Understanding the Risks:
Exploring Why Falls are a Concern

Falling among elderly in Singapore is unfortunately not an uncommon sight. Based on a report published in the National Library of Medicine, one in three elderly Singaporeans aged 65 and above fall at least once a year, while half of those 80 and above do so. These are not even the full sum as there are many who fall but do not seek medical attention for it, dismissing it possibly due to home remedies or the absence of physical injuries like bruises. The reported number of injury-related deaths due to falls in Singapore is 40%. This is a worrying figure and it is crucial to prevent these accidents as they can have permanent physical and psychological impacts, detrimentally affecting the life and overall wellbeing of an elder.

CONSEQUENCES OF FALLING

Everyone knows the physical repercussions of falling. This could range from cuts to bone fractures. However, when it comes to that of elderly, there is more to it. Treating a fall is no longer as simple as applying ointment like Zam-Buk for your Baluku. For elders, even minor injuries should not be overlooked as there could be detrimental impacts to other parts of the body. The most fragile body part is our head and any impact on it could result in dire outcomes such as a great risk of brain damage. Upon falling, if the injury is severe, one might take a long time to recover, or even worse - possibly never regaining the same level of mobility and lose their independence forever.

Inherently, the recovery time for elderly is longer than that of adults and the impact is more threatening as well. Why is it easier for younger people to stand up from a fall as compared to elderly? These are a result of:

Reduced physiological resilience:

As age catches up, the body's ability to repair and regenerate cells diminishes. In fact, the natural ageing process reduces the efficiency of bodily functions, including the immune system and tissue repair, slowing down the healing process and prolonging recovery.

Decreased muscle mass and strength:

Our muscles play a crucial role in providing us with support, protection, stability, motion and strength. Sarcopenia, which is the inevitable age-related progressive loss of muscle mass, is part and parcel of ageing. As we age, our body experiences fluctuations in hormone levels, declining capabilities of muscle regeneration and protein synthesis, and an extrinsic lack of physical activity. These factors lead to a decrease in number and size of muscle fibres which results in muscle atrophy (thinning of muscles). Muscle atrophy hence detrimentally impacts one’s ability to perform daily activities as there is reduced support, and recovery requires more time and effort to regain the same level of strength.

Impaired immune response:

Immunosenescence, which is the gradual age-related deterioration of the immune system, is a natural process of ageing. The immune system's response to injury or infection becomes less efficient as we age due to chronic inflammation and deterioration in immune cell functions. The thymus gland, which produces and matures immune cells, tends to reduce in size and become less active with age. With a reduced production of immune cells and other substances required for recovery, the rate of healing is compromised and further perpetuated with a higher risk of complications with age.

Pre-existing health conditions:

Elderly individuals often have pre-existing health conditions such as chronic diseases, cardiovascular health, or age-related conditions like osteoarthritis or osteoporosis. Chronic diseases often result in inflammation and metabolic abnormalities that can be detrimental to muscle health. These underlying conditions can complicate the recovery process, increase the risk of complications, and require additional management and treatment.

Coexisiting health conditions and medications:

Elderly individuals may be consuming multiple medications to manage various coexisting health conditions. Some medications could conversely interfere with healing processes or develop side effects that inhibit recovery. Furthermore, a myriad of conditions may further weaken the immune system due to complications or overexhaustion of immune cells in repairing the different parts of the body. Additionally, the combination of multiple medications, known as polypharmacy, can increase the risk of drug interactions and adverse effects, which can further delay recovery.

Psychological and emotional factors:

Just like anyone, recovery from an injury can be physically and emotionally exhausting with its symptoms and disruptions. The excruciatingly long waiting period for the injury to recover, being reliant on movement aids, not being able to carry out daily activities like showering or walking normally, can result in negative emotions. Knowing the amount of pain they had gone through from their past injuries, the negative emotions elderly individuals may experience manifest in increased anxiety, fear of re-injury, or psychological distress. This can result in greater resistance to adhere to rehabilitation and treatment plans as they no longer have motivation, but are overwhelmed with preexisting fears instead.

