Standing Strong Reducing the risk of falls
The difference between living and living well
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Contents What is Well-Living? ...................................................................... 4 How safe are you at home? .................................................. 6 Environment................................................................................................ 8 Healthy habits .......................................................................................... 9 Physical activity and balance exercises ............. 12 Exercises ...................................................................................................... 14 Get up from a fall ............................................................................ 20 References ................................................................................................ 23
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What is Well-Living? BaptistCare’s Well-Living approach focuses on the key components to assist you to maximise your health, wellness and independence. Well-Living is about providing the practical knowledge, assistance and support to enable you to keep living your best possible life at home.
Understanding the risk of falls Falls in older adults are serious. Broken bones can be slow to heal and can take a long period of recovery. Falls can also have a lasting impact on your confidence due to an ongoing fear of falling. The old saying ‘use it or lose it’ is especially true in helping to prevent falls. So we want to do everything we can to help you stay fit, healthy and safe from falls.
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The best way to prevent falls is by staying active, looking after yourself and improving safety around the home. Reducing your risk of falling and injury will allow you to continue to participate in activities that you value and enjoy, enabling you to live the life you choose. Evidence suggests that there are several factors that increase the risk of falls for older adults. The environment, footwear, poor muscle strength and balance, medications and poor vision can all contribute to a fall. This booklet provides important information about effective falls prevention strategies. We hope that this will contribute to helping you live safely and well at home. 5
How safe are you at home? This Home Safety Checklist can assist to identify areas of your home where changes could be made to prevent falls.
Home Safety Checklist Access to your home
Yes
No
Yes
No
Do you feel safe and steady on your feet when going through your front or back door? If you are going out at night, are you able to turn on lights so you can see your pathways and entryways clearly? Are all steps and paths outside your home free from loose or broken surfaces? Kitchen/living/dining Can you easily reach the items in your kitchen which you use every day, without needing to reach above your head or below your knees? Do you clean up any spills on the ground straight away? Are you able to easily get up from your chair in the kitchen and lounge room? If you have rugs on the floor, are they secured to the ground to prevent edges and corners curling up? Is your home free from carpet that is worn, torn, loose or uneven to walk on? 6
Bedroom
Yes
No
Yes
No
Do you feel safe and steady on your feet when walking from your bedroom to the toilet – especially at night time? Is your bed easy to get up and out of? Do you have a nightlight or bedside table light which can be turned on easily when needed during the night? Bathroom and toilet Do you feel confident getting in and out of the shower or bath? Do you feel safe and confident when showering or bathing? Are you able to keep your balance whilst showering without needing to hold onto taps or the shower screen for support? Can you easily reach soaps and shampoos whilst showering without over reaching or bending? Can you easily reach the toilet light or do you have a night light near the toilet? Does your bath or shower have slip resistant flooring and a grabrail if necessary?
If you answer ‘no’ to any of these questions it is recommended that you ask your Care Facilitator to arrange for an Occupational Therapist to visit for a home assessment. Government funding may be available to assist you. 7
Your environment Removing hazards Do you have loose mats or rugs in your home? How about electrical cords, pot plants or other small obstacles in your walkways? Securing your mats or rugs and removing or minimising hazards can be easy and quick ways to prevent falls.
Installation of minor or major home modification An Occupational Therapist can advise you on the types of home modifications that will make your home safer, and support you to be as independent as possible. Simple modifications include the installation of grab rails in your bathroom or beside external steps, whilst a more complex modification could include the installation of an access ramp, the removal of a bath and installation of a level shower recess.
Prescription of assistive equipment An Occupational Therapist can prescribe all sorts of handy equipment to improve your independence and safety within the home. People are often amazed by the variety of helpful gadgets and technologies to help with everyday activities like getting out of bed, showering, dressing, cooking, and moving around the home, garden and community.
Lighting Good lighting throughout your home, both inside and outside, is important for preventing falls. Outdoor sensor lighting can help you see clearly if you are getting home after dark. Nightlights or a bedside table light that can be reached from bed can be used to ensure that you can see properly when going to the toilet at night. 8
Healthy habits Regular health check up Conditions including diabetes, Parkinson’s disease, dementia and arthritis can cause you to feel unsteady and increase your risk of falling. Having regular check-ups with your health professional will assist to you to know how to manage these conditions and continue to move safely.
