Prévention des chutes chez les personnes âgées

People of all ages have falls. In many cases they are caused by a minor accident, and the person comes to no harm. Older people who have falls, however, are likely to have more serious injuries and to fall over again.

Preventing falls at home

Depending on your health and ability, you may find you can do a lot to help yourself. Support is also available from the NHS and social services.

See your doctor

If you have had a fall or feel you are at risk of having falls, you should ask your GP to do a falls risk assessment. This includes a general check-up, for example:

• Pression artérielle.

• Poids.

• Examination of your circulation and lungs.

• Assessment of any risk factors such as arthritis, muscle weakness, poor balance, or any other causes of falls (see below for further information)..

This is carried out to make sure you do not have any conditions likely to increase your risk of falls.

In addition to a general check-up and providing advice about how to reduce the risk of falls, your doctor will be able to:

• Review your medication and make changes if this will help to reduce your risk of falls.

• Offer a comprehensive falls assessment if you are considered at high risk of falls.

• Offer a fall prevention exercise programme.

• Consider an assessment of hazards within your home.

• Offer health and wellbeing information, and advice on physical activity.

Long-term condition risks

If you do have a long-term condition such as diabetes, the doctor will check that this is not causing complications likely to lead to falls. You may need tests to check whether you have any conditions which make it more likely that you will break a bone if you do fall (for example, osteoporosis). The doctor will also check your medication to make sure you are not on any medicines likely to cause problems.

Additional support

Your GP will be able to give you contact details of any other support that is necessary, such as the council or social services. If the doctor finds that your risk of falling is high (for example, if you are an older person who has already had a fall), you may be offered help from a hospital-based falls clinic or local falls prevention service.

Check your home for hazards

Have a look around your home to see whether there is anything that could have caused your fall or would be likely to make you fall in the future. Things that need to be considered include:

• Loose rugs or mats (especially on a slippery floor).

• Electrical leads (trailing across the floor).

• Wet surfaces (especially in the bathroom).

• Mauvais éclairage.

• Furniture which has been poorly placed.

• Objects scattered on the floor - books, papers, shoes.

• Stairs - loose carpets, broken handrails.

• Storage - frequently-used items placed on high shelves, which can only be reached by standing on a chair or stool.

• Making sure that shoes and slippers are comfortable and fit properly.

Community teams working for the local council may be able to fix problems around the home and install handles or rails free of charge.

Take lots of exercise

Keep active and faire de l'exercice as much as you can. This strengthens muscles, keeps joints supple and works the systems in your body which control balance and movement. A physiotherapist may be able to suggest an activity programme but you should take the lead in deciding what sort of exercise you are most comfortable with. For example, some people enjoy attending an exercise class whilst others prefer to take up activities such as dancing, swimming or t'ai chi. Activities which develop muscle strength and balance are particularly helpful.

Mangez sainement

Alimentation saine is important to stop you becoming deficient in vitamins (especially vitamine D), de fer, starchy foods and proteins. Keep up your fluid intake to stop you becoming low in body fluid (dehydrated).

Be sensible about alcohol

You should drink alcohol sensibly. Advice can be found in the separate leaflet called Alcohol and sensible drinking. If you are already at increased risk of falling (for example, if you are an older person who has already had a fall), even moderate drinking can increase your risk of having a fall.

Have your eyes tested regularly

Have your eyes checked every two years, or as often as your optician advises. If you are already having problems with your eyes, get them checked now. People aged 60 or over can have a free eye test.

Causes of falls in older people

There are many reasons why falls happen in older people, such as:

• Hazards in the home.

• Ill-fitting footwear.

• Muscle weakness: this can be due to lack of exercise, a AVC or glandular problems (for example, thyroïde ou adrenal disorders, stéroïde medicines).

• Problems with walking and/or balance.

• Arthrite: painful joints can make you less nimble and want to move around less. Lack of exercise can lead to muscle wasting and weakness.

• Dizzy spells: this can be light-headedness, a feeling that the ground is moving or a feeling that you or the surroundings are spinning.

• Confusion: this can be due to medicines, brain problems such as dementia (see below) or general illnesses such as infections.

• Drop attacks: this describes sudden falls in which there is no loss of consciousness. This can be due to orthostatic hypotension (see below), a mini-stroke (accident ischémique transitoire), or heart problems (for example, fibrillation auriculaire).

• Postural hypotension: this means a sudden drop in blood pressure when you stand up. It usually happens within the first few weeks of starting blood pressure tablets. Occasionally it can be due to a lack of fluid in the body (dehydration) or to a condition affecting the nerve supply to blood vessels (autonomic neuropathy).

• Fainting: this means a loss of consciousness which comes on suddenly and lasts for a short time. It can happen for many reasons. Postural hypotension and heart problems are common causes. It can also be caused by fits as a result of épilepsie or alcohol withdrawal.

• Alcohol: apart from the fact that alcohol can make you drowsy and clumsy, it can also cause long-term medical problems that make falls more likely. These include neuropathie périphérique. This is a condition of the nerves that can cause numbness and pins and needles of the feet or problems with balance sensation. A disorder of the brain (Syndrome de Wernicke-Korsakoff) can also cause falls.

• Problems with vision: for example, clouding of the lens of the eye (une chirurgie de la cataracte) and visual field defects, where part of the field of vision appears to be missing. Breakdown of the cells lining the back of the eye is known as dégénérescence maculaire liée à l'âge. It is a common cause of poor vision in older people. Sometimes an outdated prescription for glasses or bifocal lenses may increase fall risk. Older people at risk of falling may be better with two different pairs of glasses.

• Problems with the brain and nervous system: this includes strokes, la maladie de Parkinson, peripheral neuropathy (commonly due to diabetes), and démence - a condition involving loss of thinking ability due to Alzheimer's disease and several other causes.

• Medicines can cause falls in a variety of ways - for example:

  • Comprimés pour dormir and tranquillisers (for example, diazépam) can make you drowsy and clumsy.

  • Psychotropic medicines (for example, chlorpromazine) can cause confusion.

  • A long list of medicines can cause postural hypotension. This is not only blood pressure medicines but also those used to treat other conditions such as dépression, anxiety and Parkinson's disease

  • Anticonvulsant medicines: these are used to treat epilepsy and can slow down your reaction times and increase the risk of falls.

  • Studies show that taking more than four medicines can increase the risks of falls, no matter what the medicines are.