Two elderly patients in wheelchair enjoying the view in the park

In October last year, Mr Daniel Lim’s 85-year-old father suddenly complained of pain in his right hip. The next day, the pain was so bad that the elder Mr Lim could not get out of bed. His family rushed him to Khoo Teck Puat Hospital, where an X-ray revealed a fracture in the top of his femur. It turned out that while alone at home, he had slipped in the toilet and fallen. The fracture would require surgery and a two-week stay in the hospital, followed by months of physiotherapy.

Public hospitals are seeing a rise in the number of hip fractures among people aged 50 and older – from 1,900 in 2004 to 2,500 in 2014, with half of them involving seniors aged 80 and above. Up to half of those injured, they will never completely recover. Some will completely lose their independence, according to Dr Mallya Jagadish Ullal, Senior Consultant at KTPH’s Department of Geriatric Medicine. To try and reduce the fall risk faced by seniors, the Ministry of Health and Alexandra Health System launched a Community Falls Prevention Programme in July 2015.

“This is a one year programme that targets seniors aged 65 years and above, living in the north of Singapore. Our dual objectives are to bring fall risk screening to the community, and to test the use of self-screening questions as an educational tool on fall risk recognition,” says Dr Wong Sweet Fun, Chief of Transformation Office and Senior Consultant, Department of Geriatric Medicine.

Related: ABCs of Falls: Consequences of Falls in the Elderly

Risk Factors to Look Out For

Fall patient using a walking frame to move about in the ward

The first part of the programme involves a simple screening tool to identify seniors at risk of falling. Seniors aged 65 and above are asked three questions:

  • Have you fallen in the past 12 months?
  • Do you avoid going out because you are scared of falling?
  • Do you feel like you are going to fall when getting up or walking?

Seniors who answered “yes” will be asked to undergo a “Fall Risk for Older.

Checklist for risk of falls

People in the Community” (FROP-Com) screening, either at community nursing posts or in their homes. Based on the scoring of FROP-Com, the seniors will be categorised into low, moderate or high risk. General falls advice will be provided to the low-risk group while medium and high-risk groups will undergo falls assessment and appropriate intervention based on the risk factors identified.

The assessment takes into consideration their medical history, physical condition and mobility. It also considers the patient’s home environment and daily habits. A cluttered home is a major risk factor, as are slippery or irregular floorings.

Related: Preventing Falls at Home

Help is Close at Hand

Elderly lady gripping the handles of her walking frame

After the assessment is completed, community nurses will work with seniors and their caregivers to help reduce the risk. Currently, the programme is available at four community nursing posts, at Sunlove Marsiling Senior Activity Centre, Chong Pang Social Service Hub @ Thye Hua Kwan, Woodlands Galaxy Community Club and Nee Soon South Wellness Centre.

Under the programme, those seniors who are at higher risk will be referred to medical experts, including therapists, who can address critical risk factors with medical intervention. For example, poor vision and hearing can be corrected. Medication that causes dizziness or drowsiness may be reviewed and changed if necessary.

Seniors with mobility problems can also undergo physiotherapy to improve their balance. Sometimes, dietary supplements may be prescribed to help them improve their bone density, so that in the event of a fall, they will be less likely to suffer a fracture.

Patients will also be assessed for osteoporosis and fracture risk. They will be advised about exposure to sunlight, and diet to improve their Vitamin D levels and would be considered for starting on Vitamin D and treatment for osteoporosis if appropriate to reduce the risk of fracture.

Often, seniors and caregivers will also be advised on how to improve the home environment. For example, rugs, low stools, extension cords and other items that are a trip hazard should be removed. Non-slip flooring and grab bars may be installed to reduce the chance of seniors slipping and falling.

“About 30 to 40 percent of falls can be prevented,” says Dr Jagadish. “In doing so, we can reduce the chances of seniors suffering from serious consequences, especially hip fractures, which lead to loss of mobility and reduced quality of life.”

This pilot community programme will run for a year till June 2016 and the assessment is fully funded during this period. Seniors and their caregivers can call the KTPH hotline at 6555-8000 to make an appointment for a fall risk assessment.

Related: Falls Awareness and Prevention Programme

About the Community Falls Prevention Programme

The Community Falls Prevention Programme is a year-long pilot to assess the risk of falling for all seniors living in the north. Dr Mallya Jagadish Ullal, Senior Consultant with the Department of Geriatric Medicine, is the lead clinician of this community falls screening pilot programme. He works with Dr Wong Sweet Fun and Dr Wong Chek Hooi, Senior Consultants with the Department of Geriatric Medicine, in the conceptualisation and evaluation of the pilot community programme.

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