Nutrition Eating a healthy diet is important to fuel your body and to keep your muscles and bones working properly. A balanced diet consists of foods from the five food groups (fruit, vegetables, meats, dairy and cereals/grains), and drinking plenty of water. It may also be worthwhile to ask your local doctor if you are getting the required amounts of vitamins and minerals, in particular Vitamin D and calcium.
Medicines Some medicines can make you feel dizzy and drowsy, and increase your risk of falling. If you take multiple medicines, or use medicines to sleep, a medication review with your local doctor or pharmacist may be worth considering. Existing services are available through your local pharmacy. Your GP is also able to arrange for a pharmacist to visit you at home and review your medicines.
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Footwear and foot health Wearing correctly fitted, firm and supportive shoes can assist to prevent falls. Here are some things to look for when buying shoes: Firm heel counter
Fastening firm and adjustable Smooth lining Uppers of soft breathable material
Flexible at forefoot Low heel Deep and wide toe box
Stable synthetic sole
(Sutherland Podiatry, 2020)
Ensuring your feet are healthy and that conditions such as bunions, corns and calluses are treated can also be a positive step towards falls prevention. Regular check-ups with a podiatrist can be a useful way to monitor foot health and gain advice on suitable footwear.
Eyesight Changes in your eyesight often occur as you age. It is important to have regular eyesight checks to monitor vision changes and seek treatment when needed. If you are not able to see properly, you may not see the raised edge of a footpath, or the edge of a step, which could cause you to trip and fall. 10
Think twice Falls can be prevented by making careful choices about which activities are safe for you to do at home. You need to realistically consider your capabilities and what you are going to need to do to complete the task, before you start. A little planning can make all the difference. You could also consider altering the way a task is completed. For example, instead of storing your plates in a high kitchen cupboard you could place them in a cupboard at waist height or leave them on the bench. This will eliminate the need to reach up and balance whilst lifting and carrying. If you’re not sure that you can do something safely, don’t take the risk – just ask a family member, friend or neighbour to assist.
Personal monitoring system A personal alarm or monitoring system can give you confidence that you will be able to get help when you need it. There are several personal alarms and monitoring systems available. Most personal alarms are worn around your neck or on your wrist, and with the push of a button can contact your family or the emergency services. Some devices also have an automatic falls detection feature and can be programmed to contact your family automatically if you fall. If you would like to find out more about the personal alarms and monitoring systems that are available, please contact your Care Facilitator.
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Physical activity and balance exercises Balance is a complex skill that requires coordination between our brain and the information we receive from our sensory systems. Good balance is often taken for granted. As we age it may start to seem harder to step from a footpath onto grass, getting out of bed without stumbling or get up from a chair quickly to answer the phone. Research has shown that engaging in 150 minutes a week of moderate intensity exercise is important for your health. Exercises that focus on balance and strength are vital to prevent falls and should be included in your daily routine. The next section of this booklet provides some basic exercises that can assist you to improve these two areas.
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Precaution Only perform these exercises if you’re able to do so safely. A referral to an allied health professional, such as a physiotherapist or exercise physiologist is recommended if you feel unsteady or unsafe. A physiotherapist can also advise about whether a walking aid such as a walking stick would be appropriate. If you experience any of the following during the exercises you should cease exercise and seek medical help: •
Chest pain
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Dizziness
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Severe shortness of breath
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Significant change in muscle and joint pain
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Any other severe symptoms
You may experience some muscle soreness at first, or if you do a lot of the exercises. This is a natural process that allows muscles to repair and rebuild to be stronger. This feeling is completely normally and may peak up to 48 hours after. The more regularly you exercise the less likely you will experience muscle soreness. You should also ensure that you exercise in an area that is level and clear of any hazards or obstructions.
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Exercises
Sit to stand The sit to stand exercise helps with getting up and down from a chair, a toilet or in and out of a car.
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Move to the front of the chair. Lean your body forward, with your nose over your toes, and stand up slowly. Keep your knees slightly apart
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Lower yourself back down into the chair, trying to control your descent to the chair
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Repeat 5-10 times up to three times a day
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To make this exercise harder, cross your arms in front of your chest or hold them out in front of you at shoulder height
Heel to toe stance and tandem walk The tandem walk challenges your static and dynamic balance by narrowing your base of support. This helps you keep balance when you have to walk through a narrow space or turning on the spot. •
With fingertips on the top of the kitchen bench to help balance, stand heel-to-toe, bend your knees slightly and keep still for up to ten seconds, repeat up to three times a day. Keep your support on straight leg
•
If you feel confident you can vary the exercise by walking slowly, placing your heel to touch the toe of the other foot along the kitchen bench, repeat 10 steps up to three times a day
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Standing knee raise The knee raise strengthens the muscles of the hips, it helps with climbing stairs and getting in and out of cars and buses.
