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Your Guide to Falls Prevention

A MEMBER OF

All information is valid at the time of printing (July 2012) and subject to revision without prior notice. 1 w 2

Don’t fall for it While it is true that falling down is a common occurrence in life and the risk increases as we get older, falls are not a natural part of ageing and can be prevented.

Why is fall prevention important? This is because:

1. Falls that happen in the older age group have a greater risk of causing injury. Get a QR code reader app from your smartphone’s 2. The injuries sustained can also be long lasting and reduce the ability to walk app store (“search QR reader”) and scan this code and move, affecting confidence and independence. 3. A large number of falls in seniors can result in long hospital stays and using the app, or visit : www.cgh.com.sg/nofalls expensive surgeries. to read more about how to prevent falls. Don’t let falls affect your life, read this booklet and sayno to falls today! 3 4

Contents Why we fall There are many reasons why falls happen. Some of the factors which can cause 4 Why we fall falls are listed below:

5 Ageing and falls: Our changing bodies 1. Physical factors • Muscle weakness or pain – these are usually a result of • Slow reaction time changes due to ageing or some • Poor balance 7 Fall proof your environment medical conditions • Reduced vision • Poor memory 9 Fall proof your bedroom or concentration • Dizziness 11 Fall proof your kitchen 2. Medical conditions • Parkinson’s disease which can pre-dispose to falls • Stroke 13 Fall proof your bathroom & toilet area • Dementia • Arthritis 14 Walk safe: Proper footwear and walking aids • Rheumatism • Incontinence 15 Useful fall prevention products • Diabetes 3. Lifestyle reasons • Lack of exercise 17 Getting up from a fall: What to do if you are alone • Poor diet • Unsuitable footwear or attire 19 Getting up from a fall: How to help someone who has fallen 4. Environmental factors • Poor lighting and visibility • Cluttered spaces, narrow walkways, 21 Getting help: Your action plan physical obstacles • Staircases, steps, steep inclines and curbs 22 When to call an ambulance • Slippery surfaces such as wet floors

To manage and reduce your risk of falling due to medical conditions or use of medications, you need to ensure that your medical conditions are optimally treated. Visit your doctor for regular review.

Understanding these fall risk factors is the first step in preventing falls. In the next few pages, we will explain how some of these factors contribute to the risk of falling – and more importantly, how to do away with these hazards.

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Ageing and falls: Keep an eye out for poor vision Good vision is important for identifying and avoiding obstacles, sharp corners, Our changing bodies steps and curbs. Good vision in both eyes is also crucial in judging distances and As we age, our bodies change – our eyesight may dim and we may not be depth to help navigate stairs and uneven terrain. as nimble as before. Stairs and curbs may become harder to manage as our balance becomes poorer. Moving around may take longer. We might become Here are some tips to maintain good vision: more forgetful. These changes are a natural part of growing older. • Have your eyes checked every year by an eye doctor or optometrist Ageing is normal – falling is not; understanding your personal risk factors can • Wear only a single-lens pair of glasses (i.e. no bifocals, trifocals or multifocals) help you remain active and independent safely. when walking, especially when outside the home. Wear bifocals, trifocals or multifocals with caution as these vision aids blur obstacles on the ground, creating a ‘blind spot’ that can cause tripping • Always wear your glasses and keep them near you • Wear a hat and/or sunglasses when outside, especially in bright and high glare situations. • Avoid dimly lit areas if possible and turn the light on before walking in the house at night • Put on your glasses if you get up in the night to go to the toilet. • If you have cataracts which are suitable for surgery, having the operation is likely to improve your vision

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Fall proof your environment General Principles Sixty per cent of falls happen in the home. In order to continue to live safely and Take note of these general principles to ensure that they don’t cause a fall. independently, our homes have to ‘grow’ with us. Making simple modifications These apply to ALL areas of the home: to our environment, especially at home, can go a long way in reducing the risk of falls. Floor and walkway safety • Ensure floors and walking areas are clear and clutter-free. • Remove trip hazards such as loose mats and rugs, stray wiring, furniture that There are two main ways to reduce fall hazards in the home: blocks walkways, standing fans and toys. 1. Adapt your environment to increase safety • If using mats or rugs, make sure they are secured to the ground. 2. Increase your perception and awareness of your environment • Wipe up spills as soon as they occur. • If you have pets, be wary in case they get underfoot. Keep things within reach • Ensure that heavy items or items used frequently are within easy reach. You should not need to climb, bend or reach too far for these items. • Only if absolutely necessary, use a broad based sturdy and secure ladder to reach high places. Do not stand on stools and chairs to reach the high shelves. • Place your telephone within easy reach; cordless telephones are recommended. Keep dangers in sight • Highlight the edges of obstacles or changes in floor height by sticking brightly coloured tape on these edges. • Furniture colours that contrast with the walls and the floor can help you to be more aware of your surroundings. • Avoid installing heavily patterned floor coverings and furniture. Let there be light • Ensure lights are just bright enough for you to see clearly, but not too bright to cause glare or eye strain. • Ensure light switches are easy to reach and near each doorway. • Provide adequate lighting, particularly at night. Options such as plug-in nightlights, or motion sensor lights are worth considering. • Allow time for your eyes to adjust when walking from light to dark areas and vice versa. Fall proof your wardrobe • Check that clothing ends are above the ankle to avoid tripping. • Sit down rather than stand when dressing. • Avoid walking around in your socks. w 9 10

