By Dr Nicholas Altuneg
Did you know that trips and falls are the leading cause of accidental injury in older Australians? In fact, up to one in three people aged 65 and over have a fall at least once per year, with many falling more. This risk is higher again in people aged 85 and over, and increases further for residents in aged care facilities, where staggeringly, half of all residents are falling at least once a year.
A fall is defined as an unexpected event in which the person comes to rest on the ground or floor. Due to the frequency of falls occurring, we often dismiss them as a minor thing, but the impact of a serious fall can be devastating.
Falls in the older population place an emotional, physical, and financial burden on their families. The treatment of injuries from falls also places a strain on health and aged care systems in Australia.
People aged 65 and over may never fully recover after a tumble, and the injuries incurred can limit movement, reduce activity, and completely diminish a person’s quality of life.
Even when falls don’t result in injury, they often cause a loss of confidence and lead to an ongoing fear of falling. In a worst case scenario, a fall could lead to a cascade of events leading to death.
The burden from fall–related harm among our elderly is likely to increase unless action is taken. It starts with taking preventative measures.
Identifying and preventing fall risk factors
Active people experience fewer falls. However, there is no evidence that we can prevent falls by simply encouraging older people to be more active. A person’s health status at an older age has usually been influenced by past events and lifestyle choices.
One of the strongest predictors of future falls is past falls. If we can prevent falls from occurring in the first place, then there will be less impact on the person, their families, and the public health system. So, how do we do this?
We can prevent falls by understanding the factors that contribute to them and put safeguards in place to minimise the risk of these factors triggering a fall.
Falls are usually related to the person’s health status and behaviours, or are due to the environmental factors around them.
Factors related to the person include vision impairment, gait and balance deficits, mental status, and use of certain medications. There are potential underlying causes for each of these health states. For example gait and balance can be impaired due to musculoskeletal problems (e.g. arthritis) peripheral neuropathy (e.g. caused by diabetes), neurological disorders such as Parkinson’s disease and impairments cause by previous stroke (could cause confusion, disorientation, and agitation).
Environmental factors such as home hazards (unexpected obstacles), environmental hazards (uneven ground), poor vision or poor footwear need to be observed, removed, replaced, or adapted so that the risk of a fall is reduced. Environmental factors are shown to be an increased fall risk in combination with frailty and other health factors.
Optimise vision to reduce accidents from happening
Poor vision is an established risk factor for falls. Reduced fields of vision, contrast sensitivity, depth perception and poor visual acuity all increase the risk of falls, with poor visual acuity having been found to double the risk of having a fall.
An assessment by an Optometrist and provision of appropriate vision correction will significantly reduce the risk of a fall occurring. Assessment of vision should be the first thing to check because correcting vision will have one of the biggest impacts on fall risk in one of the smallest time frames.
Reduced vision is most often caused by refractive error. Providing glasses or upgrading inappropriate glasses will optimise vision and reduce the risk of falls. Inappropriate glasses may have an outdated prescription or have the wrong design e.g. bifocal, or multifocal glasses can make it harder to assess obstacles, judge the height of stairs or limit peripheral vision making a fall more likely.
Vision could also be compromised by eye diseases such as cataract, macular degeneration, glaucoma, or diabetic retinopathy. In these cases, the condition needs to be treated prior to assessing the suitability of spectacle correction to provide the optical outcome required.
Ways to reduce the risk of falling as we age
The best way to reduce the risk around falling is to have a good team of health and allied health professionals assessing and preventatively treating the risk factors for falls before they occur.
- A check up with the GP to manage general health conditions and ensure that the right medications are prescribed
- A thorough eye health check up with an Optometrist to check on the health of the eyes, to prevent sight threatening eye diseases or as a minimum prescribe an up to date prescription and appropriate glasses
- Check up with a podiatrist, occupational therapist, physiotherapist or chiropractor to assess and treat issues with gait and balance
- Certain exercise programs either at home or at the gym which include balance retraining and muscle strength
- Home hazard assessment and modification that is professionally prescribed (such as by an occupational therapist) among older people at high risk of falls or with severe visual impairment.
Falls are a significant threat to the quality of life of the elderly and their families. With professional help, most falls can be prevented, and a person’s risk of injury can be reduced. With motivation, healthy habits, and an awareness of how to reduce risk, we can all play our part in preventing older people from having a fall.
This article is intended to promote understanding of and knowledge about general eye health topics. It should not be used as a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your health care professional prior to incorporating this as part of your health regimen.
Dr Nicholas Altuneg is an Optometrist who has been working on the Central Coast for almost 30 years. He is the co–founder at Eyes by Design, which is in the Kincumber Centre. Appointments can be made by phone 4369 8169 or online at www.eyesbydesign.com.au