Fall Prevention Brochure - Changi General Hospital

Geriatric Medicine
2 Simei Street 3 Singapore 529889
Tel: 6788 8833 Fax: 6788 0933 www.cgh.com.sg
Reg No 198904226R
For appointments and enquiries,
please call the CGH Appointment Centre at
Tel: (65) 6850 3333
CGH Appointment Centre operating hours:
8.30 am to 8.00 pm (Monday to Friday)
8.30 am to 12.30 pm (Saturday & Sunday)
Closed on Public Holidays
For more information, please visit
http://www.cgh.com.sg
Organisation Accredited by
Joint Commission International
Your Guide to
Falls Prevention
A MEMBER OF
All information is valid at the time of printing (July 2012)
and subject to revision without prior notice.

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Don’t fall for it
While it is true that falling down is a common occurrence in life and the risk
increases as we get older, falls are not a natural part of ageing and can be
prevented.
Why is fall prevention important? This is because:
Get a QR code reader app from your smartphone’s
app store (“search QR reader”) and scan this code
using the app, or visit : www.cgh.com.sg/nofalls
to read more about how to prevent falls.
1. Falls that happen in the older age group have a greater risk of causing injury.
2. The injuries sustained can also be long lasting and reduce the ability to walk
and move, affecting confidence and independence.
3. A large number of falls in seniors can result in long hospital stays and
expensive surgeries.
Don’t let falls affect your life, read this booklet and say no
to falls today!

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Contents
4 Why we fall
5 Ageing and falls: Our changing bodies
7 Fall proof your environment
9 Fall proof your bedroom
11 Fall proof your kitchen
13 Fall proof your bathroom & toilet area
14 Walk safe: Proper footwear and walking aids
15 Useful fall prevention products
17 Getting up from a fall: What to do if you are alone
19 Getting up from a fall: How to help someone who has fallen
21 Getting help: Your action plan
22 When to call an ambulance
Why we fall
There are many reasons why falls happen. Some of the factors which can cause
falls are listed below:
1. Physical factors
– these are usually a result of
changes due to ageing or some
medical conditions
2. Medical conditions
which can pre-dispose to falls
• Muscle weakness or pain
• Slow reaction time
• Poor balance
• Reduced vision
• Poor memory
or concentration
• Dizziness
• Parkinson’s disease
• Stroke
• Dementia
• Arthritis
• Rheumatism
• Incontinence
• Diabetes
3. Lifestyle reasons • Lack of exercise
• Poor diet
• Unsuitable footwear or attire
4. Environmental factors • Poor lighting and visibility
• Cluttered spaces, narrow walkways,
physical obstacles
• Staircases, steps, steep inclines and
curbs
• Slippery surfaces such as wet floors
To manage and reduce your risk of falling due to medical conditions or use of
medications, you need to ensure that your medical conditions are optimally
treated. Visit your doctor for regular review.
Understanding these fall risk factors is the first step in preventing falls. In the next
few pages, we will explain how some of these factors contribute to the risk of
falling – and more importantly, how to do away with these hazards.

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Ageing and falls:
Our changing bodies
As we age, our bodies change – our eyesight may dim and we may not be
as nimble as before. Stairs and curbs may become harder to manage as our
balance becomes poorer. Moving around may take longer. We might become
more forgetful. These changes are a natural part of growing older.
Ageing is normal – falling is not; understanding your personal risk factors can
help you remain active and independent safely.
Keep an eye out for poor vision
Good vision is important for identifying and avoiding obstacles, sharp corners,
steps and curbs. Good vision in both eyes is also crucial in judging distances and
depth to help navigate stairs and uneven terrain.
Here are some tips to maintain good vision:
• Have your eyes checked every year by an eye doctor or optometrist
• Wear only a single-lens pair of glasses (i.e. no bifocals, trifocals or multifocals)
when walking, especially when outside the home. Wear bifocals, trifocals or
multifocals with caution as these vision aids blur obstacles on the ground,
creating a ‘blind spot’ that can cause tripping
• Always wear your glasses and keep them near you
• Wear a hat and/or sunglasses when outside, especially in bright and high
glare situations.
• Avoid dimly lit areas if possible and turn the light on before walking in the
house at night
• Put on your glasses if you get up in the night to go to the toilet.
• If you have cataracts which are suitable for surgery, having the operation is
likely to improve your vision

