Older People Safety

A picture of an elderly woman. Elderly people are one of the groups of our population most vulnerable to accidents, particularly in and around the home.

Background

Improved living standards, better healthcare, greater awareness of the importance of a healthy diet and taking regular exercise have led to more and more people enjoying life into their 80s and 90s. However older people, in particular the frail elderly, are one of the groups of our population most vulnerable to accidents, particularly in and around the home.

Those over 65 years of age are most at risk, suffering both the highest mortality rate and the most severe injuries. In 2009 in England and Wales alone, people aged 65 or over accounted for 7,475 deaths as a result of an accident of which 49% were due to a fall.  More dated figures relating to A&E attendances after home accidents show that falls are by far the single largest cause of attendance. In 2002, 2.7million people attended an A&E department in the UK following a home accident, of whom 1.2million had suffered a fall. Over-65s accounted for 19 per cent of the total number of A&E home accident attendances, but 30 per cent of the attendances were due to accidental falls at home.

The majority of accidents in the older age groups also involve females rather than males.

Many of the fatal and non-fatal accidents to older people are attributable wholly or in part to frailty and failing health. This can lead to failure or slowness to see and avoid risks. By drawing the attention of older people and their carers to danger spots and unsafe habits then accidents can be reduced.

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What injuries occur?

The great majority of both fatal and non-fatal accidents involving older people are falls. Almost three-quarters of falls among the 65-and-over age group result in arm, leg and shoulder injuries. Older people are also more likely to injure more than one part of their body, with 25 per cent of falls causing injury to more than one part of the body, compared to an average 16 per cent among all age groups. One in every five falls among women aged 55 and over results in a fracture or fractures requiring hospital treatment.

Other main injuries suffered are bruising or crushing, cuts, wounds resulting from piercing and straining or twisting a part of the body.

Although most falls do not result in a serious injury, being unable to get up exposes the faller to the risk of hypothermia and pressure sores. 2

Where do accidents happen?

The most serious accidents involving older people usually happen on the stairs or in the kitchen. The bedroom and the living room are the most common locations for accidents in general.

The largest proportion of accidents are falls from stairs or steps with over 60 per cent of deaths resulting from accidents on stairs. Fifteen per cent of falls are from a chair or out of bed (on two levels) and a similar number are caused by a slip or trip on the same level, e.g. falling over a mat or a rug. 2

What accidents happen and how to prevent them?

Falls

Facing up to Falls

Facing up to Falls, aims to provide families and older people with practical steps to avoid falls by highlighting key issues that lead to a tumble. Click here to watch this video with subtitles.

Download Facing up to Falls
Download Facing up to Falls (subtitles)

How to get up safely after a fall

A short video clip showing how to get up after a fall.

1. Hip fracture: The management of hip fracture in adults: NICE Clinical Guidance CG124.

Download How to get up safely after a fall

The risk of falling in the home increases with age. A substantial number of falls are due to unspecified reasons and whilst moving about on one level. This may reflect instability associated with impaired general health.

The cause of a fall is often multi-factorial, involving both environmental hazards and an underlying medical condition. Strength, balance and gait, decline in vision, mental health problems and deficiencies in the diet are all contributory risk factors. Although prescription medicines are seldom the cause of falls, they may also be a major risk factor.

Falls affect over a third of people over 65 years old and 40% of people over 80. 5

Risk factors for falls

Research has indicated a wide range of multiple risk factors for falls. 1

These include:

  • Physical ability and lack of mobility, balance and gait disorders
  • Nutritional status - vitamin D and calcium deficiency
  • Medication - analgesics, antidepressants etc.
  • Acute and chronic diseases and disorders including stroke and heart disease
  • Female gender
  • Environmental hazards
  • A history of previous falls.

Hip fractures

Fractures, particularly hip fractures are one of the most debilitating results of an accidental fall. Ninety per cent of hip fractures occur among those aged 50 and over. 4

Hip fracture is a major cause of morbidity and mortality. It can result in medical complications, infections, blood clot in the leg and failure to regain mobility.

The increased popularity of hip protectors has been very useful in preventing the severity of a falls-related injury. Click here to read the full document 'How Safe are Hip Protectors?' (PDF 128kb).

Prevention

  • Avoid leaving items on the stairs - they can become a tripping hazard
  • Ensure stairs are carefully maintained - damaged or worn carpet should be repaired or removed
  • Try to avoid repetitive carpet patterns that may produce a false perception for those with poor eyesight
  • Landings, stairs and hallways should be well lit with two-way light switches
  • Make sure banisters are sturdy. The fitting of two easy-grip handrails gives more stability

Facing up to Falls

RoSPA, the UK's leading accident prevention charity, has created the short film, Facing up to Falls, as part of its Safer Homes project. It aims to provide families and older people with practical steps to avoid falls by highlighting key issues that lead to a tumble.

The film contains advice on preventing a fall and involves real-life experiences of older people living in the London boroughs of Hackney, Islington and Newham.

More than 3,500 people in England and Wales die every year as a result of a fall and nearly a third of a million people need hospital treatment. Many older people who suffer from falls never fully recover from either the physical or psychological impact of their injuries.

Over a quarter of falls result in hip fractures and the treatment of these alone is estimated to cost around £2billion 1. Falls are a significant and growing public health issue in an ageing population.

This film is downloadable to members of the public and professionals working with older people.

Can flooring and underlay materials reduce the number of hip fractures in the elderly?

