Falls in old age: overcoming fear, gaining mobility - with targeted prevention

 

When the "Plumps!" Changes everything: Understanding the fear after the fall. The shock runs through your limbs when you get the call: "Mom has fallen!" Or you have fallen yourself and feel that one cold moment of panic. That "plop!" can change your loved one's life - or yours - from the ground up. But the real challenge often begins after the fall: how to get back on your feet mentally and physically?

An older man in a gray sweater and beige pants sits on the floor and holds the hand of a woman who helps him up. A wooden stick lies on the ground next to him.

 

Falls are not a rare problem among older people. In Austria alone around 30% of over 65-year-olds fall at least once a year. And while we first think of fractures and bruises (according to the expert standard, only 5% of falls are associated with serious physical injuries), it is often the invisible wound - the fear of the next fall - that runs deepest and severely restricts quality of life. This fear can develop into a real phobia: the post-fall syndrome.

Remember Inge, the cheerful lady who always had a joke on her lips? Ever since she fell while watering her flowers, she's been hiding behind her curtains. Her favorite flowers? Long since dried up. The light in the kitchen? It stays off. Her neighbor Karin senses her despair. Does it really have to be like this? Does a single fall have to change life so fundamentally?

 

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Nora's tip: According to the World Health Organization (WHO), falls are a major cause of injury and death in older people worldwide and often lead to serious psychological consequences such as fear of falling again (post-fall syndrome), which significantly reduces quality of life.

 

Post-fall syndrome can cause a Vicious circle: Avoided attempts at exercise lead to muscle and bone loss. The lack of physical activity and sunlight can even lead to osteoporosis, a disease in which bones become unstable and break easily. Thus, if the person does have to get up, repeated falls are inevitable. It is therefore crucial to also focus on helping the person back up psychologically and encouraging them after a fall.

 

The way out of the vicious circle: Actively help and strengthen trust

Older woman with blonde hair sitting on the floor near a sofa, with a cane next to her, looking uncomfortable.

 

Recognize and minimize risk factors

The way out of the vicious circle always starts with the attending physician. As a nurse or Relatives:r you should work with him or her to assess the risk of another fall. It is important to recognize and eliminate the causes of falls in everyday life. This illustrates that care and nursing are NOT the same thing and require careful risk assessment.

Trip hazards in the home, such as slippery floors or raised carpet edges, are often a danger. Ill-fitting shoes that offer no support can also pose an increased risk of falling. Low blood pressure is another risk factor that can lead to falls. A medication, for example, may be responsible for the legs not wanting to obey or the balance failing.

Nora's Home Safety Check: The invisible tripping hazards
  • Provide even, bright lighting in all rooms, especially at night. Motion detectors in corridors and bathrooms can work wonders. You often don't see tripping hazards when it's dusk.
  • Even at home: non-slip, well-fitting slippers with a firm sole. Walking barefoot or wearing socks without anti-slip studs increases the risk.
  • Fix all cables and avoid objects lying around that are not directly needed for walking - even in outdoor areas such as on terraces or balconies.
  • Bathroom safety: Think about non-slip mats in the shower/tub and grab rails. A raised toilet or raised toilet seat can make it easier to get up.

 

Medication & fall risk: Which active ingredients should make you mindful

 

Medication that can increase the risk of falling

Drug category Why it can increase the risk of falls
Beta blocker Can lower blood pressure, which can lead to dizziness or light-headedness, especially when standing up quickly.
Diuretics (dehydrating agents) Can lead to dehydration and electrolyte imbalances, resulting in weakness, dizziness and low blood pressure.
Antidepressants Some types (especially older tricyclic antidepressants) can cause sedation, dizziness, blurred vision and orthostatic hypotension (drop in blood pressure when standing up).
Sedatives (tranquilizers) Like benzodiazepines, can cause drowsiness, reduced coordination and impaired balance.
Neuroleptics Can lead to sedation, dizziness, orthostatic hypotension and motor side effects (e.g. stiffness, tremors) that affect balance.
Hypnotics (sleeping pills) Cause drowsiness, reduced alertness and impaired coordination, which can last into the next day and increase the risk of falling.

 

What to do after a fall in old age?

A young woman kneels next to an older woman lying on the floor and holds her hand while she talks on the phone. The older woman is wearing a scarf and appears to be unconscious or injured.

 

Immediate action after a fall

If you are helping a person to get up from the ground after a fall, the first commandment is: Keep calm! And that goes for both sides. Don't help the person immediately; instead, give them the opportunity to collect themselves and digest the shock. You can do this by placing a small pillow under the person's head and covering them up, as the risk of hypothermia on the ground is relatively high, especially if they have been waiting for help for a long time.

How to deal with stressful situations: Something can go wrong in such shock and stress situations, especially with seniors. If this happens, remove the wet clothing to prevent the person from catching a cold.

