HomeFront guide to preventing falls for older people

© Commonwealth of Australia 2006

This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney General’s Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca

Published by the Department of Veterans’ Affairs, Canberra, 2006.

P01247 January 2006

This publication was developed by the National Ageing Research Institute for the Department of Veterans’ Affairs. It includes information from the “Helpful HomeFront Hints” booklet previously published by the Department of Veterans’ Affairs, “Falls prevention tip sheets” developed by the National Ageing Research Institute and “Don’t fall for it. Falls can be prevented” booklet published by the Australian Government Department of Health and Ageing.

Project team: Keith Hill and Freda Vrantsidis from the National Ageing Research Institute and Lindy Clemson from the University of Sydney.

Acknowledgements:

Permission from the following organisations to use graphics from their falls prevention resources is gratefully acknowledged:

• Bendigo Health Care Group

• Queensland Health and Queensland Department of Housing

• Stay on Your Feet, Health Promotion Unit, Northern Rivers Area Health Service NSW

Additional acknowledgements for the use of information developed by other organisations are listed on relevant pages in the booklet.

We would also like to thank our focus group participants for their feedback on ways to improve this booklet.

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Contents

Introduction 1

Falls: The facts 1

Falls: Risk factors 2

PART 1: PERSONAL RISK FACTORS – THE FACTS AND WHAT TO DO 3

History of falling 4

Unsteadiness in walking, poor balance and muscle weakness 5

Low levels of physical activity 10

Medications 11

Medical problems, including dizziness and memory problems 13

Vision problems and other sensory loss 15

Foot problems 17

Fear of falling 18

Other risk factors – being underweight, inadequate nutrition, incontinence and alcohol use 19

Where to get help at a glance 21

Personal falls risk factor checklist 26

My action plan 28

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PART 2: THE ENVIRONMENT AND FALLS 30

Home Hazard Checklist 34

Floors and internal walkways 34

Lighting and powerpoints 35

Hallways, stairs and internal steps 35

Living / dining room 36

Bedrooms 37

Kitchen and laundry 38

Bathroom, shower and toilet 39

Garage 40

Outside your house 41

Other considerations 42

Planning for the future 44

PART 3: OTHER HELPFUL INFORMATION 45

What to do if you were alone and had a fall 45

Department of Veterans’ Affairs Services 48

1

IntroductionFalls are not an inevitable part of ageing. Most falls can be prevented. A range of actions have been found to be effective in reducing falls and injuries from falls.

This booklet provides veterans and war widows living at home with practical information about falls and how to prevent them. It details the causes that contribute to the risk of falling and helps you to consider the risk factors that may apply to you. You can then work through a list of practical actions you can take to minimise or modify each risk factor.

Unsteadiness in walking, slips or trips, or actual falls, are warning signs that should be discussed with your doctor. You may also seek assistance from other health professionals, such as a physiotherapist, occupational therapist or community nurse (for example, at a community health centre).

Activities to prevent falls are important because they also:

1 help maintain independence; and

2 improve quality of life and well being.

Falls: The factsFalls are a common and important health issue for older people. A fall can affect independence and quality of life, whether or not an injury occurs.

Did you know?

■ One in three people aged 65 and over report falling at least once a year

■ About 10 per cent of falls result in serious injury (eg fractures)

■ Falls are a leading cause of injury-related hospital admissions and deaths for older people

■ Falls can also lead to the need for residential care

I want to know more about preventing a fall

2

■ A fall can cause people to lose confidence in walking and avoid activities even if they have not been injured

■ In Australia in 2001, the cost of treating falls related injuries was estimated to be $498 million

This booklet outlines the most common causes of falls and describes ways that these causes can be addressed to reduce your risk of falling.

Falls: Risk factorsFalls have many causes. These causes, or risk factors, include both personal factors and environmental factors. Knowing more about what causes falls will help you better understand that falls are not just a natural part of ageing and that you can take action to address both personal and environmental risk factors that put you at risk of falls. What are personal and environmental factors?

