Do you feel your feet are unstable? What about your parents or someone you know? Even if they are healthy, independent adults may be at greater risk of falling because, for many people, the COVID-19 pandemic and subsequent public health guidelines can unexpectedly reduce a person's overall activities.

According to data from the Ottawa Hospital, although fewer elderly people come to our emergency department (ED), more elderly people come because of falls.

Why? It may be due to reduced activity. For example, some senior citizens choose to pick up or deliver groceries on the roadside instead of walking around in the grocery store. Many social events that could have increased the overall activity were cancelled. Especially for the elderly, less general activities can lead to muscle weakness and poor balance, which in turn leads to more falls.

Based on these trends, the hospital expects that after a fall, more elderly people will come to the emergency room by 2022. This is because as public health restrictions are lifted, older people who have been inactive for the past 18 months will again become more active and more willing to go to the emergency room for treatment after a fall.

Not sure about your fall risk? Use a separate checklist to check your risks.

Falling is not necessarily a normal part of aging. In fact, research shows that many falls can be prevented.

If you are an elderly person or caring for an elderly person, please follow the fall prevention tips below.

Staying active is one of the best ways to prevent falls, because regular physical activity and exercise can improve balance and muscle strength.

Health Canada recommends 150 minutes of moderate to vigorous activity a week, and strength and balance activities at least twice a week. If you have been inactive for a period of time, please gradually increase the activity. Before starting a new exercise program, be sure to talk to your healthcare provider to make sure it is right for you.

Generally speaking, the more drugs you take, the greater the risk of falling.

As you get older, drugs can affect your body in new ways. Carry an up-to-date list of medications with you, and take it with you at home. It is also important to use only one pharmacy so that the pharmacist can know all the medicines you are taking.

Remember to check your medicines (including over-the-counter medicines and natural health products) with your doctor or pharmacist. Ask how alcohol or marijuana affects your medicines and tell them if you are worried about your medicines and their side effects.

Falling can cause serious injuries, such as traumatic brain injury and fractures. They can also cause chronic pain, make it more difficult to move around, and reduce independence. Some falls can cause depression and even death.

A severe fall will make the otherwise healthy person weaker and less active, which in turn will further increase their chance of falling.

50% of falls occur at home, so use the checklist to determine the risk of falls. Scattered carpets, loose railings, insufficient lighting, and cluttered floors are all examples that may increase the chance of falling.

For tasks that you think cannot be done safely, remember to ask for help.

Vision changes with age. It is more difficult for the elderly to judge distance and depth. Depth perception helps us safely go up and down stairs and curbs, so poor depth perception can lead to falls.

If you have multifocal lenses such as bifocal lenses or progressive lenses, please use them with caution, as these lenses increase the risk of falls. The prescription at the bottom of the lens is for reading, not for looking at the ground, so this type of glasses will change the depth perception, causing the wearer to misjudge the height of the steps.

The elderly are also more sensitive to glare, and they need more light to see at night. In fact, 60-year-olds need ten times more light at night than teenagers. Their eyes also need longer time to adapt to sudden changes in light.

How a person’s hearing affects their chances of falling. Studies have found that people with hearing loss are three times more likely to fall than people without hearing loss.

Therefore, remember to perform vision and hearing tests on each ear, and wear any prescribed glasses and hearing aids.

Walkers such as crutches, walkers, or walking poles can help you feel more stable and comfortable, which can help prevent falls. It can also increase your endurance and reduce joint pain.

Here are some questions to ask yourself:

If you answer yes to any of these questions, you may benefit from a mobility aid. Talk to your healthcare provider.

Well-fitting and supportive shoes are a great addition to your wardrobe. They can make you feel more stable and comfortable, protect your feet and reduce the impact on your joints. The best options are closed toes, low heels and non-slip soles.

A smooth surface will greatly increase your risk of falling. Make sure your sidewalks, stairs, and driveways are free of ice and snow. Wear wide, low, non-slip boots before going out. If you use a walking stick, consider adding a retractable ice axe for extra grip. Put a bag of gravel, sand or cat litter in your pocket and sprinkle it on the icy surface when needed.

Check Rate My Treads from the Kite Institute for a list of recommended footwear and anti-slip grades.

If you are concerned about your balance or unstable walking, please tell your healthcare provider. It’s also important to share at any time

They can help determine the possible cause of a fall, and you can make a plan together.

Learn more about what to do after a fall.

Remember, falls are not necessarily a normal part of aging. If you notice a change in your balance, strength, or mobility, please consult your medical team. Taking steps to prevent falls is much better than managing health outcomes after a fall.

The Champlain's Fall Assessment and Simplified Treatment (C-FAST) Clinic at Ottawa Hospital is a clinic for patients who are at risk of falling. Held on Monday and Thursday afternoons, clinic staff usually see about 140 patients each year.

Patients referred to the clinic are evaluated in a three-hour appointment by a senior nurse practitioner, physical therapist, geriatrician, and pharmacist (if needed). During the COVID-19 pandemic, the first part of the assessment is done virtually via phone or secure video chat to shorten the time patients spend in the clinic.   

Patients can expect a "multi-factor" assessment, which means that professionals will look at each patient's fall risk factors in their area of ​​expertise and provide evidence-based recommendations to reduce these factors.

The geriatrician will diagnose and treat any medical problems that may lead to the risk of falling. They may change the patient's medication or perform tests such as blood tests, X-rays, bone mineral density tests, and CT scans. Other suggestions might include using a walking aid (such as a walking aid or cane), using a personal alarm system, or changing footwear.

Clinic staff connect patients with resources to help meet their unique needs, such as community-based exercise programs (virtual or face-to-face) and home safety assessments. The staff also followed up with patients over the phone to understand how well they followed the recommendations and provide more help when needed. Most importantly, the clinic staff hope that all patients will be welcomed and that they can take action to prevent falls and lead a healthy life.

By seeing patients early in the "fall history," the team helped them modify risk factors, which helped reduce the number of falls and fall-related injuries. Avoiding falls means that older people can stay independent for longer and reduce the chances of needing to go to the emergency room or hospital due to fall injuries. 

Family doctors may consider referring their high-risk elderly patients to specialized geriatric service centers for evaluation in C-FAST clinics or other professional programs in the area.

[1] The Public Health Agency of Canada, "The 2014 Fall Report of the Elderly in Canada".

[2] Scott, V. (2012). Fall prevention plan: Design, implement and evaluate a fall prevention plan for the elderly.

[3] Scott, V. (2012). Fall prevention plan: Design, implement and evaluate a fall prevention plan for the elderly.

[4] Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Järvinen M. Most hip fractures are caused by falls and impact on the greater trochanter of the femur: a prospective controlled study of hip fractures in 206 consecutive patients. Calcif Tissue Int, 1999; 65:183-7.

[5] The Public Health Agency of Canada, "The 2014 Fall Report of the Elderly in Canada".

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