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With fingertips on something solid like the kitchen bench to help balance, lift a knee to hip level and hold it up to five seconds
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Repeat with the other leg
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Repeat 5 to 10 times each side, up to three times a day
Side leg raises/sideways walking The side leg raise improves your stability when you have to take weight on one leg and helps you step sideways to avoid tripping. •
With fingertips on something solid such as the kitchen bench to help balance, stand on one leg and raise the other sideways, holding it up for five seconds whilst keeping your supporting leg straight
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If you feel confident you can vary the exercise by extending to walking sideways, with slow steps alongside a bench or table
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Repeat 5 to 10 times each side up to three times a day
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Heel raises
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Stand with feet shoulder width apart. Hold onto a wall or bench to help with balance if needed
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Slowly rise up onto your toes, making sure your body moves straight upwards
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Lower your heels to the floor to return to your start position
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Repeat 5 to 10 times, up to three times a day
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To make this exercise harder, stand on one leg and slowly rise up onto your toes. Hold onto a bench if needed
Stepping up a step The step up improves stability on steps, paths and uneven surfaces. •
Holding onto a rail, go up and down a single step, one foot at a time
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Repeat 5 to 10 times, up to three times a day
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Getting up from a fall Unfortunately, even if you are doing all that you can to reduce your risk of falling, you may still have a fall. Knowing what to do if you have a fall can help you feel more confident. If you do have a fall, lie still for a minute, try to stay calm and check yourself for injuries. If you know you can’t get up, or feel pain in your hip or back, then try to call for help by using your phone or personal alarm or by banging on walls. Try to keep warm by covering yourself with whatever is close by and try to keep moving your limbs and roll from side to side if you are able to or not experiencing pain. The following technique for getting up after a fall is worth knowing. You might even like to practice this technique so that if you ever need to get up from the floor, you will feel more confident. Make sure you have someone with you when you practice, just in case you need more help than you expected.
1. Roll onto your side, and then push up onto your elbows.
2. Use your arms to push yourself onto your hands and knees.
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3. C rawl towards a very stable piece of furniture (a sturdy chair or bed) and hold onto it for support.
4. S lide or raise the foot of your stronger leg forwards so it’s flat on the floor.
5. L ean forwards and push up using your arms and front leg, slowly rising to a standing position.
6. Turn around and sit down. Sit for a minute or two and catch your breath.
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Please remember, if you do have a fall, even if you are unhurt, make sure that you tell a healthcare professional, family member or carer that you have fallen. BaptistCare at home can assist you with accessing any of the services, activities and items of assistive equipment mentioned above. BaptistCare’s Home Care Package clients can use their Government funding to purchase a wide range of services and supports to ensure that you are able to stay safe and well at home.
For further information please call your Care Facilitator or 1300 275 227
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References Australian Government: Department of Health, 2015. The Five Food Groups. [Online] Available at: https://www.eatforhealth.gov.au/food-essentials/fivefood-groups [Accessed 25 September 2020]. Clemson, L. & Sherrington, C., 2013. Staying Active and on your feet. [Online] Available at: https://www.activeandhealthy.nsw.gov.au/assets/Uploads/ Staying-Active-A4-Oct2018-web.pdf [Accessed 25 September 2020]. Pharmacy Programs Administrator, 2018. MedsCheck and Diabetes MedsCheck. [Online] Available at: https://www.ppaonline.com.au/programs/ medication-management-programs/medscheck-and-diabetes-medscheck [Accessed 25 September 2020]. Sutherland Podiatry, 2020. The Ideal Shore. [Online] Available at: https://sutherlandpodiatry.com.au/wp-content/uploads/2016/06/falls-shoe. jpg [Accessed 25 September 2020]. Waldron, N., Hill, A.-M. & Barker, A., 2012. Falls Prevention in Older Adults: Assessment and management. Australian Family Physcian, 41(12), pp. 930- 935.
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Why Choose BaptistCare? We are committed to providing person-centred care that encourages independence and quality of life. Our aim to see every individual “living well” is based on Christian principles that are reflected in all aspects of our purpose, vision, values and services. We have the skills and expertise to look holistically at how we can support each individual to live their best possible life – from those who are still fairly independent, to those with complex needs including dementia and end of life care. As well as supporting older people in our community, we are here to support families to ensure their loved ones are well cared for and feel safe.
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