SUSCEPTIBILITY TO FALLS

On top of the intrinsic deteriorating physiological resilience elderly individuals face as they age, they are also more susceptible to falls specifically due to the following:

Poor Vision

Lack of Exercise

Previous Conditions & Side Effects

Envrionmental Hazards

POOR VISION

Poor eyesight makes it difficult to identify fall hazards such as puddles, unclear and uneven paths. As we age, our eyes unavoidably deteriorate due to several factors.

Firstly, the lens of a human eye becomes less flexible and transparent over time. Hence, presbyopia (or more fondly known as Lao Hua by Singaporeans), surfaces whereby those aged 40 and above face difficulties in focusing on nearby objects.

As we age, the ciliary muscles controlling the curvature and thickness of our lens weakens, reducing our eyes’ accommodation abilities to produce clear visions at both near and far distances. Our eyes’ lenses are no longer able to adjust its shape as well to focus on objects at various distances.

Photoreceptors are light-sensitive cells in the retina that are in charge of capturing light and transmitting visual information to the brain for processing. As we grow older, the number and function of these photoreceptors decline, affecting the eyes’s visual sensitivity and perception towards colour. Hence, this leads to a decrease in processing and reaction time.

As we age, the risk of developing eye conditions heightens. These include:

1. Cataract - Proteins in the lens start to accumulate and clump together to form a cloudy area, impeding the passage of light through the lens, affecting the clarity in our eyes. This condition can be perpetuated if one has prolonged exposure to the sun, certain pre-existing medical conditions and medications and bad habits.

2. Age-related macular degeneration (AMD) - Macula is the central part of the retina that is responsible for sharp and detailed central vision. It is essential for tasks like reading, driving and facial recognition. AMD affects the macula and results in difficulties in conducting these tasks - with blurred visions and appearances of dark and empty spots in the visual field. Dry AMD occurs when the macula thins and degenerates over time, resulting in a progressive decline in vision. Wet AMD, on the other hand, involves growth of abnormal blood vessels below the retina which can result in rapid and severe vision loss due to potential blood and fluid leakage.

3. Glaucoma - A group of eye conditions that causes damage to the optic nerve which results in vision loss and blindness if left untreated. It is usually due to an increased pressure in the eye known as intraocular pressure (IOP) but can also occur when IOP is regular or low. The threatening reality about glaucoma is that there are no noticeable symptoms in its early stages. When left untreated, glaucoma progressively impacts one’s peripheral vision and causes blind spots to form. Asians at a mere age of 40 years old face a greater risk and will become increasingly common as we grow older.

These visual inhibitions can pose a greater risk for falls for elderly as they fail to clearly perceive their surroundings, increasing the risk of accidents.

PREVIOUS CONDITIONS

As we age, the more likely it is for us to develop health conditions like Parkinson’s disease, Alzheimer’s disease and arthritis. Neurological conditions can affect a person's cognitive function which in turn affects their balance, coordination, and spatial awareness. They may make flawed decisions in their judgement of distance or presence of obstacles, increasing the susceptibility of falls. As neurological conditions worsen, their gait (the way they walk) and mobility are also affected. They may exhibit impaired mobility such as shuffling their feet, struggling to lift their feet properly, moving unsteadily, contributing to the heightened risk of falls. Impaired mobility can restrict an elderly’s movement which can also weaken muscles. Hence, these impede one’s ability to move about smoothly and confidently as usual.

SIDE EFFECTS OF MEDICATIONS

Certain medications for common conditions like depression, high blood pressure and insomnia may have side effects that contribute to the risk of falling amongst elderly. These include drowsiness, cognitive delays and loss of balance which pose dangers that increase the likelihood of a fall to occur amongst elderly.

LACK OF EXERCISE

Inactivity becomes increasingly common among adults as we age due to time and physical constraints. However, the lack of physical movement further weakens muscles, decreases bone density and negatively impacts one’s moods and energy. When muscles are weak, there is a loss of stability, flexibility and balance that is crucial for smooth mobility. On top of strengthening muscles, exercise also strengthens our bone density and mentality. With a stronger skeletal system, our bones are not as brittle and we are less susceptible to severe injuries such as cracks or fractures in the event of a fall. Exercise also alleviates stress and improves our emotional wellbeing. It sharpens our focus and provides the energy to go about our day. Without exercise, one may tend to feel lazy and tired easily. Losing concentration due to fatigue while walking is a very dangerous cause of falls.