■ Personal factors are those related to health problems that affect your ability to steady yourself in situations when a fall might occur (for example, poor eyesight, muscle weakness, or balance problems). Personal falls risk factors are described in detail in Part 1 of this booklet.

■ Environmental factors are things in the surrounding area that might increase the risk of falling (for example, slippery floor surfaces, uneven paths, obstacles, or poor lighting). Environmental falls risk factors are described in detail in Part 2 of this booklet.

This booklet outlines what actions can be taken to reduce these personal and environmental risk factors. Any one of these factors can cause a fall, however, the greater the number of risk factors, the higher the risk of falling.

The following information will help you better understand the personal risk factors that can cause a fall. For each risk factor, we describe how it increases the risk of falling and what can be done to reduce the risk of falling if that risk factor is present. Personal risk factors that are discussed include:

1 Previous falls

2 Unsteadiness in walking, poor balance and muscle weakness

3 Low levels of physical activity

4 Medications

5 Medical problems, including dizziness and memory problems

6 Vision problems and other sensory loss

7 Foot problems

8 Fear of falling

9 Other risk factors – being underweight, inadequate nutrition, incontinence and alcohol use

To help you further we have included a falls risk checklist and an action plan (pages 24 to 29). After reading pages 4 to 24, you may wish to complete the checklist and action plan. This will be your record of personal risk factors that apply to you and what you plan to do to address each risk factor. This information can also be given to your doctor, or other health professional, to discuss in greater detail.

3

Part 1: Personal risk factors – The facts and what to do

4

History of fallingFalls are not an inevitable part of ageing. If you have had one or more falls in the past 12 months, it is important to see your doctor to find out why. It may be a sign of an undiagnosed medical condition, muscle weakness, balance or walking problems, medication side effects, or often a combination of these factors. Your doctor will be able to investigate the cause, or causes, and talk to you about ways to reduce the likelihood of further falls. Identifying and dealing with falls risk factors in this way has been shown to be a very effective way to reduce falls.

Action to take:

■ Talk to your doctor about your history of falling. Completing the falls risk checklist on page 26 can also help. Take it with you when you talk to your doctor.

■ After completing your falls risk checklist, think about the actions you can take to reduce your risk of falling. List these in your action plan (pages 28 and 29).

■ It may be useful to record when you have fallen (time of day) and what activity you were doing at the time, or any reasons you think may have led to the fall.

■ Some people with certain medical or physical conditions continue to fall despite the precautions they take. In this situation precautions to reduce injuries need to be considered. This can include taking vitamin D and calcium supplements, wearing hip protectors, and using other aids and equipment. Your doctor, community nurse, physiotherapist or occupational therapist can assist you.

■ Make sure your environment is safe from hazards (see Part 2 of this booklet on page 30). Eligible veterans can also access the HomeFront Program.

“I started falling about 9 months

ago. I really didn’t think much about it when it first happened.

I thought accidents happen. Then it happened again, and again. After the third fall

I thought I had better talk to my doctor about it.

It was the smartest thing I did.”

Mavis, 69

5

Unsteadiness in walking, poor balance and muscle weaknessBalance problems, unsteadiness in walking and muscle weakness can all increase your risk of falling. You doctor will help to identify the causes and determine the most appropriate treatment. Your doctor may refer you to a physiotherapist for further assessment, exercise and to assess whether a walking aid is needed. Several types of exercise have been shown to reduce falls by older people.

Action to take:

■ Talk to your doctor about what type of exercise program might be most appropriate for you. Although some exercise programs are conducted in the community, a referral to a physiotherapist is often recommended. The exercises may be done under the supervision of a physiotherapist or as a home exercise program. If done regularly, balance and strength exercises can protect you from falls (see pages 7 to 9). Tai chi and other group exercise programs may also be useful to consider. Contact your Veterans’ Affairs Network (VAN) office, local council or local community health centre for activity programs in your area.

