Appendix 3:How to reduce the risk of falls and fractures – advice for patients

There are various steps people can take to reduce their risk of falling:

1. Exercise

  • It is important to keep physically active, to maintain strength and balance. Regular exercise is essential. Patients should aim for a minimum of 30 minutes of exercise, at least three to four times a week.
  • Weight-bearing exercise, such as walking or dancing can help to maintain bone density and prevent osteoporosis. Strong bones are less likely to fracture if patients do have a fall.
  • Tai Chi has been shown to have a significant reduction in falls in a number of clinical trials as well as having benefits in gait, balance and reducing fear of falling.

2. Diet

  • Eating a healthy diet, with plenty of fresh fruit and vegetables, will help to keep your energy levels high and bones and muscles strong.
  • Calcium is very importantfor maintaining strong bones. The recommended intake of calcium is at least 700mg a day. This is about equivalent to one pint of milk. Calcium can also be found in a number of different foods, including green leafy vegetables, dried fruit, tofu and yoghurt.
  • Vitamin D is also important for bones and teeth as it helps the body to absorb calcium. Vitamin D can be found in eggs, milk and oily fish. Sunlight triggers the production of vitamin D so encourage patents to enjoy some time in the sun but remind them to use a high factor sun lotion.
  • Advise patients to eat regularly to keep blood sugar levels steady. Four or five small meals are much better than one or two big ones with long gaps in between. People are more likely to fall when they are tired. Starchy foods like pasta and wholemeal bread provide sustained energy, which is much better than the 'quick fix' of a sugary snack.

3. Lifestyle

  • Alcohol can impair balance and can also increase the risk of osteoporosis therefore advise patients to limit their alcohol consumption. The recommended dailylimit is three to four units of alcoholfor men and two to three units for women.
  • Encourage patients to stop smoking: cigarette smoking is associated with an increased risk of osteoporosis

4. Home Hazards

Advise patients to:

  • mop up spills straight away,
  • remove clutter, trailing wires, and frayed carpet,
  • use non-slip mats and rugs,
  • use high wattage bulbs in lights and torches so that you can see clearly, make sure that halls and stairs in particular are brightly lit
  • organise your home so that climbing, stretching, and bending are kept to a minimum, and so that you do not bump into things,
  • get help to do things that you cannot do safely,
  • do not walk on slippery floors in socks or tights, and
  • avoid wearing loose-fitting, trailing clothes that might trip you up.

5. Personal care

  • Vision: advise patients to have their eyes tested regularly and wear their glasses if they need them.
  • Feet.: a regular visit to the chiropodist to deal with problems like corns, bunions and verrucas is important. Ensure that patients wear shoes that fit properly: floppy slippers and sandals, backless shoes and very high heels can all contribute to falls.
  • Ears and hearing are closely involved with balance. Ear infections can upset your balance, as can a build-up of wax in the ear canals. Advise patients to get prompt attention for these problems.
  • Mobility: If patients have problems with their balance or mobility due to conditions such as arthritis encourage them to make use of hand/grab rails where possible and to use a walking aid such as a frame/walking stick.

Dealing with a fall – advice for patients

Advise patients not to panic and to try and stay calm.
Patients who are hurt/feel unable to get up should follow the REST AND WAIT plan:
1. Try to summon help: use a pendant alarm if you have one, bang on the wall, call out for help, crawl towards your telephone and dial 999 and ask for an ambulance.
2. Move to a soft surface: if you have fallen on a hard floor try to move to a carpeted area.
3. Keep warm: try to reach for something to cover yourself, and try to move out of draughts. You might find it helpful to keep a small blanket hidden in a low cupboard or safely tucked behind some furniture in each room, a small bottle of water will also help prevent dehydration if you have to lie for a long time.
4. Keep moving: do not lie in one place for too long as you may get cold and suffer from pressure sores, roll from side to side and move arms and legs if possible.
Patients who are unhurt and know they are able to get up should follow theUP AND ABOUT plan:
1. Roll onto hands and knees and crawl to a stable piece of furniture such as a bed, stool, or chair without castors.
2. With hands on the support place one foot flat on the floor bending you knee in front of your tummy.
3. Lean forwards, push on your feet and hands until you bring the other foot to be beside the first.
4. Turn and sit on the seat, rest for a while before getting up.
Advise patients that they should see their GP following ALL FALLS even if they have not hurt themselvesbecause all falls are potentially serious and need advice or treatment.