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SINGAPORE: Two years ago, 78-year-old Madam Tan* lost her balance and fell during a bus ride. It caused a head injury and left her with a deep fear of leaving home.

Mdm Tan struggled to take even small steps due to a lack of confidence and lingering pain. Not wanting to burden her family, she rarely left the house and became increasingly isolated.

Madam Tan’s experience is not uncommon. One in three seniors aged 65 and older has at least one fall a year worldwide, increasing to one in two for those aged above 80.

Falls can result in significant long-term health complications, and are the leading cause of injury-related deaths in older populations. In Singapore, 85 per cent of geriatric trauma cases treated in Emergency Departments are caused by fall-related injuries, including major injuries such as fractures, joint injuries, brain injuries and internal organ bleeding.  

While the physical consequences of falls can be severe, it’s the often-unspoken psychosocial consequences that are the most devastating for seniors. Fear, anxiety, and loss of independence can lead to emotional distress.

A fall is not just a personal accident: Family members also face more caregiving responsibilities and may experience emotional or financial strain, causing family tension and burden.

THE CRIPPLING FEAR OF FALLING

Following a fall, many seniors also develop a crippling fear of falling – resulting in social withdrawal and isolation, such as in Madam Tan’s case.

Being socially connected is particularly important for the elderly. Social disconnection has been linked to a higher risk of premature death, as well as cognitive and physical conditions like depression, dementia, heart disease and stroke.

Preventing falls is therefore an important way to help us all to live long and healthy lives. But where do we start? It actually begins in the mind.

Being fearful of falling affects balance and gait, which in turn makes seniors more likely to fall, according to research. And recurrent falling, that is having two or more falls in a year, is one of the strongest predictors of accelerated functional decline and premature death.

In contrast, feeling confident in one’s ability to carry out daily activities without falling reduces the likelihood of falling. This is called self-efficacy – and it has been found to protect against falling more than physical factors such as balance and mobility performance.

BUILDING UP SELF-EFFICACY

Fortunately, self-efficacy is something that can be actively built up over time.

For example, Mdm Tan joined a community falls prevention programme piloted by the Centre for Ageing Research and Education (CARE) at Duke-NUS Medical School and the Singapore-ETH Centre. With her determination, she achieved her goal which was to take a bus ride with her daughter – an everyday act that became a significant milestone to rebuild her confidence. Mdm Tan now steps out confidently.

Seniors in the community who are at high risk of falls can also benefit from personalised interventions. CARE and the Singapore-ETH Centre are now looking at tailoring programmes based on their gait (using wearable sensors) and other lifestyle features to reduce their risk.

If an individual is found to have poor balance, the physiotherapist will focus the intervention on balance training and improving stability. Older adults will also be taught techniques for getting up safely after a fall. This is an essential skill, as many struggle to get up after a fall, which can lead to further injuries.

Preliminary findings showed that seniors who participated in such personalised programmes experienced improvements in physical performance, including balance, walking speed and leg strength. They also significantly reduced their fear of falling.

Enhancing physical capabilities and building confidence in one's ability to perform daily tasks without fear, further reinforces the importance of self-efficacy in preventing future falls.

Seniors have access to a wide network of falls risk screening and falls prevention services under the Ministry of Health’s Healthier SG initiative, which includes a 10-year goal to lower the admission rate of fall-related injuries in Singapore. Guidance on managing chronic conditions, safe medication use, improving mobility, maintaining physical function and enhancing home safety all contribute to falls prevention.

WORKING TOGETHER TO PREVENT FALLS

Besides providing the resources, knowledge and support to seniors, preventing falls requires a collective effort.

Community health initiatives, frequently organised in collaboration with healthcare providers and grassroots organisations, play a crucial role in raising awareness and empowering seniors.

Families and caregivers must also take a proactive role in creating safe home environments. Simple measures like installing grab bars (such as under the Enhancement for Active Seniors, or EASE programme), improving lighting and removing tripping hazards can go a long way in preventing falls at home.

Beyond removing environmental hazards, families can help seniors to build their confidence and resilience by encouraging physical and social activities and active participation in making decisions about their health.

Falls are preventable, they are not a normal or inevitable part of ageing. By prioritising falls prevention, we can build a community where seniors feel empowered, and age with confidence, resilience and purpose.

*A pseudonym was used in this commentary.

Dr Goh Jing Wen is a research fellow and Dr Lia Troeung is a senior research fellow at the Centre for Ageing Research & Education in Duke-NUS Medical School.