Falling is something that we expect to see in infants and toddlers as they learn about the world and their bodies. A bump, a cry and the youngster is up and running again. Unfortunately, a fractured hip or wrist or a head injury are all too often the results of a fall in an older person. The consequences range from pain and inconvenience to expensive medical treatment, lengthy rehabilitation and even death.

The causes of falls in older persons are often separated into three groups: intrinsic, extrinsic and situational.

Intrinsic factors include: medications, changes in vision or hearing, muscle weakness, osteoarthritis and osteoporosis and disease processes such as Hypotension, Parkinson's Disease and Heart problems.

Extrinsic factors include slippery floors, poor lighting, stairs, low furniture and inappropriate footwear.

Situational factors refer to specific circumstances around a fall,. for example, when a walker is parked on the far side of the room and its owner attempts to walk to the bathroom unaided.

A relatively recent addition to the discussion is the effect of a persons fear of falling. Well intentioned family and friends may instil this fear in an older person who lives alone. Someone who has fallen once or more may experience such a loss of confidence that he or she limits activities. This results in muscle weakness, lack of endurance and lack of practice in normal daily activities.

It is important to recognise that falls are often caused by a combination of factors. A fall which at first glance appears to have a single clear-cut cause may be more complicated.

An active, independent woman pruning the hedge may have simply fallen off a ladder. However it may be that she lacked the muscular strength to safely place the ladder against the tree; she may have become dizzy when tilting her head back to reach for the upper branches; she may have actually had a small stroke.

Similarly, a man who tripped over the edge of a rug while walking with his walker in his apartment may not hold the rug entirely to blame. He may be drowsy from the effects of a medications; he may be showing some symptoms of a disorder such as Parkinson's Disease; he may be experiencing problems with his co-ordination or his vision may be deteriorating so that he cannot differentiate the edge of the rug from the surrounding floor.

What can be done to reduce the incidence of falls?

1. Keep an open mind - do not assume that falling is a necessary part of the aging process. Treat each fall as worthy of investigation. This presents an opportunity to prevent future falls.

2. Keep well - review health conditions and medications regularly with your medical practitioner. Have vision and hearing checked and try different aids where available.

3. Keep your home safe - there are many check-lists available to help you identify and remedy potential problem areas such as poor lighting, loose mats, unsuitable seating etc. Also it is important to consider how assistance might be summoned in event of further falls.

4. Keep moving - physical activity keeps you strong, flexible and confident in your abilities.

5. If you are having frequent falls or sustain a significant injury consult your family practitioner

This article was prepared by Peri Howlett, Registered Physiotherapist, Outreach Assessor with the Southeastern Regional Geriatric Program.

The Southeastern Regional Geriatric Programs goals are to assist the older adult to optimise health status, improve the quality of living and promote functional independence and autonomy. The Program is located at St. Marys of the Lake Hospital, Kingston and is.funded by the Ministry.of Health. For information or referrals to the Southeastern Regional Geriatric Program please call:1-800-214-5848 or 544-7767