In Text:

If you are 65 years old or above, you are at an increased risk of falling and serious injury from falling (NICE, 2013; WHO, 2021). But falling isn’t just a part of getting older, it’s often due to a combination of factors – over 400, in fact (NICE, 2015) – some more serious than others.

If you or the person you are watching this for has just fallen and the following factors apply, please CALL 999. If you or they fall again, and the following apply, please CALL US BACK, no matter what time it is. Finally, if you have been advised to attend a&e and have chosen not to, please make sure you have someone who can check in on you over the next 48 hours (NICE, 2014). You and they should look out for:

• Breathing difficulties or chest pain
• A change in your behaviour, for example if you feel more irritated or confused than normal.
• Vomiting
• Dizziness, or feeling faint when you stand up
• Persistent headaches
• Memory changes – are you forgetting events since, or before, you fell over?
• Seizures
• Losses of consciousness, including faints.
• Any loss of sensation in your limbs or sudden new weaknesses, including signs of strokes.
• Swollen, painful muscles
• Or if you’re unable to mobilise, can’t get up from the floor, or develop any new pain

*This is not an exhaustive list.

Call 999.

If you have had alcohol, this may be hiding symptoms, so you may be advised to attend a&e.

Also, if you have fallen, hit your head, and you take blood thinners, or medications called anti-platelets, you need to be cautious.

You must attend a&e to be monitored and receive a scan of your head, a CT scan. Even if you have not drawn blood, you are still at risk of bleeding internally, especially in the brain because these medications are designed to prevent blood clots.

These medications might be called:

• Warfarin
• Rivaroxaban
• Dabigatran
• Apixaban
• Edoxaban
• Heparin (injection)

Antiplatelet medications include clopidogrel, aspirin.

• And others shown on the screen:

Dipyridamole 

Prasugrel

Ticagrelor

Cangrelor

(BNF, n.d.)

*These are more concerning when taken in combination, e.g. clopidogrel + aspirin

You must maintain extreme caution if you are on these medications. For more information about blood thinners and antiplatelets, please scroll below the video.

If none of this applies to you, but you are on the floor and you’re not hurt, don’t get up quickly.

Roll onto your knees and use nearby stable furniture to push yourself up. Then, sit down until you feel able to continue with your day (NHS, 2021).

Remember, if you’re not hurt but you still can’t get up, call for help. If you have one, you can press your personal alarm. You can call: family, friends, 999, or 111. In this circumstance, both 999 and 111 will lead to an ambulance arrival with a crew who can assess you and help you up. Both 999 and 111 result in the same ambulance service.

While you wait, the NHS recommends changing your position ‘at least once every half hour or so,’ (NHS, 2021) if you are able to and it is not painful to do so. Keep yourself warm and let 999 know if anything gets worse.

Be aware of what might have caused or contributed to your fall, and let the ambulance crew know when they arrive.

Additional Information

When to speak to your doctor:

6 out of 10 falls happen at home (SAGA, CSP, PHE, 2015), so there are often contributing factors – and there are ways we can help prevent these from causing you to fall.

If you are noticing an increase in your urine output, you should request a urine dip from your doctor in case you have a urine infection, which might make you confused (Alzheimer’s Society, 2021), or rush to the toilet (Soliman, Meyer, and Baum, 2016), often leading to falls.

If you are falling more often,

If your balance has worsened gradually,

Or you’re noticing a gradual worsening in the way you walk,

Or you’re feeling afraid of falling

*If anything mentioned here happens suddenly, you must call 999.

… You should ask for a falls assessment from your doctor. Health care professionals will look for factors contributing to your falls, which may range from problems with your eyes to problems with your bones, and looking at your medications to see if they are causing side effects (Saga, CSP, PHE, 2015).

They may also look at your home environment and identify items that could cause you to trip, even if they never have before. Ambulance crews might also point these out if they are attending to you. They should also ask to refer you for this falls assessment. (NICE, 2013)

Scroll beneath the video to find a link for information on how to get equipment, grants to pay for additional items, and personal alarms if you fall. If you have purchased your own keysafe, make sure you pass on the code to the ambulance service in case you cannot answer the door.

Thank you.

Links:

For equipment such as hand and grab rails, commodes, raised toilet seats, slip mats for the shower, grants to pay for additional items, and personal alarms if you fall, please follow this link. You should be able to get financial support from your local council for some of these items.

Other resources:

Stay Active at Home – Strength and balance exercises for older adults

Age UK also offer great advice and a ‘handyperson’ to help with small adaptations you might need.

References

Age UK. (2020). Avoiding a fall. Available at: https://www.ageuk.org.uk/information-advice/health-wellbeing/exercise/falls-prevention/ (Accessed 12/10/2021).

