Falls Prevention

Falls are an ominous yet very real part of life for people over 65 and many falls can be prevented once the causes are determined. Most elderly patients experience a decline in balance and muscle strength. The combination of this decline with visual and vestibular compromise increases the risk of falling.

The risk of falls and associated complications rise steadily with age and can be a marker of increasing frailty. Frailty is not clearly defined but is widely accepted to include a combination of weight loss, fatigue, reduced grip strength, diminished physical activity or slowed gait associated with increased risk of falls, hospitalisation, loss of mobility and independence, increasing disability and death.(1)

The Australian Bureau of Statistics has found that the number of elderly people who die each year from falls has quadrupled over the past decade. 1530 people over the age of 75 died from falls in 2011, compared to 365 in 2002. Falls are also the leading cause of injury-related hospitalisation in persons aged 65 years and over in Australia. In 2011–12, 96,385 people aged 65 and over were hospitalised for a fall-related injury. The increasing rate of fall-related hospital admissions reflects Australia's ageing population. The number of fall-related hospitalisations for older people has increased 2.3% per year between 1999–00 and 2010–11.

A randomised trial to assess the effectiveness of a multifaceted podiatry intervention in improving balance and preventing falls found, a podiatry referral and multifactorial intervention approach is recommended.(2)

Foot problems are a main cause of falls in the elderly can be prevented through proper care and consultation with a podiatrist. Foot problems than can contribute to a fall include;

  • Difficulty walking

  • Arthritis

  • Foot pain

  • Decrease in muscle strength

  • Toe deformity

  • Decreased range of motion in the joints of the foot

  • Gait impairment

  • Inappropriate footwear

Podiatrists have an important role to in play in reducing the risk of falls by means of; 

  • Identifying and correcting underlying biomechanical and gait abnormalities

  • Assessing and treating foot pain

  • Prescribing exercise programs
    (Exercises targeting gait, balance, functional tasks, strength, flexibility and endurance)
    (Home-based exercise programs containing some form of balance and strength training are the most important intervention strategy to effectively decrease falls.)

  • Maintenance of general foot health care

  • Patient education including;

  • Falls prevention booklet

  • Footwear advice/provision

  • Nail care

  • Prescription of foot orthoses

  • Mobility assistance including assessment & prescription of mobility aides if needed

Fall prevention is possible through proper care of your feet and regular consultation with a Podiatrist who will assess your risk of a fall and treat any conditions in your feet to reduce your overall risk.

References

1.    World Health Organisation. WHO Global Report on Falls Prevention in Older Age. Geneva: World Health Organisation; 2007. http://www.who.int/ageing/publications/Falls_prevention7March.pdf?

2.    Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56.

Spink MJ, Menz HB, Fotoohabadi MR, Wee E, Landorf KB, Hill KD, Lord SR. Effectiveness of a multifaceted podiatry intervention to prevent falls in older people: randomised controlled trial. BMJ 2011;342:d3411.


Cristy Houghton