Renowned radiologist, Dr. Bhavin Jankharia, recently published a blog post on Atmasvasth, chronicling his personal journey towards achieving a long and healthy life. While the article predominantly focuses on home falls and preventive measures, we acknowledge that individuals predominantly restricted to beds either at home or in hospitals also encounter an increased risk of falling. Our strategies for fall prevention include the implementation of pressure mats that generate alerts, with the goal of mitigating the risk of potential falls.
The original article is available here and is reproduced verbatim with the permission of the author.
In June 2021, I wrote why it is extremely important that we don’t fall. Falls can cause fractures, which then start a downslide that often leads to an accelerated reduction of healthspan and lifespan. Falls may also lead to a lack of confidence, which can then lead to reduced mobility and spiral into mental and physical deterioration.
In the first edition of the Atmasvasth book, in the detailed 15-point guide, these are my recommendations related to falls.
Do not fall (improve balance, take care not to fall) daily Access frailty yearly
- Physical activity and strength training improve muscle and bone strenght.
- Yoga or tai-chi or exercises help improve balance.
- Using walking aids like canes and walkers are double-edged swords – use them only if they can be monitored and only if absolutely necessary.
- Make sure you can see and hear well.
- Improve your household, building and other environment factors to minimize falls… in effect, fall-proof your home and surroundings.
- Assess and manage frailty.
Of all these factors, physical activity and strength training have the best evidence for preventing falls, especially for those at high risk for falls or those who have already had one fall. Exercise also helps with other parameters of health and should necessarily be a part of daily life, more, the older you get.What I haven’t discussed in any detail is the the 5th point, i.e. addressing environmental hazards that can lead to falls, specifically those at home.
A Cochrane analysis of multiple studies, in 2023 [1] has shown that home fall-hazard reduction interventions significantly reduce the risk of falling and rate of falls in elderly individuals. In effect, the more falls-proof the house is, the less is the chance of falls.
Interestingly in September 2023, a study was published out of Kerala on a similar topic [2] where the authors visited the homes of the elderly who had a history of falls. This is what they have said in the abstract,
show quoted text –
I asked ChatGPT to create an exhaustive summary of measures that can be taken to reduce the risk of falls at home. Here is the list.
Floor Safety:
- Remove throw rugs or use rugs with non-skid backing to prevent slipping.
- Keep floors free of clutter, including pet toys, books, and other small objects.
- Clean up spills immediately to prevent slipping.
- Avoid waxing or polishing floors to a high gloss.
Furniture Arrangement:
- Arrange furniture to create clear walking pathways.
- Ensure that furniture is stable and without sharp corners to avoid injury if someone does fall.
Bathroom Safety:
- Install grab bars in the shower, tub, and near the toilet.
- Use a non-slip bath mat in the shower or tub.
- Consider a shower chair or bench if standing in the shower is difficult.
Stair Safety:
- Ensure that stairs are well-lit and have handrails on both sides.
- Keep stairs clear of objects.
- Consider marking the edges of steps with brightly colored tape to make them more visible.
Lighting:
- Improve lighting throughout the home, especially at the top and bottom of stairs, in hallways, and in entryways.
- Replace burnt-out light bulbs promptly.
- Install light switches at both ends of hallways and staircases.
Cords and Cables:
- Keep electrical and phone cords out of walkways.
- Use cord organizers to keep cords against walls and away from walking paths.
Kitchen Safety:
- Store heavy objects at waist level to avoid the need for stooping or reaching high.
- Clean up any spills on the floor immediately to prevent slipping.
- Use a sturdy step stool with a handrail when you need to reach high places.
Doorway/Thresholds:
- Ensure that thresholds are even and not raised. If they are raised, consider ramps or beveled edge strips.
- Remove doors or maintain them fully open if they impede safe passage or wheelchair access.
Footwear:
- Encourage wearing supportive, non-slip shoes indoors rather than walking in socks or slippers.
Emergency Preparedness:
- Keep a phone within easy reach in case of a fall to call for help. Consider a wearable emergency call button.
General Maintenance:
- Repair loose floorboards or carpeting immediately.
- Ensure outdoor areas are also well-lit and free from debris that could cause tripping.
Even though most of these measures are common sense, it is a good idea to get an occupational therapist or physiotherapist to check the house once to identify potential hazards that can cause falls and then help with measures to address these issues to prevent falls. In Mumbai, I could find one company, Zealver that provides home falls risk assessment, but I am sure others exist, though I have not been able to identify specific individuals or entities who do this professionally, on a regular basis.
What does this mean for you and I? In our atmasvasth quest to live long, healthy, it is important we do not fall. Exercise that includes strength training and balance is probably the best way to prevent falls. Personal measures that include addressing hearing and vision issues and reducing polypharmacy, help too (I will discuss the issue of polypharmacy and falls soon). An important measure to prevent falls, is home fall-hazard reduction, a process that makes homes falls-proof and should be conducted by caregivers or children or whoever looks after the elderly, or by the elderly themselves, in an attempt to reduce the likelihood and the number of falls.
Footnotes
- Lewis SR, Griffin XL. Preventing falls in older people: the evidence for environmental interventions and why history matters. Cochrane Database Syst Rev. 2023 Mar 10;3(3):ED000162.
- Ravindran R, Kutty V. Assessment of Household Environmental Risk Factors for Falls Among Community Dwelling Older Persons in Thiruvananthapuram District of Kerala. MRAJ [Internet]. 2023 [cited 2023 Nov 7];11(9).
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