Notes from the Neuro Café 22nd September 2021 by Conor
In recognition of falls awareness week, the focus of the Neuro Café was falls. Conor opened the discussion with the question:
Why do falls occur?
Our bodies are intricate and our ability to remain upright depends on a complex range of systems working together. Our eyesight, hearing, muscle strength and balance are some of the body’s functions that keep us standing but there are external factors that can impact us as well including, medication, infections, poor footwear and environmental hazards.
This video describes falls prevention like a 'fuel tank' and is well worth a watch:
Falls Checklist: things to think about
There are many reasons for falls. t can be helpful to think of a checklist around situations that you will have come across day to day. This will highlight areas that can then be adapted going forwards:
Have you fallen in the past year? Think about the reasons for the fall. The questions below can help focus on those important areas.
Have you been advised to use a stick or frame? People who have been advised to use a cane or walker may have reduced balance - but an aid can decrease the risk of falling.
Do you feel unsteady when walking?
Unsteadiness or needing support while walking are signs of poor balance and can be early predictors of falls. Has this been highlighted to your GP or physiotherapist?
Do you hold onto the furniture at home when walking?
This is a sign of reduced balance - exercise, such as a strengthening programme, or class, will help. A walking aid as prescribed by a health care professional could also assist.
Are you worried about falling?
Being fearful of falling can have a big impact on confidence. This can lead to reduced independence and activity, leading to further weakness and reduced balance. This cycle can be stopped by looking at the reason for the falls, discussing it with your physiotherapist and coming up with strategies to increase your confidence.
Can you get out of a chair without using your hands? Do you have trouble going up and down kerbs?
Both situations indicate lower limb strength, if you have to use your hands when standing from a chair or have difficulties stepping up a kerb, this is a sign of reduced muscle power, which can contribute to falls. A strengthening exercise programme will combat this.
Do you have to rush to the toilet?
Rushing whilst walking, particularly at night, can significantly increase your risk of falling. If you suffer from incontinence this can can cause you to rush or feel distracted when walking. Both can be indicators of falls. Discuss any issues with incontinence with your doctor.
Do you have reduced sensation in your feet?
Numbness in your feet can cause trips or stumbles and lead to falls. Think about the footwear you use. Additionally if this a new symptom for you, contact your doctor.
Do you take medicine that sometimes makes you feel light-headed or more tired than usual? Side effects from medicines can sometimes increase your chance of falling, additionally if you are taking a lot of different medications this can cause side effects, it is important to discuss these with your doctor. Never stop taking a medication without consulting with your doctor.
Do you experience light headedness or a drop in blood pressure when changing position such as sitting to standing (postural drop)?
This maybe worse in the mornings, or when you have been in a position for a sustained amount of time. Light headedness or dizziness caused by postural drop is a falls risk. Discuss your symptoms with your doctor, you may need a change in your medication. Taking your time and pausing between each change in posture can also help. Do you take medication to help you sleep or improve your mood? These medicines can sometimes increase your chance of falling, again look out for side effects such as drowsiness. Discuss any side effects with your doctor. Do you feel depressed or low? As with fear of falling, depression or low mood can be a contributing factor to falls, as often people with low mood can be less active and more sedentary. Subsequently we can become weaker and this contributes to falls.
Do you have issues with your vision?
A simple routine eye test could highlight the need for glasses or change in your prescription. We rely on our vision for balance, if this is impaired, it can have an impact on your balance.
Falls prevention is a team effort. If you feel any of the above is applicable to you, discuss these points with your physiotherapist, GP, Neurologist, Nurse, Gym instructor, Support workers/carers or a health care professional. There are many simple changes you can make to reduce your chance of a fall.
Look around your home. Do you have lots of clutter or rugs on the floor that could be a trip hazard? If you need to change the layout of your home, ask for help moving furniture.
Is your lighting optimised? This is particularly important at night, or in the evenings. We rely on our vision for balance, so if your balance is already reduced, walking in the dark will be even more of a challenge. If turning on a light at night is difficult, maybe think about getting a 'night light'.
How have falls affected you in the past?
Some of the LEGS members shared their experiences of how falls have affected them.
One member shared her experience of how they fell after trying to install a light bulb in their house. When they tried to stand up on a table to reach the light bulb they didn’t realise they did not have the strength in their leg and they fell backwards.
LEGS members said that having a fall or the fear of falling made them feel:
- Fearful of falling again - Worried about how they would get up post fall - Embarrassed to ask for help with a task - Afraid to try new things - Afraid to attempt that task again
However LEGS members had some of their own strategies that they have found helpful:
You should always think of the task at hand and is it something that you are capable of carrying out. If the task is difficult don’t be afraid to ask for help or even for someone to assist while you are carrying it out.
Other members have attribute their falls to rushing a task and advised taking your time. Being patient and leaving plenty of time to do a task. You may not be able to do things as fast as you did before, so plan accordingly.
Exercise is a key factor in reducing falls. There are many ways to keep active, here are a couple examples of exercise options in addition to LEGS:
Make Movement Your Mission! (MMYM)
MMYM is a Facebook group dedicated to providing short, live exercise slots daily. With options of seated and standing based exercises to encourage people to "keep moving well, keep moving more". MMYM aims for 10 -15 minutes activity, 3 times a day, at 8am, noon and 4pm. These live sessions are then uploaded to youtube.
Stay Active at Home - Strength and balance exercises for older adults
This is a video from the Chartered Society of Physiotherapy (CSP), expelling some myths around falls and providing some simple exercises. We are sure LEGS members will recognise some of these key exercises!