■ Talk to your doctor or a physiotherapist about whether you need a walking aid such as a stick or a frame. They can help you select the most appropriate aid (type and height) and provide information about the safest way to use the aid. Eligible veterans can access the Rehabilitation Appliances Program (RAP).

■ If you use a walking aid, make sure it is kept in good condition. In particular, replace worn stoppers.

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■ Handrails and other home modifications may also help. An occupational therapist or HomeFront assessor will be able to assist. Contact your local VAN office, HomeFront program, RAP, community health centre, or local council home modification program. Other relevant Department of Veterans’ Affairs (DVA) programs include the Veterans’ Home Maintenance Line and Defence Service Homes Loans and Insurance (see page 48 and 49).

■ If unsteady, sit down when dressing rather than balancing on one leg.

■ Some common health conditions, such as arthritis, stroke, Parkinson’s disease and foot and back problems can affect your balance. Make sure these conditions are properly managed and discuss your concerns with your doctor.

■ Some medications have side effects that can affect your balance. Discuss any concerns with your doctor, pharmacist or community nurse.

■ Look after your health, have regular check ups, keep active and eat well.

Falls are a worry, what can we do?

7

Strength and balance exercisesTwo examples of balance exercises and two examples of strengthening exercises are shown on the following page. Before attempting to do the exercises, first read the safety precautions.

Safety precautions:

■ If you are unsteady in walking or have had recent falls, talk to your doctor before trying these exercises.

■ Perform these exercises with a wall six to eight inches (15 to 20 cm) behind you, and a bench or chair on either side. They will provide support or a means of steadying yourself if you feel unsteady during the exercise.

■ Do each exercise a small number of times (for example 5 to 10 times) to start with. Then slowly build up the number of times you repeat each exercise over three to four weeks. Most benefit is achieved if the exercises can be done each day.

■ If you experience any pain, discomfort, or find the exercises too difficult, you should stop the exercise and talk to your doctor or physiotherapist.

The exercises below are only examples of some of the range of exercises available. A physiotherapist will be able to provide you with a set of balance and strengthening exercises and other types of exercises that are most appropriate for you.

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Strengthening exercises:

Adapted from the Otago Exercise Programme to prevent falls in older adults – ACC (New Zealand)

■ Stand up tall and look ahead

■ Place your feet shoulder-width apart

■ Squat down half way, bending your knees

■ The knees go over the toes

■ When you feel your heels start to lift, straighten up

■ Repeat

You can do this exercise while you watch TV.

■ Sit on a chair which is not too low

■ Place your feet behind your knees

■ Lean forward over your knees

■ Stand up slowly without using your hands

■ Stand for five seconds, then sit down slowly without using your hands

■ Repeat

Note: use one hand for support if having difficulty.

EXERCISE 1 KNEE BENDS – NO SUPPORT

EXERCISE 2 SIT TO STAND (NO HANDS)

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Balance exercises:

Adapted from the Choose Health; Be Active booklet, Department of Veterans’ Affairs and Australian Government Department of Health and Ageing.

■ Stand next to the kitchen bench or the back of a sturdy chair – hold on if you need to

■ Lift your right leg and stand for 10 seconds on your left leg

■ Repeat 5 times

■ Repeat with other leg

■ If you feel steady enough, do it without holding on

■ If you are very steady on your feet, try this with your eyes shut

■ Stand next to a support (the kitchen bench will do) for this walking exercise

■ Step forward by putting the heel of one foot directly in front of the toes of the other foot, so that they touch (or almost touch) and then step forward with the other foot

■ Repeat for 2 minutes

■ If you can do this easily without holding on, try it with your eyes shut. Have someone stand next to you to support you if you need help

EXERCISE 2 WALK HEEL TO TOE

EXERCISE 1 STANDING ON ONE FOOT

10

Low levels of physical activity Your body requires a certain amount of activity to maintain general health and to minimise falls risk. Activity can include walking, gardening, recreational activities such as golf or bowls, or other exercises. It is common for people who fall, or feel unsteady when they walk, to reduce their level of activity. Over time, this can result in increased balance problems, increased tiredness, and increased risk of falling. It is important to discuss your concerns about falls, and maintaining or increasing your activity levels with your doctor.

