Project to reduce seniors' risk of falling

Year-long scheme seeks to check problem by referring at-risk old folk to experts early
By Salma Khalik, Senior Health Correspondent, The Straits Times, 3 Jul 2015

Every 32 minutes, an elderly person turns up at a public hospital emergency department because of an injury from a fall. Each month, about 100 seniors find themselves in hospital, staying a week or more because of such injuries.

And already the number of hip fractures among people aged 50 and older treated at public hospitals has gone up from 1,900 in 2004 to 2,500 last year - with half of them involving seniors aged 80 and up.

It is a problem that can only get worse as the population ages, bringing in its wake higher healthcare costs and lower quality of life for those affected, said Ms Gwenda Fong, director (successful ageing) in the Ministry of Health's Ageing Planning Office.

In an effort to curb it, the ministry, together with Khoo Teck Puat Hospital (KTPH), is starting a year-long pilot this week to assess the risk of falling for all seniors living in the north. Anyone judged to be at high or moderate risk will be referred to the relevant experts, such as a doctor or therapist, who will work with the individual to reduce it. The pilot will be adjusted for improvements, and rolled out eventually to the whole country.

One of the most serious consequences of falls that healthcare professionals are hoping to prevent is hip fracture, for which recovery time can be up to 18 months.

Only half will recover fully while one in four "will completely lose (his or her) independence", said Dr Mallya Jagadish Ullal, a senior geriatric consultant at KTPH.

Madam Christine Morton, 66, has had two serious falls in the past two years. The first time, in 2013, she fractured her left hip and was wheelchair-bound for a spell.

Then in March this year, a fellow cleaner at the food court where she works ran into her with a trolley, knocking her to the ground. She suffered several fractures to her right hip. She is now terrified of crowds and moves even more slowly than before.

Two weeks ago, she returned to her job at the food court in Ang Mo Kio Hub, with lighter duties.

The pilot programme comes on top of existing fall prevention efforts by the Health Promotion Board and Agency for Integrated Care. The Housing Board also provides subsidised retrofits to make flats more elderly-friendly with slip-resistant toilet and bathroom tiles, and the addition of grab bars.

Ms Fong said the new programme builds on these, but goes further in identifying individuals at risk and working with them through customised programmes.

About 30 to 40 per cent of falls can be prevented, said Dr Mallya. For example, patients with osteoporosis can be treated for this brittle bone disease so even if they fall, they have a lower risk of fractures.

New test to help assess seniors' risk of falling
Assessment will include questionnaire on medical history, mobility and physical tests
By Salma Khalik, Senior Health Correspondent, The Straits Times, 3 Jul 2015

A new initiative to reduce the number of falls will pose three questions to 12,000 seniors aged 65 years and older living in the north:

•Have you fallen in the past 12 months?

• Do you avoid going out because you are scared of falling?

•Do you feel like you are going to fall when getting up or walking?

If the answer is yes to any question, the person is at least at moderate risk of falls and will be asked to take the Preventive Falls Risk Assessment. Done at one of four centres or even at home, it includes a questionnaire that takes into account an individual's medical history and mobility, and physical tests - for instance, the time taken by a person to get up off a seat, walk to a designated spot, and return to it.

The time this takes is automatically recorded by a cushion on the seat, designed by Ngee Ann Poly-technic's Electrical Engineering Division. The person's blood pressure is also recorded.

Dr Mallya Jagadish Ullal, a senior geriatric consultant at Khoo Teck Puat Hospital (KTPH), said standing up suddenly may result in a big drop in blood pressure that could lead to dizziness and a fall.

The assessment will also review any medication, some of which can make a person drowsy and prone to falls. Other reasons for falls include poor vision, which can be corrected. There can also be contrasting colours in the house to make trip hazards - like steps - easier to spot.

Many elderly people are also deficient in vitamin D, which is needed for bones to absorb calcium.

Dr Mallya said people with dementia or Parkinson's disease are at the highest risk of falling because their minds and bodies are out of step with each other.

Families and caregivers need to realise the importance of removing anything that could be a trip hazard, even rugs. Having grab bars around the house can be a big help.

It was one put in recently that saved Mr Soh Chin Siang, 74, from a fall in the shower when his right knee suddenly gave out.

But one of the most difficult aspects of falling to fix is the fear of falling, said Dr Mallya. About half of older people worry about this because of a previous fall. He said: "Seniors fear falling, so they cut down on their activities. Their muscles get weaker, their balance gets worse, so they have even greater fear of falling."

It is important for people at high risk of falling to boost their muscle strength and improve their sense of balance and flexibility, he said.