Alter SM, Mazer BA, Solano JJ, et al. (2020). Antiplatelet therapy is associated with a high rate of intracranial hemorrhage in patients with head injuries. Trauma Surgery & Acute Care Open, 5(1), e000520

Alzheimer’s Society. (2021). Urinary tract infections and dementia. Available at: https://www.alzheimers.org.uk/get-support/daily-living/urinary-tract-infections-utis-dementia (Accessed 18/10/2021)

BNF. (N.D.). Antiplatelet drugs. Available at: https://bnf.nice.org.uk/treatment-summary/antiplatelet-drugs.html (Accessed 12/10/2021).

CDC. (2017). Assessment. Timed Up and Go. Available at: www.cdc.gov/steadi/pdf/TUG_Test-print.pdf (Accessed 12/10/2021).

The Chartered Society of Physiotherapy (CSP). (2015). Get up and go – a guide to staying steady. Available at: https://www.csp.org.uk/publications/get-go-guide-staying-steady-english-version (Accessed 12/10/2021).

CSP. (2017). Stay active at home – Strength and balance exercises for older adults. Available at: Stay Active at Home – Strength and balance exercises for older adults (Accessed 12/10/2021).

Dallas, M. (2015). The Need-to-Know Side Effect of Blood Thinners. Available at: https://www.everydayhealth.com/news/need-know-side-effect-blood-thinners/ (Accessed 18/10/2021).

Knott, L. (2021). Rhabdomyolysis and Myoglobinuria. Available at: https://patient.info/doctor/rhabdomyolysis-and-other-causes-of-myoglobinuria (Accessed 12/10/2021).

National Blood Clot Alliance. (n.d.). Living your best life while taking blood thinners. Available at: https://www.stoptheclot.org/living-your-best-life-while-taking-blood-thinners/ (Accessed 18/10/2021).

NHSa. (2021). Falls. Available at: https://www.nhs.uk/conditions/falls/ (Accessed 12/10/2021).

NHSb. (2021). Anticoagulant medications. Available at: https://www.nhs.uk/conditions/anticoagulants/ (Accessed 12/10/2021)

NHSc. (N.D.). Care Services, Equipment and Care Homes. Available at: https://www.nhs.uk/conditions/social-care-and-support-guide/care-services-equipment-and-care-homes/ (Accessed 12/10/2021).

NICEa. (2013). Falls in older people: assessing risk and prevention. Available at: https://www.nice.org.uk/guidance/cg161 (Accessed 12/10/2021).

NICEb. (2015). Falls in older people. Available at: https://www.nice.org.uk/guidance/qs86/chapter/About-this-quality-standard (Accessed 12/10/2021).

NICEc. (2019). Falls – risk assessment. Available at: https://cks.nice.org.uk/topics/falls-risk-assessment/ (Accessed 12/10/2021).

NICEd. (2014). Head injury: assessment and early management (NICE Clinical Guideline 176). Available at:  https://www.nice.org.uk/guidance/cg176 (Accessed 16/06/2020).

Nishijima, D. (2012). Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and preinjury warfarin or clopidogrel use. Annals of Emergency Medicine, 59(6), pp: 460-468.

North American Thrombosis Forum. (2020). Falls and anticoagulation. Available at: https://natfonline.org/2020/08/falls-and-anticoagulation. (Accessed 18/10/2021).

Probst, M. et al. (2020). ‘Prevalence of Intracranial Injury in Adult Patients With Blunt Head Trauma With and Without Anticoagulant or Antiplatelet Use’. Annals of Emergency Medicine, 75(3), pp: 354-364.

Public Health England. (2017). Falls and fracture consensus statement – Supporting commission for prevention. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/586382/falls_and_fractures_consensus_statement.pdf (Accessed 12/10/2021).

Saga, CSP, and PHE. (2015). Get Up and Go: A Guide to Staying Steady. Available at: https://www.csp.org.uk/system/files/get_up_and_go_0.pdf (Accessed 12/10/2021).

Soliman, Y., Meyer, R., And Baum, N. (2016). Falls in the Elderly Secondary to Urinary Symptoms. Reviews in Urology. 18(1), pp: 28-32.

Stiell, I. et al. (2003). ‘The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma’, The New England Journal of Medicine. 349. pp: 2510-2518.

Skellet, S. et al (2021). Paediatric advanced life support Guidelines. Available at: https://www.resus.org.uk/library/2021-resuscitation-guidelines/paediatric-advanced-life-support-guidelines (Accessed 18/10/2021).

WHO. (2021). Falls. Available at: https://www.who.int/news-room/fact-sheets/detail/falls (Accessed 18/10/2021).

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A history of falls in the past year is the single most important risk factor for falls and is a predictor of further falls.

https://www.nice.org.uk/guidance/qs86/chapter/Quality-statement-1-Identifying-people-at-risk-of-falling>

NICE (2019) recommends using the ‘Timed Up and Go’ test to assess a person’s risk of falling. Details on this can be found here: https://www.cdc.gov/steadi/pdf/TUG_Test-print.pdf

‘An older adult who takes ≥12 seconds to complete the TUG is at risk for falling’

(CDC, 2017)

A video on this is available from the CSP here.

Thank you,

Louise Sopher
HCPC Registered Paramedic
Article 999 Founder