There is an old saying, “Pride goeth before a fall,” that still rings true today. Its truth lies in the false notion that people generally believe that a fall won’t happen to them. The fact of the matter is that everyone is susceptible to a fall regardless of his/her age. Although persons of all ages do fall at one time or another in their lives, the elderly are more likely to become victims. According to Health Canada, approximately one in three persons over the age of 65 will suffer a fall this year.1 Why are the elderly particularly at risk for falls? What can be done to prevent such falls? This article responds to these two questions in the hope that falls by the elderly can be avoided as much as possible.

CHRs at the AGM Training Session learn and practice interactive games and movements to utilize with the elderly

Why are the elderly particularly at risk for falls?

To answer this question, one must consider what happens to the body as it ages. The book, “Prescription for Nutritional Healing” describes the physical state that older adults find themselves in as follows:

“Older adults are more likely to have weak muscles, poor vision, weaker legs, decreased sensation, or other medical conditions that make them more likely to fall easily and with more troublesome consequences.”2

The authors further explain that older persons are more likely than younger persons to take prescription medication, some of which can slow reflexes, decrease perception and/or impair mobility. All of these factors combined increase the danger of injury from an accidental fall. Hip fractures are the most common injury resulting from a fall.3 Recovery by older adults usually takes longer than for those who are younger, and this can lead to added complications such as bedsores, further muscle weakness and susceptibility to infection.4

What can be done to prevent such falls?

One of the best defenses against such possible hazards that accompany aging is exercise. Importantly, the level of exercise must be set appropriately to the health of the senior. Not only does exercise maintain strength and coordination, but this combination is one of the best defenses against accidental injuries. Benefits to the overall body are numerous and include: increased strength of heart muscle, increased blood flow to some organs, increased endurance, improved overall breathing and blood flow, decreased blood pressure, increased joint flexibility and strength, decreased vulnerability to bone fractures, improved digestion and excretion, increased bladder control, improved or maintained elasticity of the lungs, chest, ribs and diaphragm, improved circulation of air in the lungs, strengthened breathing muscles, maintained number and function of sweat glands, and the slowing down of the drying of the skin.5

CHRs helping each other learn safe movements for frail elderly

Before an older adult begins an exercise program, it is strongly advised that the senior approach his/her doctor with a physical copy of the exercise program to ask whether it is appropriate to his/her health condition, if and how it can be streamlined to a safe level, and whether there will be possible side effects of any medications that are being taken.

This is just the first step that the elderly can take to prevent falls and to be in a position to live a better quality of life in what should be their glorious golden years!

The following article describes a project on ‘falls and the elderly’ currently being undertaken by the University of Ottawa. It has a national scope and its findings will certainly shed light on the serious and complex issue of falls and the elderly.

1 Health Canada/Veterans Affairs Canada. Falls Prevention Initiative. Retrieved from: http://www.hc-sc.gc.ca/seniors-aines/ July 14, 2003.
2 Balch, P.A. and J.F. Balch. Prescription for Nutritional Healing. New York, N.Y.: Avery Publishing: 2000, p. 138.
3 National Center for Injury Prevention and Control. Falls and Hip Fractures Among Older Adults. Retrieved from: http://www.cdc.gov.ncipc/factsheets/falls.htm July 14, 2003.
4 Balch, P.A. and J.F. Balch. Prescription for Nutritional Healing. New York, N.Y.: Avery Publishing: 2000, p. 138.
5 Wagorn, Y. et al. Healthy Happy Aging. Burnstown, N.Y.: The General Store Publishing House Inc.:1991, pp 18-41.

Two elders enjoying the Pow Wow, Kahnawake, Que., 2003

Seniors have much to give to our communities, and we want them to be healthy and independent in the community for as long as possible. Falls are one of the most dangerous events that can happen to older adults. Falls are the number one cause of injury for all age groups both on and off reserve, ahead of motor vehicle accidents. Although data on reserve is lacking, work done among Saskatchewan First Nations seniors attributed some 60 per cent of admissions to hospitals to falls. Falls are a cause of death in seven per cent of the B.C. Aboriginal population, ahead of drowning and fire-related deaths, and many of these falls and fall-related injuries can be prevented.

In its 2001 First Nations and Inuit Regional Health Survey, the Assembly of First Nations (AFN) pointed to falls and injuries as an important health concern for First Nations. Health Canada has defined falls in Aboriginal communities as a “priority area of intervention.” Falls are the “number one priority issue among (seniors), and also affect all other age groups.” Although much work has been done on fall prevention in the Canadian population, little is known about priority interventions to help
prevent falls on reserve. The University of Ottawa’s Community Health Research Unit, in partnership with national and regional
Aboriginal organizations, has launched a pilot project to bring awareness about fall prevention to Aboriginal communities, and deliver tools to allow them to reduce the risk of falls among
seniors. At the same time, we will be building Aboriginal Capacity for Community-Based Action Research among health professionals on reserves.

As a first step in this pilot project, we invited CHRs and Elders who attended the NIICHRO Coming Full Circle Workshop in Ottawa to participate in one of two focus groups (one for Elders, one for CHRs). We were interested in hearing about their experiences with falls and strategies that have been tried or may be useful in reducing the risk of falls in their communities. All participants provided verbal informed consent to participate. In total, 10 Elders and 10 CHRs participated in the 75-minute sessions. Honoraria ($20) were given to all participants.

Preliminary results indicate that falls are a serious concern on reserve. This belief was expressed by both Elders and CHRs. All the CHRs and Elders were able to describe a fall in their community. Causes that were most often identified in the descriptions of falls were environment hazards, for example, poor stairs, disabling housing, and poor maintenance of icy roads and sidewalks.

Both groups felt that preventing falls will need to be a community-wide initiative involving several community members and groups, including home and community care workers, CHRs, community nurses, band council, carpenters, and home inspectors to name a few. Further, CHRs expressed that they were the group responsible for taking a leadership role in preventing falls on reserve.

Some of the next steps for the project are to work, using a participatory approach, with national, provincial, and community level advisors to develop tools and strategies to mobilize First Nations communities to prevent falls.

Steps that you can take to prevent falls among seniors in your community are to:

-ensure that sidewalks and walkways are free from cracks and holes
-ensure that walkways/driveways are free from ice and snow
-ensure that there is proper lighting in and outside the home
-ensure that stairs and ramps have handrails on both sides, are not slippery, have good lighting, and that step edges are marked or painted with a contrasting color
-help seniors to have grab bars installed in their bathrooms, near the toilet and in the bathtub
-help seniors to fall-proof their home, for example remove scatter rugs and clutter
-encourage Elders and seniors to do
balance and strength exercises
-encourage seniors to have their medication reviewed on a regular basis
-encourage seniors to have their eyes checked regularly

What has been done to reduce the risk of falls in your community? If you would like to share your experiences of falls or tell us what your community is doing to prevent falls, please e-mail Sabrina Farmer at sfarmer@mail.health.uottawa.ca or call (613) 562-5800, ext. 8513. For more information go to www.otworks.ca.