Slip, bend and then fall down

Evert Rijks (82) leans to the right. He says: “I was never aware of it, but the physical therapist pointed out to me that when I walk, I always put my left foot in a straight line in front of my right foot. I walk narrow, as it is called. I’m swaying, I’m not stable.”

Rijks, former head of the student sports center at the Free University in Amsterdam, has fallen four times since November last year: once from a bicycle and three times while walking. He landed on his head twice.

Fortunately, the consequences were not serious. However, the falls were the signal to participate, on the advice of the GP, in a fall prevention training of several weeks, twice a week, in his hometown of Amstelveen. “I try to change my posture so that I am less likely to fall. It’s not easy for me, it feels like I’m walking very wide all of a sudden, but I’m staying focused and now I’m getting used to it.”

Rijks is one of many elderly people who are at risk of falling and can suffer serious consequences. They become less mobile, they become depressed or lonely, they can no longer live independently, their health deteriorates. In the past ten years, the number of cases of serious injury after a fall among the elderly has risen by 11 percent and this increase will continue, according to the prognosis of the Knowledge Center Injury Prevention SafetyNL, which this week popped up.

Without measures, 50 percent more elderly people will end up in the emergency department of hospitals after a fall within ten years, according to the knowledge centre, and the direct medical costs for this will double to 2.4 billion euros per year. Last year, nearly 103,000 elderly people were treated in the emergency room of a hospital after a fall.

Increased risk of falling

The most obvious remedy, of course, is to make sure you don’t fall. There is a ‘huge profit’ to be made there, according to program manager Saskia Kloet of SafetyNL. Of the elderly who fell and had to go to the emergency room for this, 80 percent already had an increased risk before that fall. “You should identify all the elderly who are at increased risk of falling.”

To this end, there must be more intensive cooperation between, for example, general practitioners, home care workers, welfare workers and physiotherapists. “That is not yet the case. Everyone is in their own domain.”

Fall prevention should no longer depend on local enthusiasm, according to Kloet, agreements must be made about it. According to her, one in three people over 65 and one in two people over 75 are at an increased risk of falling. The elderly could participate in a preventive exercise programme, made possible by municipalities and insurers. “Ideally, there should be one million people participating in these types of programs every year. That is by no means the case now.”

Also read: The elderly on an obstacle course: you can learn to fall

A training course costs about four hundred euros per participant without subsidy. Physiotherapist Verena Janga from Aalsmeer teaches the elderly to maintain their balance and strengthen their muscle strength in twelve weeks. “If the elderly don’t move enough, they start to shuffle and curve, they don’t wrap their feet well.”

Regular training can maintain muscle strength and balance. “It doesn’t matter if you’re twenty or a hundred, you can always improve muscle strength.” The training is preceded by lessons in awareness about how it could happen that the elderly fell. Is their house very full of stuff? Are there rugs that you can trip over? Don’t they have grab rails in the bathroom or toilet? Can they still see well? Do they have side effects from medications such as dizziness?

Movement disorders

“Falling is a symptom,” says Nathalie van der Velde, professor of geriatric medicine at the University of Amsterdam. Main causes of falls are movement disorders and mobility problems, such as lack of strength and balance. But you also need to “look further” to make sure there is no underlying disease, such as a heart condition or a medication side effect.

Van der Velde: „Often a preventive exercise program is nice but not sufficient, because there is more to it. If you only treat the injury after a fall and not the underlying conditions, vulnerable elderly people in particular will quickly fall again. Of the elderly who present themselves to the emergency room after a fall, 20 percent return within a month with another fall. You can reduce that number by a third to half through a structural assessment of possible fall risk factors.”

Also read: Costs of falls ‘double to 2.4 billion euros’

Which care provider is responsible for restoring fallen elderly people differs per region. Sometimes this is a district nurse, home care or the general practitioner, sometimes it is the fire brigade, police or ambulance personnel. Professor Van der Velde has no overview about it. “But it is important that anyone who joins it realizes that just standing up is not the solution. A fall is a symptom. It should be looked into whether someone may have pneumonia, and whether they need follow-up care because they fall more often.”

Evert Rijks will soon start a follow-up course to prevent falls. “I want to force myself to do exercises. I don’t do that enough at home. I have not had enough exercise for a long time, also because I took the corona advice too seriously. You have to keep moving.”

A version of this article also appeared in NRC Handelsblad on September 28, 2021 A version of this article also appeared in NRC in the morning of September 28, 2021

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