Patient and Family Education on Fall Prevention

Falls are not only the most common cause of injury among older adult population, but are also the leading cause of leading cause of accidental death in the United States and Singapore as well. Older adults who fall, sustain a hip fracture and are hospitalized, die within a year of the fall

Even if the fall does not result in hospitalization, fear of falling has become a major factor. In some cases, fear may lead to inactivity and loss of confidence. This can produce a cycle of fear, loss of self-confidence, and inactivity, thereby decreasing the quality of life and increasing the risk of falls.

Patient and family education are important and the following guides will advise you on how best to safeguard your health. Some of the tips here are good common sense measures for people of any age, which you can also do to lower risk for falls. This is not intended to be exhaustive instructions and in case you may receive different/additional instructions from your doctor. You are advised to follow any specific written or oral instructions given to you by your doctor or healthcare worker. Do seek clarification when in doubt.

Activity / Rehabilitation
• Continue with the exercise regime as taught by the therapists.
• You may increase your activities of daily living gradually as tolerated.
• Rest in between activities. Try not to do activities for more than one hour without a break so that you do not tire yourself.

Nutrition / Diet
• Maintain daily calcium by eating foods rich in calcium e.g. milk, cheese, yogurt, anchovies, sardine, green leafy vegetables, beans, soya bean milk, tofu and dhal. Make sure there is no contraindicated with the medicine or special diet that you are taking.
• Remember to avoid alcohol intake as it can impair your balance and slow your reflexes.

Safe and effective use of medication
• Discuss with your doctor or pharmacist:
 o If your medications will increase your risk for falls
 o If the combinations or timings can be adjusted to reduce the side effects.

Lifestyle Changes
• Take your time when standing up from lying or sitting position. A sudden change of position may cause dizziness.
• Wear well fitted rubber-soled / non-slip shoes.
• Keep a look out for wet floors and clutters when walking indoors and outdoors.
• Reduce the needs of going to toilet at night by:
 o Reduce fluid intake after dinner
 o Empty bladder before sleeping
 o Seek medical advice regarding the management of incontinence.
 o Avoid rushing
 o Use walking aids when necessary.

Home Modifications
Toilet
• Use non-skid mats on the bathroom floor, as well as apply non-skid strips inside your bathtub / shower.
• Install grab bars or handrails around the bathtub and attach tem through the tile and to the structural supports of the wall.
• Use a non-skid shower chair and hand held showerhead

Bedroom
• Ensure bedroom is free of clutter with a clear walking path.
• Always keep a night light and phone beside the bed.
• Use night-lights next to your bed and between your beds to toilet.
• Have a bedside table to hold glasses, water and other items.
• Ensure that your bed is not too high. Your feet should touch the floor when you sit on the bed.

Living Room
• Rearrange living room furniture to allow for a clear walking path.
• Leave extra space if you are using a walker.
• Rugs, runners and floor mats should be secured or removed.
• Secure and keep electrical cords and telephone cables out of the walkway. The telephone should be at a safe and convenient position for the user.
• Use chairs and couch that are easy to get in and out. It is recommended that chairs should have armrests and is of appropriate height.
• Lighting should be adequate and easily accessible.

Kitchen
• Place commonly used utensils within easy reach.
• Avoid standing on chairs and stools to reach for objects. Get someone to assist.
• Long handle utensils should be turned to the side so as not to obstruct your path
• Clean up spills immediately.

Stairs
• If you have stairs in your house ensure that there is ample lighting to guide your steps.
• Install handrails on both sides of the stairway.
• Place coloured strips at the edge of each step and at the top and bottom step to make it easier to see.

When and how to seek further treatment
• Inform your doctor if you have fallen and describe the circumstances of the fall.
• Inform your doctor if you have trouble balancing or walking.
• Inform your doctor if you experience blurring of vision and any other medical problem.
• Inform your doctor if you experience any weakness or other problems with your legs.

Others
• A fall may not result in a serious injury, it still need to be evaluated in the elderly due to:
 o Loss of confidence
 o Fear of further falling may restrict their subsequent mobility.
 o It may be a sign of serious illness.
• Speak to your therapist or nurse if you need more advice.

As in any education, there must be some response from the patient or the family when the above are shared with them. It is an important that they understood what were being taught to them so that fall can be prevented. Therefore, useful guides on the type of learning outcomes can be:
• Patient / Family are Not Competent – not interested or not able to comprehend?
• Patient / Family are Not Receptive to Teaching – not interested at all!
• Patient / Family Verbalizing Understanding – theoretically know what to do but not going to demonstrate how to do them.
• Patient / Family are Able to return demonstration with Assistance – not able to grasp the concept but able to demonstrate with proper guidance given.
• Patient / Family are Able to return demonstration Independently – good to Go!