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Breaking the falls


Prime Magazine


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Do you think that having a fall is a minor issue as compared to having a stroke? If your answer is yes, you are wrong – falls are more common than strokes, and can be just as serious in their consequences


Falls are common among those aged 65 and above, and its incidence increases with age.


In Singapore, the prevalence of falls among community dwellers aged 65 years and above stands at 17.2%. Approximately half of these people are likely to suffer a recurrent fall.


Studies have shown that falls are a major cause of hip fractures, especially among women. In Singapore, more than 20% of patients die in the first year after suffering from a hip fracture, while 25% of older persons require a higher level of long-term care after a fracture.


Falls can result in injuries (such as hip fractures), social isolation because of the fear of falling, disability or death. Here’s a piece of good news – falls can be prevented. Falls usually occur due to imbalance. Let us take a look at how we get our sense of balance.


How our balance works


When we rise from a chair, climb stairs and walk outside on uneven terrains, there is also some action going on in our body – cooperation between the brain, nervous system, muscles and bones help to prevent us from falling.


Visual cues: comes from our eyes and tell us all sorts of information about our environment. Our eyes help us see and prepare for potential dangers and obstacles which can prevent falls.


The inner ear: contains a fluid-filled semi-circular canal which gives us important information on the position of our head and its movement in space in relation to gravity.


Internal spatial orientation: tells us where our arms and legs are positioned in space. For example, if you close your eyes and then lift your arm and wave it about your head, you know where your arm is because of this inner sense of feedback.


Visual cues, the inner ear, as well as the internal spatial orientation are essential to gain balance and work together with our musculoskeletal system to prevent falls and imbalance.


When any of these fail to work properly, we lose our sense of balance. The following conditions explains why balance is lost, resulting in falls.


Risk factors




People are often unaware of the frequent link between a broken bone and osteoporosis. Osteoporosis is known as a silent disease because it progresses without symptoms, which involves the gradual loss of bone tissue or bone density. As a result, these bones become so fragile that they break under the slightest strain. For example, people with osteoporosis can break a bone just from a minor fall, such as tripping on a loose rug in the living room.


Consequently, falls are especially dangerous for people who are unaware that they have low bone density. If the patient and the doctor fail to connect the broken bone to osteoporosis, the chance to make a diagnosis with a bone density test and begin a prevention or treatment programme is lost. Bone loss continues, and other bones may also break.


Loss of muscle mass and body fat


As people get older, they lose muscle mass because they have become less active over time.


Loss of muscle mass, especially in the legs, reduces one’s strength to the point where she or he is often unable to get up from a chair without assistance. In addition, as people age, they lose body fat that has cushioned and protected bony areas, such as the hips. This loss of cushioning also affects the soles of the feet, which upsets the person’s ability to balance. The gradual loss of muscle strength (common but not inevitable in older adults), also plays a role in falling. Muscle strengthening exercises can help people regain their balance, level of activity, and alertness regardless of their age.


Changes in vision increase the risk of falling


Diminished vision can be corrected with glasses. However, these glasses are bifocal or trifocal – when the person looks down through the lower half of the glasses, depth perception is altered. This makes it easy to lose one’s balance and fall.


To prevent this from happening, these people must practise looking straight ahead and lowering their head.




Drinking alcoholic beverages also increases the risk of falling. Alcohol slows reflexes and response time; causes dizziness, sleepiness, or lightheadedness; alters balance; and encourages risky behaviours that can lead to falls.




As people get older, they also are more likely to suffer from a variety of chronic medical conditions that often require them to take taking medications. Some medications may increase the risk of falls due to drug-related side effects, such as dizziness, confusion, disorientation, or slowed reflexes. These medicines include blood pressure pills, heart medicine and muscle relaxers.


People with chronic illnesses that affect their circulation, sensation, mobility, or mental alertness are also at risk.


The importance of sunlight


Vitamin D is needed for strong bones and muscles, and it helps the body to absorb calcium. The body makes most of the Vitamin D it needs from direct exposure to sunlight and small amounts from food. The skin’s ability to make Vitamin D reduces after the age of 60. Therefore, older people are more at risk of being deficient in Vitamin D. If you spend more time indoors, it further reduces Vitamin D production. Spending 10 minutes outdoors in the sun for 5-6 days per week will give your body the amount of Vitamin D it needs.


Minimising the risks of a fall


Remove the hazards


Make your home a safer place by removing possible hazards that may result in a fall.


Light up your living space!


Keep your home brightly lit to avoid tripping on objects that are hard to see.


Use assistive devices


You might want to consider getting yourself some assistive aids to help keep you steady. A cane or walker is usually recommended for outdoor use, as well as fixtures of some assistive aids at home such as hand rails, grab bars and non-slip mats.


Reduce bone fragility


Prevent osteoporosis by consuming a calcium-rich diet that provides a 1,000 mg dose of calcium for men daily, as well as women those below the age of 50. Women over age 50 and men over age 70 should increase their intake to 1,200 mg daily from a combination of foods and supplements.


Keep moving!


Physical activity can go a long way toward fall prevention. Activities such as walking, water workouts or tai chi can help to reduce the risk of falls by improving strength, balance, coordination and flexibility.


Source: Prime Magazine Issue Oct-Nov 2015. Reproduced with permission.


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