As a paramedic, I am often the first on the scene when someone gets injured. For the elderly population, falls are particularly detrimental and have serious life altering implications for their health and autonomy. According to Statistics Canada, falls are the most common form of injuries in Canadian over 65 years of age, and one third of seniors who are hospitalized for falls are subsequently placed in Long Term Care (2015). An ecological model is an effective way to identify and influence health-related behaviours to determine numerous small changes that can have an overall larger impact on a person’s health. Those familiar with the ecological model like to imagine them as concentrically smaller circles, with the larger having a direct impact on the smaller, like in Figure 1. However, a more realistic model probably looks more like
Figure 2; many realms of influence that may or may not interact to influence the individual, as represented by G. This does not mean we should not make these small changes to impact the individual, but it means we need to be adaptive in our approach to influence healthy behaviours. When considering fall prevention strategies, it is important to engage with the individual so the approach can be tailored to them. Considering humans are now living longer, it is important to live better, and fall prevention is one way to ensure seniors maintain autonomy in the golden years.
Using a socio-ecological model for fall prevention, we must first evaluate the individual. Attitudes, beliefs, genetic predispositions, balance, and muscle weakness are but a few factors that affect seniors at the individual level. Roe et al. found that a majority of older adults assumed falls were a natural part of aging, or were the results of an inconvenient accident (2008). A study by Braun found that older adults often believed falling was related to extrinsic factors like uneven pavement and had very little to do with intrinsic factors like weakness and dizziness (1998). Also, older adults tend to think of falls as something that won't happen to them, or when they do fall it's related to a temporary conditions and not because they are “fallers” (Hughes et al., 2008; Yardley et al., 2006). Fear of falls also creates a self-fulfilling prophecy in that those who fear falling, therefore they're less active which leads to decreased muscle mass and balance, making them more prone to falls (McInnes & Askie, 2004). Lastly, the attitude around adopting existing fall prevention strategies has fallen on deaf ears. Exercise has been identified as a highly successful intervention to help increased muscle mass and tone, as well as increase balance. However, one study found that the exercise was employed by less than 50% of participants, while another study found as few as 10% (Roberston et al., 2001; Day et al., 2002). Based on the ecological model, the environment surrounding an individual has tremendous influence over them. Therefore, to change the mindset of seniors regarding fall prevention strategies, a more accepting and positive attitude needs to surround the individual in addition to negating physical detriments like poor balance and dizziness.
When evaluating the next level of an ecological model for fall prevention among seniors, we must consider the immediate social relationships surrounding the individual. Yardley determined that most seniors think fall prevention is solely physical environment modification, like using walking aids, but don’t realize the value an exercise program adds to fall prevention (2006). Evidence has shown a targeted home exercise programs supervised by a trained health professional can prevent falls for seniors living in a community dwelling (Sherrington et al., 2004). Influence of family on the individual’s social environment have also been found to decrease the number of falls by providing education to the individual and their family, while also engaging family in patient surveillance (Luo, 2011). Additionally, the influence of a healthcare guided program on the social environment encourages seniors to actively combat falls by inspiring a preventative mindset, as well as strengthening their muscle composition and increase balance; thereby, influencing the individual level. Furthermore, health care personal can utilize the STEADI assessment to identify seniors at risk for falls and create a plan to provide physical modifications to their home that can prevent falls (Stevens et al., 2017).
When considering the physical environment, the following infographic by the Harvard Medical School provides information on quick and easy fall prevention strategies (2018). Keeping the floor free from clutter removes immediate tripping hazards and costs nothing. Making repairs to uneven floor transitions and adding slip
resistance surfaces decrease trips and slips. Improving lighting and adding high contrast markings to the floor allow those with visual impairments to see changes in floor level and texture. As previously mentioned, those who fear falling will often decrease their movement, so a person who feels confident moving about their home can be encouraged to remain active (McInnes & Askie, 2004).
This same mentality can be applied to the larger physical environment of the community and a senior’s perceived walkability of their neighborhood. If sidewalks are narrow, signs are hard to read, and the overall layout is confusing, seniors will not feel as comfortable entering the larger environment, decreasing their access to physical activity and making them feel secluded (Destifano et al., 2020). Policy changes and inclusion criteria need to be assessed in the planning stage to not segregate the elderly community. These policy changes take the form of sidewalks that accommodate walkers, surfaces with level transitions, crosswalk timers need not be too fast, and signs are readable by those with visual impairments. These requirements not only apply to those with age related to declines, but all persons with varying physical abilities. For more information regarding accessibility legislation and policy, you can visit the following website.
The benefit of actively preventing falls among seniors has been proven from many aspects. Decreasing falls leads to a longer, more meaningful life for the aging population and is less costly on the healthcare system (National Council On Aging). Resources can be found on the Government of Canada’s website, the National Council on Aging, or by taking part in the Parachute Canadian Fall Prevention Virtual Conference that is being hosted online from November 16th to 20th, 2020. All of the above resources provide information on programs and initiatives that can be employed by both the public and healthcare practitioners, to create changes at each ecological level, leading to meaningful results for the senior population.
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