Calm yourself too: Nothing can happen to the fallen person on the ground and you have time. As soon as the situation has calmed down a little, carefully feel the person. Let them know immediately if they are in pain so that you can assess any injuries. Fractures in particular are often barely visible from the outside; however, if there is one, the person must not be moved or encouraged to stand up. It is therefore important to listen to the affected person's assessment and take it seriously.

Getting up with aids or external help

No serious injuries found? Great! But what happens now? It's best to get two sturdy chairs for the person to lean on and try to stand up on their own. If you have to leave the room to do this, explain to them why you are leaving them alone and that it is only for a brief moment.

 

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Nora's tip: Picking yourself up again after a fall can be very helpful for the person's self-confidence - they now know: "I may fall, but I can also help myself". This can prevent the fear of further falls.

 

When additional help is needed: Often, however, the fright is still deep-seated, or the person cannot gather enough strength to pull up their own body weight. In this case, it is important to assess whether you are able to lift the person up on your own. If you have any doubts, you should never just try, because if you fall under the weight and injure yourself, you will no longer be able to provide any help.

It is best to call a neighbor for help who can deal with the situation together with you. If no one is available and friends or family members only answer their voicemail, it is also perfectly legitimate to call the emergency services. After all, no fallen person should lie on the floor for longer than 45 minutes.

When do I need an emergency doctor? And first aid on the ground

Asian elderly man lies on the floor after a fall while a nurse rushes to his aid. An overturned walker lies next to him in a well-lit room.

 

When to call the emergency number (144 / Europe-wide 112):

  • If there are fractures, a joint is unnaturally twisted or the person is unresponsive.
  • When there are signs of circulatory failure (e.g. pale, clammy skin, rapid breathing, weak pulse).
  • If you suspect a head or spinal injury (e.g. neck pain, numbness).

In such dangerous and risky situations, movements should be avoided at all costs! Until the rescue team and emergency doctor arrive, you should do everything you can to make the person who has fallen feel comfortable and safe.

First aid measures on the ground:

  • The Breathing control is most important. Because rarely, but nevertheless, circulatory failure can also be the reason for collapse.
  • If the person is unresponsive but breathing, you should place them in the stable lateral position.
  • In case of breathing leads to life-saving measures, so Reanimation, nothing over.
  • Open fractures can be provisionally covered with a clean wound dressing and bandaged without pressure.
  • If the legs or hips are affected by a serious injury, the person who has fallen should not move or stand up under any circumstances.
  • In the case of a broken arm the relief provided by a triangular scarf helps.

In any case, the emergency services (144) should be contacted immediately after basic care and protection. Keep an eye on the injured person and, if possible, do not leave the room until the emergency services arrive.
 

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Nora's tip: Even falls that do not result in injury or those that can still be stopped should always be reported to the doctor. Because even if no treatment is necessary, there is still a reason why the balance has failed. This should be determined in order to reduce the risk in the future.

 

Expert standard for falls: classification & measures

In the expert standard, falls are divided into four classes depending on their severity. The measures required depend on which class the fall belongs to:

 

Lintel classes & measures

class Class description Necessary measures
Class 1 No injury (48%)
The shock is great. There is no pain, a few bruises may appear a few days later. 		Calming measures, listening, possibly psychological support for anxiety (post-fall syndrome).
Class 2 Minor injury (20%)
Small scratches or bruises are painful but do not require intensive treatment. 		Disinfect wound, plaster, care, anxiety support as for class 1.
Class 3 Moderate (27%)
Bruises, contusions or sprains. 		Contact family doctor, medical clarification for speedy recovery.
Class 4 Serious injury (5%)
Fractures or large, deep wounds. 		Call 144 / 112 immediately! Keep calm, monitor vital signs, wait for professional help.

 

Prevention & Self-help: Feel safe, stay independent

An elderly couple is standing in a bedroom. The man sits on the bed and holds a walker, while the woman stands next to him and puts her hand on his shoulder.

 

Practicing getting back up: gaining confidence

If a fall has happened in the past, you should practice the best way to get up from the ground if no one is around to help. It is often possible to crawl to the nearest chair on the floor and pull yourself up.

The "roll and seal" trick: stand up safely on your own

Finding ways for the person to help themselves provides additional security, and the big fear becomes a small insecurity. It is advisable to regularly practise getting up after a fall.

Attracting attention: When standing up doesn't work

You should also explain to the person how they can draw attention to themselves if - for example due to a fracture - they are unable to get up:

  • Calling out loud: Instead of "Help!" scream: "Help, I've fallen! I can't get up!" so that the call is clear. Unfortunately, simple calls for help are often not weighted by the human brain as they should be.
  • Knock sign: Knock on walls in a clear rhythm to alert neighbors.
  • The home emergency call: It is an indispensable aid. Make sure that the button is always within reach (e.g. on the wrist). The person who has fallen should have no inhibitions about pressing the button, as this is an emergency case.
  • Phone within reach: Sometimes it is possible to crawl to the phone and call for help. It is therefore best to position the device beforehand so that it can also be reached from the ground.
  • Warmth: If nothing else helps, if possible pull a blanket, jacket or towel over you to keep your body warm.