ENVIRONMENTAL HAZARDS

The living condition of the elderly individual may pose a highly potential risk factor for falls. In fact, the majority of these accidents occur in the senior's home (63% as of 2015 by a report from Health Promotion Board). These hazards could include wet floors, clutter, change in furniture positioning or dim lighting. Sometimes, even the most careful of us are vulnerable to accidents due to the nature of an accident’s unpredictability. Sometimes, dementia can perpetuate the possibility as you may forget that you have left the floor unattended when you thought you had already dried it. Most accidents occur due to our carelessness - be it from not moving about cautiously to not being thoughtful enough about our surroundings. While we cannot totally prevent falls from occurring due to any unintended carelessness, we can take concrete steps to reduce the possibility of falls.

WAYS TO PREVENT FALLS

Vision Management

Health Checkup

Vitamin D

Monitor Medications

Creating a Safe Environment

Stay Active

Support & Education

Independence with Safety

VISION MANAGEMENT

As our eyes undergo inevitable deterioration as we age, it is essential for all adults to go for regular eye checkups as any inhibitions to the eye can be undesirable towards smooth movement. Eye checkups can be as simple as having opticians verify the usefulness of your visual aid and making updated changes if necessary. It can also include eye examinations with optometrists to test for specific diseases such as glaucoma. As mentioned, conditions like glaucoma have no noticeable symptoms. Hence, it is essential to go for regular eye examinations (especially for those with higher risks due to family history, for example) for early detection and intervention to treat them before it is too late, preserving vision for as long as possible.

REGULAR HEALTH CHECKUPS

As we age, it is important for adults to go for regular health checkups to identify any conditions before it is too late. As mentioned, some coexisting health conditions do have a correlation with falling. Primary care doctors, more commonly known as General Practitioners (GP) in Singapore, can screen for aforesaid fall risk factors such as poor vision, balance, poor gait, motor weakness, joint disorders and more. For more niche aspects or for conditions that require a greater depth of examination, timely referrals and follow ups can be done for them to seek treatment and reduce the risk of falls. Hence, through early intervention and undergoing early treatment one’s body will not deteriorate so quickly and one would not have to suffer from the negative repercussions of all the conditions at once. With proper management and understanding of the conditions, one can be better prepared by being aware of its side effects and thereby taking concrete steps to ensure optimal safety.

VITAMIN D

Vitamin D is an effective supplement that helps to prevent falls. It is essential in maintaining bone and muscle health.

Enhances bone health: Vitamin D assists with the absorption of calcium from the food we consume, which is essential for bone strengthening. By maintaining adequate Vitamin D levels, bones are less brittle, and the risk of developing osteoporosis and fractures is reduced, which in turn lowers the risk of falls.

Muscle strength and function: Sufficient Vitamin D levels help maintain muscle strength and coordination. Having strong muscles are essential in preventing falls such that it provides for stability and balance in movement, and support to prevent severe injuries.

Improves proprioception: Proprioception is the ability of the body to sense its position in space, movement and orientation of body parts. It is a sensory feedback mechanism to aid us in maintaining balance and having spatial awareness. By enhancing proprioception, our bodies can have better and faster response to changes, having quick reflexes. As we age, proprioception may be impaired due to neurological conditions and reduced physical activity. Vitamin D is beneficial in improving proprioception, promoting better sense of body positioning and reducing the risk of falls.

MONITOR MEDICATIONS

As mentioned, certain side effects of medications for ageing conditions contribute to the increased risk of falls amongst elderly. Polypharmacy may cause unexpected side effects and delay recovery. It is essential to heed your doctor’s advice and be transparent about all the medications your elder is taking such that the doctor will be aware of the appropriate medications to prescribe. It is also important to be attentive and aware about the types of medications and side effects that your elderly is consuming instead of feeding them blindly. Clarify when in doubt and raise concerns about the prevalence of falling to your doctor as well for a more tailored prescription. to note the possible side effects of every medication taken and how they might increase the risk of a fall.

