Discussing the ‘Father wound’
April 20, 2018
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April 20, 2018

No need to fall

Photo from The Stay Steady Foundation of Trinidad and Tobago

By Lara Pickford-Gordon, lpgordon.camsel@rcpos.org

I once witnessed an elderly relative of mine fall. One Sunday, she apparently stumped her foot and fell on her knees, which would have hurt immensely because of arthritis. She took a few minutes to absorb the shock and pain before standing upright without assistance.

Ageing is a risk factor for falling but falling is not inevitable because of age. “As you age, you become more at risk for falls,” said physiotherapist Dr Carla Rauseo in an interview with Catholic News, April 9. She listed muscle loss, degeneration of eyesight, balance, hearing loss, skeletal deformity and arthritis as contributing factors. These however, “do not mean we have to fall; there are things we can put in place to lower our risk”.

The World Health Organisation (WHO) estimated 646,000 persons die annually from falls globally, 80 per cent in low- and middle-income countries. Adults over 65 years suffer the greatest number of fatal falls. The WHO fact sheet on ‘Falls’ stated, “Prevention strategies should emphasise education, training, creating safer environments, prioritising fall-related research and establishing effective policies to reduce risk.” (www.who.int/mediacentre/factsheets/fs344/en/)

Last year Total Rehab, an outpatient rehabilitation facility, the Physiotherapy Association of Trinidad and Tobago and the department of Physiotherapy Springfield College, Massachusetts collaborated to host a Fall Prevention programme.

Rauseo said there was overwhelming attendance so they decided to form the Stay Steady Foundation, a non-profit aimed at “addressing the problem of falls among older adults” with tagline “Falls are Preventable”.

The foundation got sponsors and another Fall Prevention programme was held March 12–15 offering screening and education sessions at venues in the west, east, south and Tobago. There was again an overwhelming response with more than 360 persons screened.

Rauseo said: “There is a tremendous thirst among older adults for information on how to prevent falls because obviously it infiltrates into their everyday life, the fear of falling and we all know someone who has fallen”. There is a multidisciplinary approach involving exercise, education and home modification. The foundation has a geriatric psychiatrist to provide information on age-related brain changes, depression, Alzheimer’s, dementia and occupational therapists, advising on home modification to decrease risks in the home. The foundation collects information from medical practitioners (general practitioners, orthopaedic surgeons) on medication which can contribute to falls.

Rauseo referred to ageism in the society commenting, “Not only do people feel ‘that person is old’ but older people themselves accept the fate ‘well, I am getting old so let me just sit down in the gallery, read the papers and have an afternoon nap’”. She said the public needs to understand the contribution older adults can still make to society. There are also centres for them to socialise and keep active.

Older adults have reported they “have a real problem navigating the community”. She said, “The environmental factors really impact them because of a lack of accessibility: the uneven pavements, lack of railings in public buildings, the stairs.”

In the home, the placement of rugs, absence of hand rails, extension cords located in walkways and even pets are other environmental factors. Intrinsic factors for falls include dementia, diabetes, blood pressure and improper use of medication.

While both males and females can suffer the same injuries, women tend to fall and fracture their hips and their wrists while men may get head injuries from “falling backwards and hitting their heads”.

Preventing falls is important because recovery is difficult.

She explained that individuals who break their hip may use a walking stick for the rest of their lives. Persons with canes who injure themselves need a walker, and after injury, individuals using walkers require wheelchairs.  Rauseo said a quarter of older adults who fall and fracture their hip die within the first year due to the significance of the hip fracture, decrease in mobility, post-operative or pre-operative complications, and pain which is avoided through reduced mobility. This leads to being bed-ridden and possibly pneumonia.

Even if a hip fracture does not occur after a fall, there is the fear. Rauseo said many elderly don’t have the strength to get up after a fall so they sit on the floor waiting for assistance. For persons living alone, the wait can be very long. One woman waited for two days until she was found. Financial means, social interactions—support from family and friends, and level of function before a fall, can impact recovery.

Outlining some of the ways falls may be prevented, Rauseo suggested installing nightlights as many falls occur in the dark. Patients have said their doctors do not ask about falls. She advised persons to get annual regular check-ups to assess if falling “could be a symptom, of the need to exercise [and] challenge your balance, improve your frame of mind, avoid those depressive symptoms that can lead to falls.”

The data collected from the Fall Prevention outreach will be reviewed for trends to see any variations and risk factors in different parts of the country.

Anyone interested in finding out more about fall prevention can contact The Stay Steady Foundation at 389-5768 or visit their Facebook page.