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Falls and Injury Prevention

Falls and Fractures

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Osteoporotic bones are fragile and porous and more prone to breaking than normal healthy bones. Osteoporotic fractures can occur in any part of the skeleton but are most common at the wrist, spine and hip. There is a lot of pain and morbidity associated with all fractures, but it is the hip fracture that is the most devastating of all. Hip fracture is the most common reason of the permanent loss of elderly people's independence.   

Fractures of the hip are common injuries in older and elderly people, who have weakened bones and low muscle mass.  In the frail elderly people, the thinned muscle lining around the hips leaves the bony area exposed and unprotected from the effects of common traumas, such as falling, slipping or tripping. Many hip fractures result from a sideway fall, which subjects the greater trochanteric area of the proximal femur to the force of the impact. 

Hip Fracture Prevention Strategies include the following preventive actions:

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Prevention and treatment of osteoporosis

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Prevention of falls

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Protection of hip injury site by external hip protectors   

 Hip fractures are most commonly sustained during a fall.

The fracture can happen in the area of the femoral neck or in the trochanteric area. The hip can be best described as a ball and socket joint. The socket is located in the pelvis and the ball is the head of the femur - the thigh bone.  The area of the thigh bone at its upper end is called the greater trochanter. You can feel it moving, when you place your fingertips on the side of your hip, while slightly raising your knee. The neck of the femur is between the ball and the greater trochanter. Hip fractures occur in the area of the femoral neck or in the area just below the femoral neck called the trochanteric area.

The trochanteric area is the most vulnerable to fracture. It lies at the very top of the thigh bone in close proximity to the pelvic joint. The trochanter feels like a small bony elevation on the side of the hip. This ball will notably move, when the knee is slightly raised. Most people can identify their trochanter by placing the fingers on the side of the hip whilst standing and slightly raising their knee. The trochanter should not be confused with the pelvic bone that is located higher and further towards the front of the body and does not move on raising the knee.                                                                                                                                                    

There are many factors that play a role in sustaining a hip fracture. Amongst these are falls. 

Falls prevention

Although anyone can fall, the risk of falling increases with age. This may be due to age related health factors like impaired eyesight, compromised lower body strength, impaired mobility, poor balance and body agility. Risk of falls can also be caused by medication, especially if taking 4 or more different medicines or simply due to an unsafe living environment. Effects of falls in elderly people can be very serious. Falls prevention is an important primary activity - however, all falls cannot be prevented and despite all efforts, elderly people continue to fall! Protecting the most vulnerable sites of the body from the impact of the falls should therefore be a serious consideration and an integral part of care standards.  

As most falls occur at home, everyone – especially older or elderly people - should ensure that their home is safe and the likelihood of accidentally falling is reduced. Health advice should be also be considered and followed.  

General tips to reduce the risk of falling at home: 

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Ensure good lighting to avoid tripping over items not easily seen. Lights should be places in all bedrooms as well as in halls, bathrooms and kitchens. Using self-adhesive non-skid mats and safety treads in showers, bathrooms and even bathtubs is most helpful!

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Install a night-light to help you find light switches during the night.

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Remove all clutter from the floors and place handrails in bathrooms and toilets and on staircases. Two sided rails provide the most effective support. Consider attaching safety treads to steps. If you have bare floors and use mats, always use non-skid pads underneath the mats to prevent accidental skidding.  

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Do not store items in high places – such as high kitchen cupboards or top surfaces of wardrobes – steps and ladders can be very unstable. Avoid climbing ladders, chairs or stools when alone!

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Remove rugs from the floor or fasten them permanently with specific attention given to any loose ends. 

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Do not leave telephone or electric cables and cords lying on the floor. Tie them with a tape and tuck them safely away from the proximity of walking areas.

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Wear shoes with non-slip soles. Avoid loose-fitting slippers that can cause tripping. Always tie shoe laces securely.

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If you live alone - ask your friends or relatives to check on you regularly.

Important common sense advice:

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Have a regular eye checks – poor eyesight can cause you to trip or slip and fall.   

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Kip fit by exercising regularly. Exercise will help to maintain the strength of your muscles and bones.

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Wear shoes and slippers that are well fitting, securely fastened and comfortable.

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Keep your feet healthy and pain free – get rid of hard skin, calluses and corns – your GP can refer you to a chiropodist or a podiatrist. 

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Use a walking stick when walking – it can help you to be more stable.

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When getting out of bed – take time; sit for a while before standing up – this will help you maintain your balance, which can be lost, if you get up too fast.      

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Ask your doctor about the possible side effects of any medication that you are taking.

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See your doctor if you are experiencing dizziness or fainting.

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Limit alcohol intake.

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Stop smoking.

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Discuss your health concerns with your doctor, a nurse or a health visitor.

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Ask your friends, relatives and neighbours for help. 

Creating a Falls User Information Pathway - an informative poster for healthcare professionals

The poster from Sally-Ann Belward and Margaret Hanson of the Falls Prevention Team at Southampton City PCT aims to give a clear guidance on the provision of helpful and appropriate evidence based information to people at risk of falling and to those who have fallen.

Information given to older people during falls prevention programmes and during rehabilitation of those who have fallen is likely to be better understood and acted upon when supported by written materials. Such written materials should clearly complement verbal advice and reinforce important key messages conveyed. Older people and/or their carers can re-read the materials as required at their own convenience. Professionals involved with the preparation of informative materials should ensure that the written materials and the key messages are standardised across the network to prevent costly duplication and potential confusion.

Currently available educational materials were reviewed for clarity, accuracy, acceptability, availability and cost and subsequently divided into informative resources aiming at 3 main target groups:     

A. General Information - materials that can be given to older people or carers during the first contact with them (i.e. information about falls and creating of safe home environment). 

B. Information to be given to the patients and/or their carers in conjunction with treatment and education sessions on falls prevention (i.e. how to prevent falls and what to do in case of a fall).  

C. Information given with specific diagnoses in addition to the information in the A and B sections as outlined above (i.e. information on postural hypotension, vaso-vagal syncope, osteoporosis, fractured neck of femur).     

The poster lists suitable validated resources and provides information on how/where to obtain them. It is a valuable source of information for all professionals involved with the development of local Falls Care Pathways and Falls Education Plans.

Click here to download pdf file with the poster  'Creating a Falls User Information Pathway'     

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