Falls Prevention for Older Adults in Tyne and Wear

About a third of people over 65 fall at least once a year. Most falls do no lasting harm, but they change how people live: they go out less, do less, and get weaker, which makes the next fall more likely. The good news is that falls are one of the risks of getting older that respond well to the right kind of exercise.

Why do falls happen?

Hardly ever for one reason. A fall is usually several small things lining up at once, which is why fixing just one of them often is not enough.

• Weak legs — the most common cause, and the most fixable
• Slower balance reactions — so a trip that was once a wobble becomes a fall
• Tablets — blood pressure tablets, sleeping tablets and some antidepressants all add to the risk, and the more tablets, the higher it goes. Ask for a review; do not stop anything yourself.
• Blood pressure dropping when you stand up, which causes falls getting out of a chair or bed
• Eyesight — and varifocal glasses, which blur the edge of a step
• Feet and footwear — painful feet, and slippers with no backs
• The house — rugs, trailing wires, dark stairs, a rail on one side only
• Fear of falling — which makes people walk stiffly and carefully, and stiff, careful walking is less steady

Tyneside housing adds a few of its own. Many older terraces and Tyneside flats have steep, narrow stairs, a step down into the back yard, and an outside step at the front door. None of that has to be a problem, but it needs to be part of the plan.

What actually reduces the risk?

This is one of the best-studied areas of physiotherapy, and the answer is quite specific. Exercise cuts falls, but only the right kind.

What works: programmes that properly challenge balance, combined with strength work for the legs that gets harder over time, done at least twice a week and kept going for months. The balance part has to be genuinely challenging — standing with the feet together or one in front of the other, reaching, turning, stepping in different directions. If it feels easy, it is not training your balance. Tai Chi also has good evidence behind it.

What does not work on its own: walking. Walking is good for lots of things, but it does not build leg strength or train balance, and walking programmes on their own do not cut falls. Gentle seated exercise has the same problem.

A medication review, an eye test, and making the house safer all help as well, and the house works best when someone looks at it in person rather than from a leaflet.

What does a home falls assessment involve?

About an hour, in your own home, looking at three things.

You. Simple tests that give a number to work from: how many times you can stand up from a chair in thirty seconds, how long you can balance with your feet in a line, how long it takes to stand, walk a few steps, turn and sit down again. Plus a look at how you walk, and your blood pressure lying and standing if the falls happen when you get up.

Your house. Room by room. The stairs and the rails, the lighting and where the switches are, the height of the bed and the chair, rugs, thresholds, the bathroom, the back yard step, and the route you take to the toilet at night.

Your life. What you have stopped doing, and what you want to get back to. The plan is built around that, because a plan aimed at nothing in particular does not get done.

What does the exercise look like?

Usually a short daily routine rather than a long weekly one, using things you can do in your kitchen holding the worktop. Standing up from your own chair, heel raises at the sink, stepping practice, standing with your feet closer together and then in a line, and shifting your weight. It gets harder by using less support, a narrower stance and more effort — not simply by doing more.

After six to twelve weeks most people can do measurably more. The chair test is the easiest to watch, and it is usually the first to improve.

What if I have already fallen?

Tell your GP, even if you were not hurt. A fall is the best sign that another may follow, and it should lead to a look at the cause and at your tablets. If you could not get up, or it took a long time, that is worth practising with a physiotherapist — see our guide on how to get up safely after a fall.

NHS falls services work across Tyne and Wear and your GP can refer you. Private home physiotherapy is an option if you would rather not wait, or an extra if you want more visits than the service can offer.

Why home visits suit falls prevention

Falls happen at home, mostly on the stairs, getting out of a chair, or on the way to the toilet at night. A clinic cannot check any of those. Working in the actual rooms, on the actual stairs, with the actual chair, means the plan fits the place the problem lives.

Home visits across Tyne and Wear

Falls prevention checks and strength and balance programmes are available at home across North Shields, Tynemouth, Whitley Bay, Newcastle, Gateshead, South Shields, Sunderland and across Tyne and Wear.

About Steve McLaren

Steve McLaren is a chartered physiotherapist (MCSP, HCPC PH52681) providing home visit physiotherapy across North Shields, Tynemouth, Whitley Bay, Newcastle, Gateshead, South Shields, Sunderland and across Tyne and Wear. He qualified in 1997 and has spent more than 20 years in community rehabilitation, treating people in their own homes. He works in the NHS in Newcastle, in a rapid response team that treats frail older people at home and in the emergency department, and his particular interest is falls prevention. He lives in North Shields.

Read Steve's profile or call 07788 974385.

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