Podcast Episode 62: Falls Prevention

Hi I'm Dilshara and I'm Roz and we are both physios and we work together in a rehab hospital. Myself I've been a physio for about 30 years with 15 years in rehab and Dilshara has about 11 years experience as a physio with 10 in rehab and we both run a weekly falls prevention session here in our hospital. So today we'd like to talk to you about falls prevention. First a disclaimer The content within this recording is for the purpose of general information only and is not intended as therapeutic advice or personal guidance. For advice specific to your own circumstances please consult your health practitioner. Okay so Doshara how about you start us off by telling us why we want to prevent falls. So of course the biggest reason of wanting to prevent falls is that risk of injury, ending up in hospital, but also how it impacts on your confidence and quality of life. For example if you have a fear of falling after having a fall. In my experience I have seen the impact that having a fall can have on the physical function, mental health and quality of life of an individual. However the good thing is that strength, balance, mobility and confidence can all be improved with exercise. Okay so firstly what can you tell us about balance and why it's so important? So ultimately balance really means staying upright, staying steady on your feet and not falling over. So your body's mass is concentrated around one point in your body which is called your centre of mass. To keep our balance we need to keep this centre of mass over what's called our base of support, the area we are standing on or sitting on. A wider stance means a wider base of support with which it is easier to keep your balance. Using a walking aid increases your safety by increasing your base of support. If you are reaching or bending try a wider stance such as a lunge stance or a wide squat that will make it easier to keep your balance. So talking about balance there are several things which contribute to us keeping our balance. This includes strength, reflexes and coordination, as well as certain forms of feedback like your vision, sensation and proprioception. Proprioception is an awareness of where your body is in space, which we gain through constant feedback from receptors in our limbs. So now over to Roz, how can we improve our balance? OK, so the good news is that balance can be improved with exercise that is specific and challenging and particular to the task of improving our balance. So the types of exercise that we want to do is to challenge our balance by starting to our base of support so we want to do these types of exercises in a very safe environment either with someone else with us or somewhere where we can hang on to something if we need to like the back of a chair or for example a kitchen bench and these types of exercises can be done at any time through the day at home they don't need any special equipment really but they're the types of things where we start to maybe try and stand with our feet a little bit narrower and try and balance and let go. If you're feeling wobbly in that position you can just have one hand on a bench or a chair and then gradually try and just let go and try and count for you know 10 seconds or 30 seconds or a minute and try standing firstly with for example your feet close together. You could then try standing with your feet one foot in front of the other what we call like a tandem stance or a semi tandem with your feet a little bit apart And yeah, just trying to practice letting go and keeping your balance in those positions. And then you can improve that by also doing things like reaching or turning your head and also doing things like stepping over things or stepping around things, practicing kind of obstacle courses. And a lot of these things can be done in a physio class. There's a lot of classes out there that are balance and strength classes that you can practice some of these things. But a lot of them you can just do at home while you're boiling the kettle or brushing your teeth, just practice trying to stand on one leg, trying to let go a little bit. And obviously, you wanna be safe, so you don't wanna do it if you're not feeling safe. And always have something to hold onto if you need to. And the other thing with exercise is that you wanna be able to keep your strength of your legs is very important. So the big muscles in your thighs are really important to keep strong. So exercises like squats or sit to stand from a chair are really good exercises just to strengthen all those big muscles in your legs. Heel raises, standing at a bench is a really great exercise to keep your calf muscles strong, which are really important for staying on your feet. And yeah, so a lot of these exercises are things you can do during the day, just around the house. And in, you know, incidentally, just trying to do things like, you know, walking is really one of the best exercises that we can do, just whether that's getting out and about with a friend, making it a social event, you know, instead of going for just, you know, going out for coffee or something, maybe you could go for a walk with a friend as well, going somewhere pleasant where it's nice to walk. And yeah, it's all those kind of incidental exercises, if you're safe to go upstairs then try and use the stairs if you can to just increase the exercise that you get from that. So all of these types of exercise can be really helpful just to improve our coordination, improve our balance and yeah, it has been shown that people who can actually stand on one leg for 10 seconds actually have a greatly reduced chance of having a fall. So obviously that's going to be different for everyone and you want to get some advice on what the most appropriate exercise is for you from your health professional. But yeah. So now over to you Dilshera. What are some other strategies that we can use to reduce the risk of falls? So firstly, I'll talk about not rushing. So rushing is a very common reason for falling. So our muscles do turn on both in preparation for movements that we're planning to do, as well as in reaction or as a response to things happening around us. So when we're rushing, you've just got less preparation time and less reaction time for your muscles to turn on. So it's much easier to lose your balance when you're rushing. So try to remind yourself not to rush. Don't rush if the phone rings or the doorbell rings. just let the answering machine get it or just call out that you're coming. And remember if it's important, whoever it is will wait or they'll call back. Other options might be having a cordless phone or a mobile phone. If you're running late for an appointment, also try not to rush. Make a phone call, let whoever it is know that you're running late so that takes the pressure off you for rushing. But also try to give yourself enough time to get ready for things, so when you're planning a day. When you're turning, try to step and turn slowly. Don't quickly turn. And when you're getting out of bed as well, try to just move safely and slowly. Another point is footwear. So your footwear can also really affect your risk of falling. So safe footwear involves wearing a shoe that covers most of your foot, has a snug grip at the heel and plenty of room for the toes. Try to avoid wearing shoes with high heels, backless shoes, any shoes that are worn or floppy or in need of repair. Maybe you want to ask a family member to help you find something more suitable. And there's also clothing. So clothing can also affect your risk of falling. You can try to be more aware of things like long hems or long trouser legs. Try to get those hems taken up so you don't trip over them. Be aware of long dressing gown cords