke or arthritis. It is also important to know whether the individual is taking several drugs, as multiple medications could lead to confusion, dizziness or change in toilet habits.
• Be aware of the extrinsic risks – These are environmental conditions that increase the likelihood of a fall, and include poor lighting, slippery flooring, stairs, clutter on the floor or inappropriate footwear. Doing a walk around the house will reveal where you could install brighter light bulbs, secure rails, grab bars and non-slip tiles or mats.
• Adopt a mindset change – Many seniors do not think they are at risk of a fall. However, studies reveal that one in five individuals above 65 years in Singapore will fall every year. Once seniors are aware of the dangers, they may be more open to using aids such as a walker or cane. They are also more likely to move about carefully, in particular in high-risk areas such as the toilet or kitchen, or in scenarios such as moving from a sitting to a standing position.

In the hospitals

It is also important to prevent falls while the elderly patient is in hospital. Inpatient falls tend to cause a longer and more expensive hospitalisation stay, as the severity of the injury increases. It is also known that elderly patients who have fallen are more likely to fall again. One key performance indicator for a hospital is the number of falls per 1,000 patient days in a year. Fortunately, Singapore hospitals achieve low rates, averaging about 0.9, comparing well to hospitals in the US that averaged at a rate of 3.2.

To keep fall rates low, more hospitals are putting in place strategies to reduce the risk of inpatient falls. These include:

• Fall prevention programmes – Healthcare professionals use methods such as the Morse Fall Risk Assessment tool to develop a fall prevention programme. Patients are assigned a score based on various factors such as fall history, gait and mental status. Nurses use this tool to determine if a patient is at risk of falling and can take appropriate action. Preventive care can be something as simple as tagging high-risk patients, as a reminder to nurses to pay more attention to this group of patients.
• Sensors and alert systems – Latest technology advancements are now available to help healthcare professionals to prevent inpatient falls. Sensors positioned above each bed can track patients’ activity, and send an alert within seconds should the senior try to get out of bed. This gives an early warning to the ward staff, who now have sufficient time to reach the patients’ bedside and provide necessary assistance.
• Physical therapy programmes – A research team from Duke-National University School Medical School, Singapore General Hospital, Changi General Hospital and Agency for Integrated Care has developed a new physical therapy programme to prevent falls. Patients older than 65 years, who had experienced a fall-related injury, were recruited to the programme. Half received tailored, intensive physical therapy, while the other half received the standard care. The team found that while this physical therapy programme did not reduce the number of subsequent falls, it did appear to reduce the severity of injury from the fall and slowed muscle decline.

The good news about falls is that many of them can be prevented. This enables our senior loved ones to stay as healthy and independent for as long as possible.

Steve Kyaw is co-founder and CEO of Apeiron Technology, a medical technology start-up that has developed an Intelligent Monitoring System (iMOS) for hospitals, care centres, or even home-based caregivers. The iMOS device can give early an alert to the caregiver in case the patient tries to get out of the bed so that potential fall cases can be prevented. This is a non-contact device that is wall-mounted and hence, non-contagious, making it ideal for hygiene critical settings. Apeiron Technology is incubated by NUS Enterprise.