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and restricting bi and multi focal use.
Also, older people should be careful
when changing spectacles and make
sure there is not a huge change in the
5. FLOOR SURFACES
"The latest research on this topic is about
the type of surface a person might fall
onto. In Canada, researchers are working
to find a floor surface that will actually
absorb the force of a fall so, for example, a
person won't fracture their hip when they
fall and hit the ground.
The surface they are looking at is
firm, supported by cylindrical rubber
legs that deform when a person falls
on the surface. Experimental studies
show the flooring surface is sufficiently
compliant to stop a fracture and
relatively firm enough to walk on.
It's expensive though and there are
just a few demonstration trials being
undertaken in Canada.
The other main intervention is hip
protectors...but they are very unpopular
as people don't like wearing them. Some
randomised control trial results have
found that, as there is poor adherence,
they don't prevent fractures overall.
The slipperiness of floors is a big issue,
particularly wet tiles. Researchers are
trying to work with manufacturers of
surfaces to create optimal floor coverings."
"What you typically think is a sensible or
sturdy shoe -- that's what the evidence
shows to be true. Firm fitting, low heeled
shoes with tread around the back of
the heel are the optimal type of shoe
to reduce the risk of falls. The least
optimal are women's high heel shoes
and poorly designed slippers. But that is
What is more important in relation
to falls prevention however is foot care.
Painful and misshapen feet (bunions,
hammer toes) are a big predictor of falls
and it's possible to address that with a
"The old rule of thumb is that it is
dangerous for an older person to be on
more than four types of medication. But
it's quite possible to be on more than four
medications at a time as long as they are
being appropriately prescribed for the
person's condition with no or minimal side
effects or drug interactions. So, it's not so
much the amount of drugs that a person
is on but that the prescribing GP must
have a good rationale for all the drugs to
be in place.
Every study that has looked at the use
of psychotropic medications also shows
they increase the risk of falls by almost
double...But research shows about 20 per
cent of older people are on psychoactive
agents. So the issue here really is to try
to avoid starting people on them, as it is
very hard to withdraw them once they've
started. Restriction is a good idea and
withdrawals need to be done carefully."
8. NEW TECHNOLOGIES
"There are a lot of new technologies but
not a lot of definitive results about them.
NeURA is working with Phillips to try
and develop a device that a person can
wear at home which will detect if they are
becoming unstable and at risk of falls.
There is also research to devise
specific exercise programs that are
appropriate and fun for older people
using technologies like the step mats and
Connect programs. These programs might
well be the answer for some people who
like to exercise alone."
"There is not a lot of new research in this
area as things haven't changed much.
For example, low-low beds are still
appropriate for use in hospital.
But the main thing in this area is the
research around home modifications.
"The most effective intervention to
reduce the risk of a fall is not just to put
up grab rails but to modify a person's
living environment using the skills and
experience of an occupational therapist
(OT). OTs will not only consider an
environment change but watch how the
person transfers around the house, and
will ensure the individual safely transfers
around the home."
10. WHY DON'T WE FALL?
"Research at NeuRA and other institutions
has shown that to stand and walk steadily,
we continually use sensory information
from the eyes and inner ear, as well as
sensory inputs from the muscles and limbs
that inform us about our body position
We need to have sufficient strength,
particularly for the hip, knee and ankle
muscle groups to provide a stable posture;
adequate reaction time to correct our
balance if we lose it, or are knocked off
balance; good overall balance control over
our very small base of support as we stand,
turn and walk; an intact central nervous
system to integrate all these sensory and
motor components; and sound cognitive
function to plan movements and cope with
distractions if they occur.
This all seems 'automatic' to most
people but age-related changes impair
all of the above, putting older people
at risk of falls. However, interventions
addressing these fall risk factors can
reduce fall risk significantly." n
AAA | JULY -- AUGUST 2012 | 57
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