 

Graphic of nurse Nora with a stethoscope around her neck and the text 'Nora's conclusion' on a green banner. Closing remark or summary in the health sector.

 

Together for more safety and quality of life! A fall almost always triggers great uncertainty and fear in those affected, which can lead to a vicious circle. Relatives also often struggle with helplessness.

But you have the power to break this cycle! With exercises, professional help and a safe environment, it is possible to regain confidence and feel safe on your own two feet again. Practicing getting up again after a fall and being able to help yourself gives enormous confidence and takes away the fear of another fall. In an emergency, calmness, the right first aid and knowing when professional assistance (emergency call) is essential are important.

Let's work together to ensure that a fall does not mean the end of independence, but the beginning of increased confidence in your own abilities. Your steps count!

 

A turquoise banner with white text that reads 'Nora's Frequently Asked Questions'. On the right is an illustrated avatar figure of a nurse with blonde hair wearing a turquoise nurse's cap with a white cross, a white collar and a stethoscope around her neck
Post-fall syndrome describes the psychological reaction to a fall in which those affected develop a strong fear of falling again. This often leads to avoidance behavior, inactivity and social withdrawal. You can recognize it by a sudden decrease in movement, increased anxiety, insecurity when walking and the desire to never leave the house again.
No. According to the expert standard, only 5% of falls are associated with serious physical injuries (e.g. fractures). The majority of falls result in bruises, grazes or remain physically unharmed. However, the psychological consequences are often more serious.
Not mandatory. Call an ambulance (144 or 112) if the person who has fallen is unresponsive, in severe pain, has visible fractures or joint misalignments, shows signs of shock or if you are unsure whether there could be serious internal injuries. In the case of minor abrasions and if the person is responsive and oriented, it is often sufficient to contact the family doctor.
Keep calm! First check whether there are any serious injuries (do not move if a fracture/spinal injury is suspected). Place a pillow under the head and cover the person. Then try to calm them down carefully and guide them to stand up independently on stable furniture. If this is unsuccessful and you cannot lift the person safely on your own, call for help (neighbors, friends, family or, if in doubt, the emergency services).
Certain groups of medications such as sedatives, hypnotics, some antidepressants, diuretics and beta-blockers can increase the risk of falling due to side effects such as dizziness, a drop in blood pressure, tiredness or unsteady gait. Always discuss your medication plan regularly with your doctor.
Yes, absolutely! Fall prevention is very effective. Important measures include regular balance and strength training, eliminating tripping hazards in the home (e.g. good lighting, non-slip floors), checking medication and using suitable walking aids.
noracares helps you to find qualified caregivers who can support you or your loved ones in everyday life, help with exercise training, create a safe environment and support you in coping with anxiety. We are also a community for exchange and information.

 

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Some terms used in the article, briefly and simply explained:

  • Expert standard in nursing:Guidelines and recommendations that are based on scientific findings and ensure the quality of care in specific areas (such as fall prevention).such as fall prevention).
  • Fixing:A measure that restricts a person's freedom of movement (e.g. by strapping them to a bed).e.g. by strapping to the bed or bed rails). This is a liberty-depriving measure that may only be used under strict legal conditions and for the protection of the person.
  • Geriatrics:A field of medicine that deals specifically with the diseases and needs of older people.
  • Cognitive Behavioural Therapy (CBT):A form of psychotherapy that aims to identify and change negative patterns of thought and behavior in order to overcome psychological problems such as anxiety or depression.
  • Multimodal intervention:A therapeutic approach that combines different forms of treatment (e.g. physical training, ).e.g. physical training, Medication review, psychological support and housing adaptations) to address a problem holistically.
  • Osteoporosis: A bone disease in which bone mass decreases and bones become more fragile, increasing the risk of fractures (broken bones).
  • Post-fall syndrome: A psychological reaction after a fall that manifests itself through a strong fear of falling again, insecurity and avoidance behavior. This can lead to restricted movement and social withdrawal.
  • Reanimation:Resuscitation measures performed in the event of cardiac arrest to restore breathing and heartbeat.
  • Stable lateral position:A first aid measure in which an unconscious but breathing person is placed on their side to prevent them from choking on their own tongue or vomit.
  • TUG test (Timed Up and Go Test):A simple, standardized test to assess mobility and the risk of falling. The time it takes a person to stand up from a chair, walk 3 meters, turn around, walk back and sit down again is measured.
  • Living room adaptation: Measures to redesign the home environment to make it safer and more barrier-free and to minimize the risk of falling (e.g. removing carpets, anchors, etc.).e.g. removing carpets, installing grab rails, improving lighting).

 

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