CREATING A SAFE ENVIRONMENT

Home modifications are essential steps that we can take into our own hands to prevent further risk of falling. By providing a safe living environment, even if the elder has medical fall-inducing conditions that take a while to recover, one does not have to take the extra mile to walk through obstacles. That being said, one still has to be extra cautious when manoeuvring, just that with home modifications like proper lighting and walking aids like anti slip mats, bars and clear floors, your elder can walk with a greater ease.

Create a safe environment: Ensure that the living space is clear and free from unnecessary obstacles that will increase the risk of falling such as clutter. Arrange furniture in a way that allows for clear pathways and smooth walks, without requiring your elder to take many turns to get to their destination like their bedroom or bathroom. Make their pathway the clearest such that they remember the route and have the least physical worry when walking.

Handrails and grab bars: Install handrails along steps and other areas where additional support is required. Bathrooms are also high risk areas as it can be slippery or hard to move around. Install grab bars in the bathroom to assist with balance and prevent falls even on slippery floors.

Non-slip mats: Place non-slip mats areas prone to wetness or spills such as the kitchen to reduce the risk of slipping. It is crucial to have non-slip mats inside and out of the bathroom to prevent slipping when moving inside, and drying of feet before walking out. Be aware of possible leakages in certain household items such as washing machines and place non-slip mats there for precaution.

Lighting: Ensure that the living space is well-lit, especially at areas frequently used by the person with dementia. Consider nightlights in bedrooms and bathrooms to provide guidance during nighttime. Install additional lights such that they are clear directives for elderly in their day to day movement if they are constantly using the same route so that they have a constant sign to follow.

Footwear: Ensure that your elder with dementia wears suitably fit, comfortable shoes with anti-slip soles. Shoes that do not fit to size can pose a great risk to falls whereby larger shoes are prone to trips and smaller shoes are uncomfortable and restrict proper movement. Avoid open-toe sandals as it can increase the risk of sudden tripping. Shoes with straps and proper support are useful for elderly to walk comfortably. While it may be more cumbersome to constantly help to undo straps instead of just slipping out of the shoes, your elder’s safety is of priority over convenience.

Technology: Falls among elderly can oftentimes occur out of nowhere where you as the caregiver may not be physically present. With the proliferation of technology, tap on it to provide almost instant care for your elder in the event of a fall. Technologically useful devices such as fall detection systems and home monitoring systems are beneficial in providing such instant feedback. For fall detection systems, an example would include a simple non-imposing wearable that sends alerts or produces alarm sounds to alert you of a fall should you not be at your elder’s side. For home monitoring systems, smart home technological devices can monitor the movements of your elder, prompting you if they detect potential hazards. Click here to see how other technology can provide an added layer of protection for the care of your elder.

STAY ACTIVE

Staying active is essential to keep our muscles strong to provide support and balance. We acknowledge the physical and time constraints adults have but engaging in regular light exercises do make a positive difference in preventing falls amongst seniors and maintaining their independence. Click here for our suggestions on elderly-friendly exercises that are beneficial in improving physical growth. Consult with a healthcare professional as well to identify appropriate and tailored exercises for your elder.

CAREGIVER SUPPORT & EDUCATION

Gain knowledge through reliable sources about falls amongst elderly with dementia and learn effective strategies to boost your confidence in providing good quality of care to your elder. Some reliable sources include caregiver support groups, articles from reliable caregiving websites or courses with which we too provide here at CaringWheels. As a caregiver, your role in ensuring fall prevention is paramount. Knowing how to prevent falls and what to do in the event of a fall is crucial as a fall can occur in less than a second and the repercussions of falls are dire. You are not alone in this journey. Join caregiver communities to foster friendships with those who are in the same boat as you and share opinions with each other. You may gain new perspectives from others in this field that you are struggling with.

INDEPENDENCE WITH SAFETY

As with the consequences of falling, this does not mean that you restrict movement from your elder such that they are not at a risk of falling at all. That would simply be more harmful and unhealthy instead. We should encourage autonomy and freedom for your elder with dementia whilst providing a safe environment to do so. Such include identifying tasks that your elder enjoys and can safely partake in, provide clear instructions and give them the freedom of choice. Assess your elder with dementia’s abilities and determine how much you can let go and ensure that everything is being done in a safe and conducive environment.

Understanding the Risks: Exploring Why Falls are a Concern