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Fall proof your environment
Sixty per cent of falls happen in the home. In order to continue to live safely and
independently, our homes have to ‘grow’ with us. Making simple modifications
to our environment, especially at home, can go a long way in reducing the
risk of falls.
There are two main ways to reduce fall hazards in the home:
1. Adapt your environment to increase safety
2. Increase your perception and awareness of your environment
General Principles
Take note of these general principles to ensure that they don’t cause a fall.
These apply to ALL areas of the home:
Floor and walkway safety
• Ensure floors and walking areas are clear and clutter-free.
• Remove trip hazards such as loose mats and rugs, stray wiring, furniture that
blocks walkways, standing fans and toys.
• If using mats or rugs, make sure they are secured to the ground.
• Wipe up spills as soon as they occur.
• If you have pets, be wary in case they get underfoot.
Keep things within reach
• Ensure that heavy items or items used frequently are within easy reach.
You should not need to climb, bend or reach too far for these items.
• Only if absolutely necessary, use a broad based sturdy and secure ladder
to reach high places. Do not stand on stools and chairs to reach the high shelves.
• Place your telephone within easy reach; cordless telephones are recommended.
Keep dangers in sight
• Highlight the edges of obstacles or changes in floor height by sticking
brightly coloured tape on these edges.
• Furniture colours that contrast with the walls and the floor can help you to
be more aware of your surroundings.
• Avoid installing heavily patterned floor coverings and furniture.
Let there be light
• Ensure lights are just bright enough for you to see clearly, but not too bright
to cause glare or eye strain.
• Ensure light switches are easy to reach and near each doorway.
• Provide adequate lighting, particularly at night. Options such as plug-in
nightlights, or motion sensor lights are worth considering.
• Allow time for your eyes to adjust when walking from light to dark areas and
vice versa.
Fall proof your wardrobe
• Check that clothing ends are above the ankle to avoid tripping.
• Sit down rather than stand when dressing.
• Avoid walking around in your socks.

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Fall proof your bedroom
Use a cordless phone to help
you make phone calls without
getting out of bed. A cordless
door bell may be used to call for
help.
Install a night light.
Consider placing a commode
or urinal next to the bed at
night to avoid the need to
walk when sleepy.
Ensure that the bed is of a correct height.
You should be able to place your feet
flat on the floor when you sit at the
edge of the bed.
Place walking aids close to
the bed.

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Fall proof your kitchen
Place utensils and commonly
used items within easy reach
at chest or waist level.
Have good, non-glaring lighting
over the counter top and stove,
especially when food is being
sliced or cut.
Turn in long handled
utensils when cooking.
Reduce glare by using shades or indirect lighting.
Install additional lighting if needed.
Clean up spills immediately.
Store heavy items or
frequently used items
within easy reach or in
lower cabinets.
Do not stand on stools
and chairs to reach the
high shelves.

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Walk safe:
Proper footwear and walking aids
With age, our feet may change shape, be prone to swelling or loss of feeling.
Combined with other changes in muscle strength and balance, the risk of falls
increases. Hence, it is important to wear appropriate shoes.
Safe shoes
The ideal shoe should fit well, be flat, broad-based and have non-slip soles.
• Buckles, Velcro straps,
and laces help to
ensure a snug and
safe fit. Be mindful of
laces when walking
• Heel cup should be
low, wide and have a
rounded edge. Ensure
that they provide
adequate support
Fall proof your bathroom & toilet area
• Showers are safer than bathtubs.
• Sit on a stable shower chair with back support to make
shower time safer.
• Ensure that soaps, shampoos and towels are within easy
reach in the shower.
• Install grab bars to help you get in and out of the shower
safely if needed **.
• Where possible, remove the raised edge of the shower stall
to prevent trips.
• Avoid squatting toilets or use a commode chair instead.
• Install grab bars and/or use a raised toilet seat if you have
difficulty getting on and off the toilet.
• Make sure light switches are within reach.
• Install slip resistant flooring or use non-slip mats.
• Consider a distress alarm or phone in the bathroom in case
of emergencies.
• The front of the shoe
(known as the toe
box) should be wide
and deep so that it
fits snugly (not too
loose nor too tight)
Unsafe shoes
• Buy shoes at the end
of the day and try on
both sides to ensure
a proper fit
• Soles should be nonslip
and of the correct
thickness to allow you
to ‘feel’ the ground
• Slippers and thongs do not have laces/buckles to hold firmly onto your foot
• Shoes with slippery or worn soles are a balance hazard, especially in wet
weather
• Shoes with high or narrow heels make you unstable when walking and can
cause ankle sprains
• Shoes without heel counter/support such as slippers or mules, do not provide
support and your feet can slide out of the shoes
** For installation of grab bars, please seek professional
advice from an Occupational Therapist.

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Useful fall prevention products
• Personal alarm
A personal alarm can help alert family members
or neighbours to your situation if you fall or need
help. This can be a pendant or wrist tag with an
activation button, whistle or a cordless door bell. A
cordless phone may be helpful if it is placed at
an appropriate location
• Neon strips
Place strips on high risk areas such as edges of
stairs, raised curbs and uneven floor areas in the
house.
• Shower chair
A sturdy chair in the shower can help make
shower time safer.
• Commode chair
A commode chair may make night time visits to
the toilet more convenient and safer.
Get some support
• Grab bar
Grab bars act as useful handholds. An occupational
therapist should be consulted for advice on
appropriate installation of grab bars.
• Night lights
Night lights in the bedroom, bathroom and living
space can help increase safety in the night time.
• Rubber matting
Non-slip floor coverings such as rubber mats may
be placed in toilets, kitchen and under floor mats
to reduce slips.
• Arm chair
Choose stable chairs with arm rests to help you.
The seat should be firm because a seat that’s too
soft makes it hard to get up after sitting down.
When seated, you should be able to place your
feet flat on the ground. Chairs should be of the
correct height for you. When you are seated,
you should be able to place your feet flat on the
ground.
If you have a prior injury or condition that makes
walking difficult, you may benefit from a walking
aid. A quad stick, walking frame or walking stick may
help enable you to become more mobile. Speak to
a doctor, physiotherapist or occupational therapist;
they will be able to recommend an appropriate
walking aid that suits your needs.