hanging down. Make sure any cords or belts are fastened securely. Generally well-fitted clothing is safer than loose or baggy clothing. So if you've been unwell and lost weight, You might want to purchase some smaller size clothing. Loose or baggy clothing can catch on to things around you. Same with wide open pockets sticking out. And now, Ros, what can we do to improve our safety around the home? OK, so there's lots of things that we can do to keep our home environment safer. One of the most important things is just getting rid of clutter around the house so that we don't have a lot of things in our hallways or in our passageways or around the floor that we might trip on. Also things like mats, it's very important that we don't have too many mats around the house that might trip us up. And particularly if we do have carpets and mats that they have a really good non-slip backing on them that will stick them down to the floor so they're not gonna bunch up or trip us up. And yeah, it's just we're trying to think about reducing the number of mats or carpets that we have in our house is a good idea. And also things like electrical cords that might be running along the ground, just making sure that we're either taping them down or just not having them there at all, trying to take them up to walls or yeah, just not having them running along the floor is really important. Also lighting is really important. So making sure that we have lights, particularly if we're someone who gets up in the night to go to the toilet, just making sure that you've got either a nightlight in the bathroom or in the hallway. You can get lights that go, you know, into the power points down at floor level, which can be really helpful, or a touch sensor light or sensor lights to light the way when we're coming into our house at night particularly, a really good idea. So that, yeah, we're just not fumbling around in the dark. Also just, if you have stairs in your house, it's really important that you have rails, at least one railing on stairs that you can hold on to just to keep you safe. And you can also have things like non-slip treads put on your stairs, particularly if you have carpet on the stairs, that can sometimes be a hazard that if the carpet's worn or coming loose that you want to make sure that that's being replaced regularly. And also, yeah, just taking care on stairs, making sure that you are holding on and just taking care. Also in our outdoor environment, there's lots of hazards that can present themselves, particularly if we're out and about in garden areas or we have our own gardens at home, just making sure that they're maintained regularly, that things like branches are cut back regularly or leaves are swept up or things like gum nuts or little seed pods, things like that, that could be a real trip hazard that we're getting that cleaned up regularly or getting someone to do that, getting a gardener or a family member to help with that if we're not able to do that ourselves. And yeah, just making sure that if we are out and about in the community that we are just watching out for hazards. So uneven paving or footpaths that might have tree roots that have dug up the paving, just trying to avoid those kinds of areas. And using walking aids when we're out and about if we do feel unsafe can be a really helpful thing to just give us that extra stability. You know, stepping down curbs, just looking for perhaps a pole that we might need to hold on to to help us get down a curb if we're a bit unsteady or a bit unsure, or going out and about with a friend or a family member if we do feel unsafe. So yeah, and also in the community that, you know, if areas are really in poor repair, it's a good idea to report them to the local council so that they can be repaired. Yeah, so I think that's the main things about home safety, but yeah, there's also personal alarm systems that are especially good for people living on their own for long periods during the day. So did you wanna tell us a bit more about that, Dilshad? Yeah, so wearing a personal alarm system involves wearing a pendant or a wrist button, which you can press and get help immediately if you're having any difficulty. And it can also help give your family friends a peace of mind as well. They do need to be worn at all times, including in the shower, which is a place where you're more likely to fall as well. And even if you decide that's not for you, you could even consider setting up your own sort of system, like having a family member ring you at the same time each day or having a neighbor drop in to check on you. Now, Ros might talk to us about what to do if you do have a fall. Okay, so if you are unfortunate enough to have a fall, it's really important that you don't rush to try and get up too quickly, that you actually take a bit of time to just assess the situation and work out whether you are injured and whether you're injured in a serious way, in which case you wouldn't want to try and get up because you may make the injury worse. So yeah, really important that if you are in pain or you think you may have hurt yourself, then you really shouldn't try and get up. If you are able to get up, you obviously wanna try and do it in a safe way. And so the best way to do that is to try and get yourself to some kind of chair or table, low table, or maybe a lounge or something that you can hold on to to try and get up and use like one leg getting up first onto one knee, get up onto your knees and then get one leg up and then try and push up using your arms, holding onto either a chair or a table or something that you can hang on to to pull yourself up one leg at a time. If that's not possible, and you wanna try and get to some kind of assistance to get someone to help you, then it's really important that you obviously have a phone or a personal alarm system that you can get to quickly. So just making sure that you have something that you know, particularly if you're at home, that you can get to easily. You may have to crawl to get to the phone. But if you can have the phone in your pocket, if you're going out, that's obviously going to be helpful. So if you can't get help, you can always try and call out to someone or crawl to a doorway where you can call out. And hopefully, a neighbor or someone might hear you. But that's obviously the last resort. So really important that you do have some way of contacting people and you can get to it. And yeah, so obviously if you are injured, the first thing to do is to call the ambulance because it's really important that they get you up in a really safe way and get you to hospital if you need to be attended to. So don't ever hesitate to call an ambulance if you do need help. Yeah, so the main thing with that is don't injure other people. If they're helping you get up, it's really important that they do it in a safe manner. And if they're not confident, don't rush into it. try and call for help if you do need it, get the professionals in. So yeah, I think that's the main things with what to do if you do have a fall. And if you really can't get up and you can't get help, just trying to make yourself as comfortable as possible and wait for help to come. So yeah, I think we've talked about a lot of things today. We've talked about, yeah, how falls can have a really negative effect on our health and wellbeing, but also that there are lots of things that we can do to help prevent them. So things such as safety around the home, safe footwear, safe clothing, not rushing, and also personal alarm systems and also the importance of exercise. So yeah. So remember to stay active, take those opportunities to keep active when you see them and stay safe. We hope this helps you. Thank you for listening. Thanks, everyone. Take care.