22 Mar 2011
Efforts include screening them for risk factors and teaching them balance
ABOUT one in four people over the age of 65 in Singapore will have a fall, say doctors.
And the older you are, the more likely it is to happen.
That is why hospitals are increasingly bringing in measures to prevent the elderly from falling, such as carrying out screening in the community to assess their risk.
Most old people who take a tumble end up with minor injuries such as cuts.
But about 10 per cent suffer fractures and another 10 per cent, head injuries, said Dr Noor Hafizah, senior consultant at Tan Tock Seng Hospital's Continuing and Community Care department.
Falls do not only cause physical injuries – the consequences may be social and psychological.
Up to 70 per cent of elderly people who fall develop a fear of it happening again. This fear could make them hesitant to leave the house or take part in various activities. It could lead to further weakness, social isolation and even depression, said Dr Reshma A. Merchant, head of general medicine and a geriatrician at the National University Hospital (NUH).
In Parliament earlier this month, Health Minister Khaw Boon Wan said every doctor, nurse and therapist will be taught geriatric medicine so they will be well-placed to help the ageing population manage their diseases well.
This will become increasingly important as the population ages. By 2030, one-fifth of Singaporeans will be 65 and above. Mr Khaw noted how staff at Tan Tock Seng Hospital coach elderly patients on maintaining their balance, which has led to fewer needing readmission for falls.
Most public hospitals have fall-management clinics and physiotherapy programmes to help sufferers. Hospitals are also trying to prevent falls from happening in the first place by screening not just elderly patients but the elderly in the community.
Tan Tock Seng Hospital's Stepping Out programme screens elderly residents in the community to assess their risks of a fall. Partnering several voluntary welfare organisations, a team made up of doctors, nurses and therapists conducts free screenings at housing estates in Toa Payoh and Ang Mo Kio.
Participants are assessed for risk factors such as problems with their vision, hearing and walking. Those deemed at high risk are enrolled in an intervention programme where they learn how to balance better, and are given nutrition tips to improve their overall health. They are also given help with managing their medications, as some medicines can cause side-effects such as dizziness or drowsiness.
The programme, which started in 2009, has screened 250 people, with 170 enrolled for intervention. An analysis of 147 participants in the intervention programme revealed that after 12 weeks, 48 per cent showed an improvement in their balance and about 32 per cent, progress in their walking speed. The programme aims to screen 1,500 elderly people by 2015 and extend its reach to more areas, including the Sengkang, Hougang and Balestier estates, said Dr Noor Hafizah.
National figures on the number of elderly people being admitted to hospitals purely as a result of falls are unavailable. But NUH said that about 11 per cent of its daily admissions of patients above 65 are for falls.
About 600 patients a year are referred to the geriatric department for recurrent falls, said Dr Reshma.
Every patient admitted to NUH is asked to fill in a questionnaire to assess his risk of having a fall. Nurses also look at indicators such as how mobile the patient is, and whether his blood pressure changes according to posture. This is done regardless of whether the patient's condition is fall-related.
Some hospitals have brought in extra measures to reduce falls among the elderly.
At Singapore General Hospital, patients at risk are given identification wrist bands. A sign is also placed in front of their beds.
Special bedside commodes were also designed for frail older patients and night lights were installed in wards.
"If we can reduce falls, we can reduce hospital admission rates as well," said Dr Noor Hafizah.
Stay on your feet
TIPS for the elderly on reducing the chances of falling:
Raise the hems on trousers and long skirts so you do not trip on them.
Loose-fitting slippers or high heels make it hard to maintain balance. Flat shoes with broad heels and non-slip soles are better.
Too-bright or too-dim lighting makes it hard to see. A 75-watt bulb provides the best light source at home.
Keep the bathroom and kitchen areas dry. Install handrails in the bathroom.
Coffee tables, small items of furniture and toys may cause you to trip. Move tables against the walls.
Note that some medications can cause dizziness or drowsiness.
Low sofas can make it hard to stand up. Use higher chairs with armrests.
Source: Falls and Balance Clinic at Tan Tock Seng Hospital
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