Falls awareness week 2013 – case study on fall prevention

This week is national falls awareness week. Charity Age UK reports that more than 250,000 people aged over 60 are hospitalised each year due to falls. Every year one older person in three will fall over, sometimes with profound physical, emotional and financial consequences (information from study by Dr Heather Hall – physiotherapist and falls lead practitioner in Scotland).Falls and the fear of falling can make older people lose their confidence in how they go about their daily activities and can affect their level of independence and cause isolation. As a physiotherapist working with older adults I often play a key role in falls prevention, not only in assessment and treatment to improve balance, strength and mobility, but in assessing someone holistically to identify the many other factors contributing to falls.

The NICE guidelines (national institute for health & care excellence) on preventing falls in older people states every person who is over 65 when seeing a healthcare professional should be asked if they have ever fallen,with further questioning around the circumstances and outcome if they have fallen.Many things contribute to falls including certain medication (some anti-depressants and sleeping tablets), low blood pressure, poor balance and muscle strength, problems with vision and hazards in the home such as poor fitting carpets or mats and poor lighting. Thus by reviewing these areas with older people  healthcare professionals and family and friends can have a significant effect in fall prevention.

Below is a case study of a client I recently assessed and treated in his home who had recently fallen and been admitted for a short time in hospital:

This was a gentleman living independently in Derby who had limited mobility due to a long-standing neurological condition, being able to transfer only a few steps from his wheelchair into his kitchen or other rooms in his home. His family were concerned about his mobility and the recent falls he had. After assessing his physical ability and his home environment I discussed with him the areas I felt needed addressing to improve his safety and reduce his risk of falls and we agreed to work on the following areas:

  • Poorly fitting open toe shoes that provided little support and stability when he got on this feet.
  • A loose mat in his kitchen that he could easily trip on
  • A loose grab rail by the bath which he used to get in and out of the bath by himself
  • A recent deterioration in his vision
  • An unsafe and inefficient technique in transferring from wheelchair to stand with the support of furniture
  • Poor standing posture and strength in his legs on standing
  • Partially inflated tyres on his wheelchair and reduced effectiveness of the brakes

Actions and outcomes as discussed and agreed with client:

  • Client bought new shoes which supported his feet well to help increase his safety when standing
  • Client removed his mat from the kitchen
  • I referred him to Derby Social Services for a review of grab rails in his home and he got his neighbour to fix the bathroom grab rail
  • I gave information on where he could access a home visit by an optician to have his eyesight tested
  • We worked on his posture, leg strength and transfer technique to improve efficiency and safety
  • Advice on local disability shops to get his wheelchair serviced.

After 5 physiotherapy sessions I helped this gentleman to address  many key areas that can contribute to falls and he is now continuing to work on his home exercise programme to improve his leg strength and posture with on-going support from his family. Awareness and knowledge of local services through my time working in the NHS and through updating my knowledge of local services, both statutory and local community organisations helped me to meet this gentleman’s needs more holistically in reducing his risk of further falls.

Further information on falls prevention can be found on:

This article was written by: melanieparker