Fall proof your bedroom Use a cordless phone to help you make phone calls without getting out of bed. A cordless door bell may be used to call for help.

Install a night light.

Ensure that the bed is of a correct height. Consider placing a commode You should be able to place your feet or urinal next to the bed at flat on the floor when you sit at the night to avoid the need to edge of the bed. walk when sleepy.

Place walking aids close to the bed. w 11 w 12

Fall proof your kitchen

Place utensils and commonly used items within easy reach at chest or waist level. Have good, non-glaring lighting over the counter top and stove, especially when food is being sliced or cut.

Turn in long handled utensils when cooking.

Store heavy items or frequently used items within easy reach or in lower cabinets. Do not stand on stools Reduce glare by using shades or indirect lighting. and chairs to reach the Install additional lighting if needed. Clean up spills immediately. high shelves. 13 14

Walk safe: Proper footwear and walking aids With age, our feet may change shape, be prone to swelling or loss of feeling. Combined with other changes in muscle strength and balance, the risk of falls increases. Hence, it is important to wear appropriate shoes.

Safe shoes The ideal shoe should fit well, be flat, broad-based and have non-slip soles.

• Buckles, Velcro straps, • Heel cup should be and laces help to low, wide and have a ensure a snug and rounded edge. Ensure safe fit. Be mindful of that they provide laces when walking adequate support

• The front of the shoe • Soles should be non- Fall proof your bathroom & toilet area (known as the toe • Buy shoes at the end slip and of the correct • Showers are safer than bathtubs. box) should be wide of the day and try on thickness to allow you • Sit on a stable shower chair with back support to make and deep so that it both sides to ensure to ‘feel’ the ground shower time safer. fits snugly (not too a proper fit • Ensure that soaps, shampoos and towels are within easy loose nor too tight) reach in the shower. • Install grab bars to help you get in and out of the shower Unsafe shoes safely if needed **. • Where possible, remove the raised edge of the shower stall • Slippers and thongs do not have laces/buckles to hold firmly onto your foot to prevent trips. • Shoes with slippery or worn soles are a balance hazard, especially in wet • Avoid squatting toilets or use a commode chair instead. weather • Install grab bars and/or use a raised toilet seat if you have • Shoes with high or narrow heels make you unstable when walking and can difficulty getting on and off the toilet. cause ankle sprains • Make sure light switches are within reach. • Shoes without heel counter/support such as slippers or mules, do not provide • Install slip resistant flooring or use non-slip mats. support and your feet can slide out of the shoes • Consider a distress alarm or phone in the bathroom in case of emergencies.

** For installation of grab bars, please seek professional advice from an Occupational Therapist. 15 16

• Glow in the dark stickers Useful fall prevention products • Grab bar Stick glow in the dark stickers on light switches. Grab bars act as useful handholds. An occupational • Personal alarm therapist should be consulted for advice on A personal alarm can help alert family members appropriate installation of grab bars. or neighbours to your situation if you fall or need help. This can be a pendant or wrist tag with an activation button, whistle or a cordless door bell. A • Night lights cordless phone may be helpful if it is placed at Night lights in the bedroom, bathroom and living an appropriate location space can help increase safety in the night time.

• Neon strips Place strips on high risk areas such as edges of stairs, raised curbs and uneven floor areas in the house. • Rubber matting Non-slip floor coverings such as rubber mats may be placed in toilets, kitchen and under floor mats to reduce slips.

• Shower chair A sturdy chair in the shower can help make • Arm chair shower time safer. Choose stable chairs with arm rests to help you. The seat should be firm because a seat that’s too soft makes it hard to get up after sitting down. When seated, you should be able to place your feet flat on the ground. Chairs should be of the correct height for you. When you are seated, you should be able to place your feet flat on the ground.