Hip fractures in the elderly after a fall are a major cause of morbidity and mortality. They can result in complications, infections, blood clot in the legs and failure to regain mobility. Hip fractures can have a serious impact on a person's life.

One suggested method of preventing hip fracture is through the use of improved flooring. Slippery floors and unsuitable shoes are some of the major factors that contribute to over a third of all falls annually.

Can flooring and underlay materials reduce the number of hip fractures in the elderly? (PDF 248kb)

Falls are so commonplace that they are accepted as almost inevitable. More public awareness needs to be achieved. Professionals and carers can help older people to sustain an active life where possible by helping them to identify potential hazards and making known sources of assistance.

Older people need to be made aware of:

  • The importance of using the right equipment to carry out the task in hand
  • Loss of balance through sudden movements, e.g. getting out of bed or a chair too quickly
  • The danger of slipping and tripping created by worn rugs, slippery floors or paths, uneven surfaces, trailing flexes, and items left lying around
  • Loose or badly worn footwear. Well-fitting shoes can help with balance and stability
  • Grab rails and places to sit down in the bathroom and kitchen could be an advantage if dizzy spells occur
  • Spills on the floor should be cleaned up immediately to prevent slipping on them.

What to do if you have a fall:

  • Don't panic - you will probably feel a little shocked and shaken but try and stay calm
  • If unhurt look for something to hold onto and something soft to put under the knees
  • Hold onto a firm object for support and out the soft object under the knees; place one foot flat on the floor with the knee bent in front of the body
  • Lean forward putting weight on hands and foot until it is possible to place other foot beside the one on the floor
  • Sit down and rest for a short time.

What to do if hurt:

  • Try to get comfortable until help arrives
  • Keep warm, starting with feet and legs
  • It is uncomfortable to keep still for any length of time and this may lead to pressure problems. Moving position every half hour and moving feet helps the circulation and improves comfort.

Fire-related accidents

143 people over the age of 65 died in 2010 in fires to which fire brigades are called. Poor mobility, poor sense of smell and a reduced tolerance of smoke and burns contribute to fatalities. Major sources of ignition include cookers, materials, candles, coal fires, heaters and electric blankets. 2

Prevention

  • Take care with smoking materials and try to avoid smoking in bed
  • Fit a fireguard
  • Use electric blankets correctly and have them checked regularly
  • Fit a smoke alarm preferably main-operated or one with a ten-year battery
  • Do not dry clothes on fireguards or heaters.

Poisoning

Medicines and gases, mainly carbon monoxide and pipeline gas, predominantly cause accidental poisoning of people over 65. 2

  • Have fuel burning devices checked regularly by an expert
  • Have chimneys and flues swept at least once a year
  • Be aware of the dangers of exceeding prescribed drug doses.

Burns and scalds

For older people the rate of risk for severe accidents involving burns and scalds is lower than other age groups. However, older people are at the highest risk for fatal injuries from burns and scalds - four to five times greater than the population as a whole. Pre-existing conditions often contribute to their deaths. 2

Contact burns to those over 65 can prove to be fatal. Frail and poor health of the victim are often contributing factors. The main sources of heat include radiators, electric fires and cookers. Many are scald injuries, involving the use of kettles.

Prevention

Encourage the use of:

  • Coiled kettle flexes or a cordless kettle
  • Spout-filling or jug kettles (boil only sufficient water for immediate needs)
  • Wall-mounted heaters instead of kettles
  • Try not to carry hot liquids further than necessary. (Re-arrange tea/coffee-making area to accommodate this.)
  • Water at the point of delivery to the bath should be no more than 46° C to help prevent scalding
  • Fit a thermostatic mixing valve
  • When running a bath, turn the cold water on first
  • Always use rear hot plates and turn the panhandles away from the front of the cooker
  • Ensure that hot water bottles are of good quality and do not show signs of wear.

Hypothermia

Hypothermia occurs when the body temperature drops to 35° C. It is the main contributing factor in cause of death for more than 400 people in the over-65 age group each year.

The cost of providing adequate heating in winter is undoubtedly an important factor.

  • Wear several thin layers of clothing
  • Natural fibres like wool are warmer than synthetic fabrics
  • Eat regular meals and take hot drinks during the day
  • Move about at regular intervals
  • Contact local electricity and gas boards if difficulty is experienced in meeting bills.

Age UK – Advice Line 0800 169 6565

Available 8.00am-7.00pm, 365 days a year. A free national advice service for older people and their carers. Help and advice is given on welfare and disability rights, housing and community care.

Website: www.ageuk.org.uk/

Alzheimer's Disease Society - Helpline 0300 222 11 22

Available Monday to Friday from 8.00am to 6.00pm. Calls charged at local rates. A helpline providing information, education and advice on dementia for people with dementia and their carers.

Website: www.alzheimers.org.uk

References

  1. DEPARTMENT OF TRADE AND INDUSTRY: HEALTH PROMOTION ENGLAND Avoiding slips trips and broken hips Older People and Accidents Fact sheet 2
  2. DEPARTMENT OF TRADE AND INDUSTRY. Home accident surveillance system: 24th annual report. London: DTI, 2002
  3. OFFICE FOR NATIONAL STATISTICS: MORTALITY STATISTICS; injury and poisoning 2012: England & Wales.
  4. DEPARTMENT OF HEALTH. Fractures caused by osteoporosis. London: DoH, 1999
  5. DEPARTMENT FOR WORK AND PENSIONS, Falls in older people.

Contact Us

Alison Brinkworth, Public Health Support Officer
+44 (0)121 248 2107
abrinkworth@rospa.com
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