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Reducing the Risk and Effects of Falls

Kevin Doughty
Centre for Usable Home Technology
University of York
United Kingdom
e-mail: dr.k.doughty@btinternet.com

Mobility problems, ranging from frequent falls to difficulties standing up or of walking further than a few yards, affect millions of elderly Americans. Sometimes, falls lead to no more than a few scrapes or bruises and damaged pride, but often also lead to serious complications requiring long-term treatment, especially where a fracture of the hip has occurred. Nine out of ten hip fractures, for example, occur in people over 50 - and 80 percent of them women. For people who live alone, a fall can lead to a major loss of confidence, irrespective of any injuries that may be suffered. The prospect of lying helpless on the floor for hours can force someone to give up their home in order to move into an Assisted Living facility or a nursing home.

There are many possible causes for a fall. Most people have one or more risk factors that make them likely candidates. As they get older, the chances of experiencing a fall within the home rather than outside increase quite rapidly. The percentage of fallers with the top 7 risk factors are shown in Figure 1. They range from poor eyesight (which often means walking around without wearing spectacles) and which is relevant in 12% of falls, through to poor balance which is likely in the vast majority of cases. By addressing some of these risks, the likelihood of experiencing a fall that could change a person’s life can be greatly reduced, but there are currently few sources of information that can help people understand their own risks, and modify their behaviour.

Figure 1: Risks Associated with Falls in Older People

In the UK, older people who fall and who are taken to the Accident and Emergency Department are often referred to a Falls Clinic, especially if it is their second or third visit within a year. They will be assessed to find out why they fell so that interventions can be offered, including training on how to get up from the floor unaided if they aren’t injured. Their home environment will also be surveyed to identify trip and fall hazards. These include poorly defined steps, worn carpets and trip hazards such as electrical or telephone wires, and a long and difficult-to-navigate path to the door to admit visitors.

A more significant part of the Falls Prevention programme is the use of telecare, which in the UK now includes any electronic device that helps to support someone living independently. The three most popular items of telecare are:

• Automatic lights – a plug-in light source which automatically switches on when movement is detected during the hours of darkness. These sell at under $10.
• Wirefree telephones – these help to avoid the clutter of wires, especially around the chair of the individual. There are dozens of different models available at less than $100.
• Video doorbells – a camera at the front door allows the older person to view who is at the door without having to rush out to answer it. Models starts at about $75.

When people live alone, telecare can also ensure that a fall can be detected quickly by the use of sensor devices that link into a Personal Emergency Response System. Worn devices have been used for 10 years and have been successful in identifying design faults and weaknesses in the way that people react to them. The most successful approaches involve bed use sensors or virtual sensor combinations that allow the occupancy of a room to be determined. In each case, an alarm may be generated if occupancy defies a set of programmed rules. Evaluations have shown that people feel more confident when they have a telecare system in place. Family members also feel less anxious knowing that the telecare devices are effectively an electronic safety blanket around their loved ones.

Back to Falls Among the Elderly: Key is Prevention, Not Detection