• Commode chair A commode chair may make night time visits to Get some support the toilet more convenient and safer. If you have a prior injury or condition that makes walking difficult, you may benefit from a walking aid. A quad stick, walking frame or walking stick may help enable you to become more mobile. Speak to a doctor, physiotherapist or occupational therapist; they will be able to recommend an appropriate walking aid that suits your needs. 17 9 18

Getting up from a fall: 4. Bend one knee and use your supporting foot and arms to brace What to do if you are alone yourself. Falling can be a distressing experience, especially if one is alone or if there is an injury sustained. In the event of a fall, it is important to get up or get help as soon as possible. Lying on the floor for long periods of time can lead to more problems. If you are alone when a fall occurs, follow these steps to get up safely and get help.

1. In the event of a fall, don’t panic. Take deep breaths and remain where you are. Assess the situation; can you move your body, arms and 5. Push yourself into a half-standing legs? If you are in pain and unable position and slowly turn yourself to get up, call for help. Sit or lie around to take a seat. down on the floor in a comfort- able position till help arrives.

2. If you are not in too much pain, roll to your uninjured side. Rest in this position until you feel strong enough to move. 6. Sit or rest until you feel strong enough to call for help. Tell a family member or friend that you have fallen and seek medical help if needed.

3. Get onto all fours and crawl towards the nearest support, such as a sturdy piece of furniture. 19 20

Getting up from a fall: 4. Guide the person to place both arms on the chair as support and How to help someone who has fallen prop himself or herself into a If you are helping someone get up after a fall, it is important to let the fallen person kneeling position. get up on his or her own; you should only act as a guide. 1. Calm the person down and let him or her remain lying down while you check for injuries. Ask the person if he or she can move. 5. Guide the person to push himself or herself into a half standing position and place second chair behind the person.

2. If there is no significant injury and pain and if the person can move, help lightly roll him or her onto the his/her side and allow him/ her to rest. Meanwhile, place two 6. Guide the person to use his/her chairs nearby as shown in the arms and legs to push up and sit illustration. back on the chair behind him/her. Guide the person to sit back into the seat. Remember not to lift the person as undetected injuries 3. When the person feels strong may be aggravated if you pull on enough, help him or her to get him/her. Keep your back upright onto all fours and move towards when assisting. the chairs. 7. Allow the person to rest and check again for injuries. Seek medical help if needed. 21 22

Getting help: When to call an ambulance Your action plan Some falls may be minor and only result in bruises and cuts, but more severe falls are medical emergencies. Here is how to identify a severe fall: It is important to have a Help Action Plan in place so that in case of an emergency, you – and your family, helper, spouse and neighbours – know what to do and you • If the person who has fallen is unconscious can get help readily. • If there is severe pain • If the person is unable to move Your plan should be two-fold: • If there is difficulty breathing. If breathing stops, start CPR if you are trained 1. Proactive – engaging your family, friends and neighbours about the importance • If there is fluid or blood from the nose, ears or mouth of fall safety • If the fall involves injury to the head, neck, back, hip or thighs Engage your support group • Speak to your family, friends and neighbours about how they can help Call 995 if any of these situations should happen. While waiting for help, do not you in case of a fall and ask if they can be your emergency contact/help move the person but keep the person warm with a blanket or towel. • Leave your emergency contact number with your neighbour/s so they can contact your designated family member or friend • Leave a copy of your keys with family members or a trusted neighbour so Medical service providers – they can get into your house in an emergency Fall prevention/assessment 2. Reactive – knowing what to do in the event of a fall 1. Falls Service 6. Help Action Plan: Raising the alarm Tel: 6476 8828 Internal Medicine Centre • If someone is at home with you, call out for help www.alexhosp.com.sg (Geriatric Medicine) • If you are alone, try crawling to a phone. Have phones placed in accessible Tel : 6311 1111 2. AgeWELL Seniors Clinic www.rafflesmedicalgroup.com.sg places in areas such as the bathroom, the kitchen or the bedroom Tel :6258 9792 • Activate your personal alarm, sound a help bell or similar device that can www.agewell.com.sg 7. Singapore General Hospital alert your helper, family members or even neighbours to your situation Mobility and Falls Clinic 3. Changi General Hospital Tel: 6321-4377 Geriatric Centre www.sgh.com.sg Fall Assessment Clinic Tel : 6850 3333 8. www.cgh.com.sg Geriatric Medicine Clinic/ Falls and Balance Clinic 4. Hua Mei Seniors Clinic Tel : 6357 8013 Tel: 6593-9530 www.ttsh.com.sg www.tsaofoundation.org

5. National University of Singapore Falls and Balance Clinic Tel : 6772-5733 www.nuh.com.sg

The publisher does not endorse the service providers listed here and does not accept responsibility or liability for the quality of the services listed here.