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Getting up from a fall:
What to do if you are alone
Falling can be a distressing experience, especially if one is alone or if there is an
injury sustained. In the event of a fall, it is important to get up or get help as soon
as possible. Lying on the floor for long periods of time can lead to more problems. If
you are alone when a fall occurs, follow these steps to get up safely and get help.
1. In the event of a fall, don’t panic.
Take deep breaths and remain
where you are. Assess the situation;
can you move your body, arms and
legs? If you are in pain and unable
to get up, call for help. Sit or lie
down on the floor in a comfortable
position till help arrives.
4. Bend one knee and use your
supporting foot and arms to brace
yourself.
5. Push yourself into a half-standing
position and slowly turn yourself
around to take a seat.
2. If you are not in too much pain, roll
to your uninjured side. Rest in this
position until you feel strong
enough to move.
6. Sit or rest until you feel strong
enough to call for help. Tell a
family member or friend that
you have fallen and seek medical
help if needed.
3. Get onto all fours and crawl
towards the nearest support, such
as a sturdy piece of furniture.

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Getting up from a fall:
How to help someone who has fallen
If you are helping someone get up after a fall, it is important to let the fallen person
get up on his or her own; you should only act as a guide.
1. Calm the person down and
let him or her remain lying
down while you check for
injuries. Ask the person if he
or she can move.
4. Guide the person to place both
arms on the chair as support and
prop himself or herself into a
kneeling position.
5. Guide the person to push himself
or herself into a half standing
position and place second chair
behind the person.
2. If there is no significant injury and
pain and if the person can move,
help lightly roll him or her onto
the his/her side and allow him/
her to rest. Meanwhile, place two
chairs nearby as shown in the
illustration.
3. When the person feels strong
enough, help him or her to get
onto all fours and move towards
the chairs.
6. Guide the person to use his/her
arms and legs to push up and sit
back on the chair behind him/her.
Guide the person to sit back into
the seat. Remember not to lift
the person as undetected injuries
may be aggravated if you pull on
him/her. Keep your back upright
when assisting.
7. Allow the person to rest and
check again for injuries. Seek
medical help if needed.

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Getting help:
Your action plan
It is important to have a Help Action Plan in place so that in case of an emergency,
you – and your family, helper, spouse and neighbours – know what to do and you
can get help readily.
Your plan should be two-fold:
1. Proactive – engaging your family, friends and neighbours about the importance
of fall safety
Engage your support group
• Speak to your family, friends and neighbours about how they can help
you in case of a fall and ask if they can be your emergency contact/help
• Leave your emergency contact number with your neighbour/s so they can
contact your designated family member or friend
• Leave a copy of your keys with family members or a trusted neighbour so
they can get into your house in an emergency
2. Reactive – knowing what to do in the event of a fall
Help Action Plan: Raising the alarm
• If someone is at home with you, call out for help
• If you are alone, try crawling to a phone. Have phones placed in accessible
places in areas such as the bathroom, the kitchen or the bedroom
• Activate your personal alarm, sound a help bell or similar device that can
alert your helper, family members or even neighbours to your situation
When to call an ambulance
Some falls may be minor and only result in bruises and cuts, but more severe falls
are medical emergencies. Here is how to identify a severe fall:
• If the person who has fallen is unconscious
• If there is severe pain
• If the person is unable to move
• If there is difficulty breathing. If breathing stops, start CPR if you are trained
• If there is fluid or blood from the nose, ears or mouth
• If the fall involves injury to the head, neck, back, hip or thighs
Call 995 if any of these situations should happen. While waiting for help, do not
move the person but keep the person warm with a blanket or towel.
Medical service providers –
Fall prevention/assessment
1. Alexandra Hospital Falls Service
Tel: 6476 8828
www.alexhosp.com.sg
2. AgeWELL Seniors Clinic
Tel :6258 9792
www.agewell.com.sg
3. Changi General Hospital
Geriatric Centre
Fall Assessment Clinic
Tel : 6850 3333
www.cgh.com.sg
4. Hua Mei Seniors Clinic
Tel: 6593-9530
www.tsaofoundation.org
6. Raffles Hospital
Internal Medicine Centre
(Geriatric Medicine)
Tel : 6311 1111
www.rafflesmedicalgroup.com.sg
7. Singapore General Hospital
Mobility and Falls Clinic
Tel: 6321-4377
www.sgh.com.sg
8. Tan Tock Seng Hospital
Geriatric Medicine Clinic/ Falls and
Balance Clinic
Tel : 6357 8013
www.ttsh.com.sg
5. National University of Singapore
Falls and Balance Clinic
Tel : 6772-5733
www.nuh.com.sg
The publisher does not endorse the service providers listed here and does not accept responsibility or liability
for the quality of the services listed here.