What can we do to prevent falls in elderly Filipinos? 

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Heads of households should conduct a simple ‘fall checklist,’ which includes removing or repairing anything that can cause an elderly to trip or slip, like loose rugs, cords, or uneven flooring

When Luisa (not her real name), a hale and healthy sexagenarian, hit her head on the floor after falling off her favorite folding chair, her daughter contacted me immediately to ask whether Luisa should be brought to the emergency room. I examined Luisa for worrisome signs of head trauma and fortunately found none. 

“We can observe Luisa at home,” I told her daughter. “But your mom should never use her folding chair again.”

Asking Luisa to get rid of her favorite piece of furniture might seem harsh, but I thought it was essential if she were to minimize her risk of falling — an alarmingly common cause of debility and financial strain among elderly Filipinos. 

One in five elderly Filipinos have experienced a fall, according to the 2018 Longitudinal Study of Ageing and Health in the Philippines, the first nationally representative survey on aging in the country. 

Of those who had a fall, 15% reported being injured seriously enough to need medical treatment. Unfortunately, the survey also found that, more broadly, one in five senior citizens in need of medical care were unable to access it, primarily because of financial reasons. 

Even for those fortunate enough to obtain medical care or avoid serious injury, falling can still result in a debilitating fear of falling. The WHO Global Report on Falls Prevention in Older Age warned that falls may result in a “post-fall syndrome” characterized by dependence, confusion, immobilization, and depression, which strips senior citizens of the confidence to live vibrant, independent lives. 

All of these highlight the importance of preventing falls from ever happening in the first place. 

Heads of households should conduct a simple “fall checklist” of their home environment. Remove, adjust, or repair anything that can cause an elderly person to trip or slip, such as loose rugs, cords and wires, clutter, or uneven flooring. 

Ensure that there is adequate illumination along pathways, especially to the washroom. Install grab bars and use rubber mats in the bathroom and by the toilet. 

Local chief executives should also employ a “fall checklist” of walkways and public places, especially areas with high foot traffic. 

Remove obstacles to pedestrians, such as illegally parked vehicles, utility poles in sidewalks, potholes, and cracked and uneven sidewalks. Obstructed sidewalks force pedestrians to alternate unsafely between walking on the curb and on the road. It’s easy to see how this poses a risk of falling for elderly pedestrians. 

Once we’ve secured the physical environment, we should turn our attention to improving the elderly’s strength and balance. 

In a meta-analysis of 11 studies published in the Journal of Orthopedic Translation, balance and strength exercises were shown to prevent falls among the elderly and were especially found to be effective in preventing fractures in elderly women. 

Senior citizens should be encouraged to take up home exercises that strengthen the lower body, such as repetitively standing from a seated position without using one’s hands, and activities that improve balance, such as tai-chi. 

But just as important as conditioning older people’s muscles is strengthening the elderly’s social bonds. In this regard, the availability of a reliable, affordable, and accessible pedestrian and public transport network is crucial. 

As the WHO Age-Friendly Cities Framework reminds us, the lack of accessible public transport and community spaces isolates older people who are unable to drive, making it impossible for them to participate in community life, and increases their risk of loneliness and frailty. 

I would like to exhort my fellow health professionals to discuss fall prevention with all their elderly patients. Often, a recommendation from a health professional is all it takes to convince people to change their habits for the better. 

Diminished senses increase the risk of falls — we should then screen our patients for low vision, difficulty hearing, and impaired foot sensation. We should review our patients’ medications for unnecessary pills — the American Association of Family Physicians identifies polypharmacy (specifically, the use of four or more prescription medications) as a risk factor for falling. 

Fortunately, the Department of Health has ongoing capacity building activities for the care of the elderly at the primary care level, and is proposing that the Senior Citizens Act be amended to mandate geriatric care training for medical and allied health professionals, including fall prevention training. These reforms will go a long way in equipping health professionals to advocate for fall prevention. 

Three weeks after Luisa fell from her chair, her daughter told me that not only has Luisa gotten rid of the chair, she has also started taking up basic strength training with the help of YouTube videos (Luisa found squatting exercises to be helpful in alleviating her knee pain). 

Perhaps more importantly, Luisa has become an advocate for fall prevention and has begun to spread the gospel of grab bars in the toilet and strength training among her kith and kin. 

To this day, I am still amazed at the changes that my patients are willing to impose on themselves just because I advised them so. “They took your advice seriously,”Luisa’s daughter told me. “Laking bagay din talaga that the advice came from a doctor.” (It really maters when an advice comes from a doctor.)

I hope that you do the same for your patients, friends, and families. – Rappler.com

John Carlo B. Timbol, MD, is a member of the Philippine Society of Public Health Physicians. This article was written with valuable input from Dr. Gabriele Domingo of the DOH Disease Prevention & Control Bureau and Mr. Jedd Ugay, a transport economist and commuter advocate.