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Managing The Risk Of Falls For Older Patients

Managing The Risk Of Falls For Older Patients
Photo: Managing The Risk Of Falls For Older Patients
Falls are common in older people and can not only cause injury but can also knock their confidence. In fact it is said that older people are 12 times more likely to suffer a fall than be involved in a pedestrian or motor accident. Further to this, around one third of people aged 65 and over, suffer a fall injury at least once a year; resulting in bruises and scrapes, fractures, dislocations, and head injuries. For this reason, it's patently obvious that risk management for falls in the elderly is an area of real concern.

New guidelines for physiotherapists

As people get older the risk of them taking a fall increases, regardless of their environment or background. As well as the physical and psychological trauma suffered, falls also have a heavy impact on already stretched hospitals and care homes.  As a result, in the UK in August of 2012 recent guide lines were put in place by ‘Agile’ (The Chartered Society of Physiotherapy's professional network for those working with elderly people). These guidelines promote a new method of approach with regard to the prevention and management of falls in the elderly and indeed were devised in conjunction with the UK based Peninsula College of Medicine and Dentistry.
It is important to note that although there were guidelines already in existence, there have been considerable advances in technology, practice and policy. Therefore unlike before, these latest guidelines look at factors such as assessment, prevention and the role of exercise in the elderly as well as risk management. The new guidelines are short and concise and very easy to follow, and they focus on four main elements:
Preventing falls occurring
Ways of improving patient balance
Methods to avoid the effects of a “long lie” if the casualty is unable to get up after a fall
Improving confidence and reducing the fear of falling

Increasing exercise

One of the major changes to these new guidelines is that increased emphasis has been placed on steps that physiotherapists can take to actually prevent falls from occurring. These include precise recommendations for a ‘high dose’ of exercise in the elderly.
One of the major risk factors for falls in older people is balance. This is particularly true of those suffering with long term conditions such as Parkinson's disease or a stroke. The exercise component looks at improving balance through exercise and concentrates on three key areas:
Gait, co-ordination, balance
Strength training
Three dimensional training such as dance or Tai Chi.
It is suggested that dynamic exercise programmes which takes place three times weekly over a three month period, are deemed to be the most effective in improving patient balance.

Getting up after a fall

The guidelines also question the fact that very few elderly patients are taught to get back up when they suffer a fall.  Even people who have suffered a fall but are non-injured can still be at risk from other underlying problems. This is especially true if the time lapse between the fall and help arriving is one hour or more. Problems such as sores, dehydration and hypothermia are unfortunately all too common and result in a high risk of hospital admittance or being placed in an elderly care facility.
The new guidelines suggest that elderly patients should be asked whether they are able to get up from the floor following a fall. If the answer is no, then they should be taught how to get up from the floor and wherever possible practise. Patients should also be encouraged to have a strategy in place in order to get help should they fall and are unable to rise.
It is hoped that in the very near future physiotherapists the world over, will take on board these new guidelines and procedures, that will drastically reduce the amount of fall injuries in our ever growing elderly population. 
Resources: Medical News Today; Guidelines for the Physiotherapy Management of Older People At Risk Of Falling – Victoria Goodwin and Louise Briggs August 2012

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