We got a great question this week from one of our RN followers who was wondering- is it possible to prevent injury with our older adults who fall?
Ok, sure, we all know falls are an ongoing problem for our older adults, and can result in countless injuries, cost to the medical system and the individual, and countless after effects which can include of further fear of falling, familial strain, and even subsequent institutionalization.
However, as I watch my toddler falling down and hopping back up twenty times a day without being fazed in the least bit, it makes me realize- there must be some degree of falling “well” (as opposed to having a well padded diaper!). But as an adult, if you are at risk for falling, how do you prevent injury? Is it possible to “learn” how to fall or to “fall well”? And, as clinicians, is this something we are overlooking?
In this article: Prevent the fall, How to Fall, Fall Training, and Fall Injury Prevention Products
Prevent the Fall
Well first and foremost, the most effective way to prevent injury from a fall is to prevent the fall from happening in the first place. This is a concept we are all pretty familiar with, so I won’t labor on, but balance interventions such as perturbation training, stability and strengthening, home modifications, and environmental/behavioral changes can greatly reduce risk of falling. In our seminar and webinar, Home-Based Balance Rehab, we discuss all of the above, their support in the literature, and different programs you can implement with your patients to improve balance, compliance, and reduce falls. We also have some other articles on the topic, if you want to read further, click here.
On the other hand, falls are, by their nature, unpredictable and can’t be planned for! So how, then, to reduce injury from that fall? We can take some tips from “professional fallers” (no, I’m not talking about your home-care patients!). Professionals such as paratroopers, soldiers, martial artists and stunt men and women are all trained in falling techniques that enable them to crumble to the floor without injury.
The Brain Injury Law Center and AARP provides these 5 Tips to Avoid Injury During a Fall, from the pro’s:
1. Protect your head by tucking your chin when falling back or to the side when falling forward
Falling is a major cause of Traumatic Brain Injury (TBI). By turning your head to the side (if falling forwards) or tucking your chin (if falling backwards) you can protect your skull as nest as you can to avoid sustaining a brain injury as you fall.
2. Bend your elbows and knees and fall on the fleshy part of your body
When we sense we are losing our balance, we tend to tense up and become rigid. This often is what will cause injury- falling on locked arms or knees will cause more injuries than staying bent and loose, and attempting to fall on a fleshier part of your body (think back, thighs and butt). By keeping joints bent, you are less likely to land on a crack bones.
3. Shift your body weight to land on your side
Spread the impact from the ground onto the larger area on your side, if possible. With bent arms and legs, you may also be able to use your hands and thighs to brace your fall, leading to less injury then a fixed hip or wrist fall.
4. Avoid rigidity and don’t panic. Instead, loosen up as you fall
Panicking and tensing up, or trying to grab movable objects, could in fact worsen your injury as you will fall in an even more “unnatural” pattern. Counter-intuitively, ‘relaxing’ into the fall is a better technique to prevent injury
.5. Don’t fight the fall- relax and roll with it
Although it may feel counterintuitive, once you have begun to fall, the best thing to do is to keep going. The more you roll with the fall, the more you can spread impact throughout your body as opposed to one area, which will reduce the chance of injury.
Fall training: “Falling Well”
With so many adults so frightened of falling, however, the above tips for falling may be difficult to effectively incorporate into training and rehab. After all, it would require practicing falling, right?!
Well, that’s exactly what a great Dutch program, reported here in the New York Times does. The Vallen Verleden Tijd course (“Falling is in the Past”) is having their seniors do. This course, along with hundreds of similar ones, is being taught by Physical and Occupational Therapists across the Netherlands.
One aspect of the course is an obstacle terrain, with loose-tile simulations, sloping ramps, curled rugs and blankets. Seniors walk and re-walk along the obstacles to build their confidence. The courses have been specially devised to teach seniors how to navigate tricky grounds, without fear of falling- and how to fall if they lost their step.
The other aspect of the course is reserved for the actual falls. The students approach soft mats slowly, lowering themselves down at first. Over a period of several weeks they learn to fall correctly onto the foot-thick mats. Learning how to ‘fall well’ is also a powerful fear of falling reducer- fear of falling being strongly correlated with an increased risk of falling.
Products to prevent injury
The last word we will address here with regards to preventing an injury when falling, are products designed to protect the person during a fall. Hip protectors, a form of clothing with protective pads around the hip and trochanter regions has been clinically shown to be very effective in reducing hip fracture in those who fall, according to a large study by Korall et. al in 2019. Hip Protectors were worn in 2108 of 3520 recorded falls over the course of a 12 month cohort study, and fracture rates for thiose wearing hip protectors were 0.33 per 100 falls compared to 0.92 per 100 falls in those who did not wear hip protectors. In other words, wearing hip protectors reduced injury to the hip 3-fold.
However, the compliance rate for hip protectors is low across seniors and institutions; and they do not, of course, protect other regions vulnerable during a fall; therefore though they are a great intervention for some situations, they should not be used as a catch-all to prevent injury during falls!
Preventing injuries during falls is an area I believe we can definitely make a positive difference in as clinicians. Including education about falls outside of traditional balance training, like how to fall ‘well’, reduction of fear of falling, education about products that may break the fall and so on, could mean the difference between a devastating injury or a harmless fall!
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