How can we prevent falls among the elderly?
When Luisa (not her real name), a hale and healthy sexagenarian, hit her head on the floor after falling off her favorite folding chair, her daughter contacted me immediately to ask if she should be brought to the emergency room. I examined Luisa for worrisome signs of head trauma and fortunately found none. “We can observe Luisa at home,” I told her daughter. “But your mom should never use her folding chair again.”
Asking Luisa to get rid of her favorite piece of furniture might seem harsh, but I thought it was essential if she were to minimize her risk of falling—an alarmingly common cause of debility and financial strain among the elderly.
One in five elderly Filipinos have experienced a fall, according to the 2018 Longitudinal Study of Ageing and Health in the Philippines. Of this, 15 percent reported being injured seriously enough to need medical treatment. But the survey also found that one in five senior citizens in need of medical care were unable to access it mainly for financial reasons.
Being fortunate enough to obtain medical care or avoid serious injury can still mean a debilitating fear of falling among the elderly. The “post-fall syndrome” is characterized by dependence, confusion, immobilization, and depression, which strip senior citizens of the confidence to live vibrant, independent lives.
To prevent this from happening, heads of households should conduct a simple “fall checklist” of their home environment. Remove, adjust, or repair anything that can cause an elderly person to trip or slip, such as loose rugs, cords and wires, clutter, or uneven flooring. Ensure that there is adequate illumination along pathways, especially to the washroom. Install grab bars and use rubber mats in the bathroom and by the toilet.
Local chief executives should do a “fall checklist” of walkways and public places, especially areas with high foot traffic. Remove obstacles to pedestrians, such as illegally parked vehicles, utility poles in sidewalks, potholes, and cracked and uneven sidewalks. Obstructed sidewalks force pedestrians to walk on the curb and on the road, which poses other risks to safety.
After securing the physical environment, we should turn our attention to improving the elderly’s strength and balance with exercises shown to prevent falls and fractures among them. Senior citizens should be encouraged to do home exercises that strengthen the lower body, such as repetitively standing from a seated position without using one’s hands, and activities that improve balance, such as tai chi.
Just as important as conditioning older people’s muscles is strengthening the elderly’s social bonds. In this regard, the availability of a reliable, affordable, and accessible pedestrian and public transport network is crucial. As the World Health Organization Age-friendly Cities Framework reminds us, the lack of accessible public transport and community spaces isolates older people who are unable to drive, making it impossible for them to participate in community life. This increases their risk of loneliness and frailty.
Health professionals can discuss fall prevention with their elderly patients as often, a health professional’s recommendation can convince people to change their habits for the better. Diminished senses increase the risk of falls so we should screen our patients for low vision, difficulty in hearing, and impaired foot sensation. We should review their medications too for unnecessary pills, as polypharmacy (specifically, the use of four or more prescription medications) is a risk factor for falling.
Fortunately, the Department of Health has ongoing capacity building activities for the primary health care of the elderly, and is proposing that the Senior Citizens Act be amended to mandate geriatric care training for medical and allied health professionals, including training on fall prevention.
Three weeks after Luisa fell from her chair, her daughter told me that not only has her mom gotten rid of the chair, she has also taken up basic strength training with the help of YouTube videos. More importantly, Luisa has become an advocate for fall prevention and has begun to spread the gospel of grab bars in the toilet and strength training among her kith and kin.
To this day, I am still amazed at the changes my patients are willing to do just because I advised them so. “Laking bagay talaga that the advice came from a doctor,” Luisa’s daughter told me. I hope you can do the same for your patients, friends, and families.
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John Carlo Timbol is a member of the Philippine Society of Public Health Physicians. This article was written with valuable input from Dr. Gabriele Domingo of the DOH Disease Prevention & Control Bureau, and Jedd Ugay, a transport economist and commuter advocate.