Action to take:

■ Keep physically active every day as every little bit of activity counts. Keeping active increases muscle strength, keeps your joints more flexible and improves independence. Aim to do at least 30 minutes of activity, five or more times a week.

■ Find ways of including extra activity in your day to day tasks. For example, exercise while watching television, or take the longer route to or from the shops.

■ Using a walking aid, such as a stick or frame, can sometimes increase your steadiness and confidence to do more walking outdoors. Talk to your doctor or physiotherapist about whether you need a walking aid. They can also help you select the most appropriate aid (type and height) and show you how to use the walking aid correctly. Eligible veterans can access RAP.

■ Ask DVA or the Australian Government Department of Health and Ageing for a copy of their “Choose Health; Be Active” booklet. This booklet shows you simple ways to keep fit and active.

“My wife and I joined an exercise group

about 6 months ago, I can’t believe how great I feel. I have so much energy and my walking and balance has

improved. When my wife first suggested it I thought she was crazy, “what good is

it at our age”, but she was right, it’s never too late

to start.”

Jim, 78

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MedicationsSome medications can increase your risk of falling. These include some of the medications you may be taking for:

■ Anxiety or depression

■ Difficulty sleeping

■ High blood pressure

■ Parkinson’s disease

■ Circulation or heart problems

Some of the side effects from these medications can include drowsiness, confusion, dizziness or unsteadiness. Ask your doctor or pharmacist for written information about your medication. The more medications you take also increases the risk of falling. It is important for your doctor to know if you are feeling unsteady or if you have had a fall. Your doctor can review your medications to see whether any of these might be the cause. Reducing some of these medications associated with increased falling has been shown to reduce the risk of further falls.

Action to take:

■ Take your medication as advised by your doctor and follow the instructions that come with the medication.

■ Ask your doctor or pharmacist about possible side effects and whether the medications you are taking put you at risk of falling. Notify your doctor if you experience any side effects, especially if you have been prescribed new medication or have had a change in the dose administered.

■ Regularly review your medication with your doctor or pharmacist. Ask your doctor about a Home Medicines Review (see page 50).

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■ When discussing your medications with your doctor, make sure they are aware of any falls you have had.

■ Do not stop taking your medication, or change the way you are taking the medication, without discussing this with your doctor first.

■ Do not use any medication prescribed for someone else.

■ If you are thinking about taking herbal medicines, talk to your doctor first. They may interact with other medications causing serious reactions.

■ Be aware that alcohol can interact with some medications to cause harmful effects, for example, your medication may not work as well or at all.

■ Also discuss alternatives to medications with your doctor. For example, avoid drinking coffee before going to bed and try not to ‘nap’ during the day. Using relaxation strategies, such as gentle music, at bed-time may also improve your sleep pattern and reduce the need for sleeping tablets.

■ A dosette box or webster pack may help organise your medications. Discuss these options with your pharmacist.

■ Spring clean your medication cupboard and discard any old medication you no longer use or whose expiry date has passed.

Be inspired –

Spring clean

your medicine

cupboard

13

Medical problems, including dizziness and memory problemsMany chronic medical conditions, that is, long term health problems, can increase your likelihood of falling. Some conditions can make you dizzy, alter your balance or the way you walk, make you stiff and therefore less able to react quickly, or distract you because of pain. Conditions that may increase your risk of falling include:

■ Stroke

■ Parkinson’s disease

■ Arthritis

■ Low blood pressure

■ Dizziness

■ Diabetes

■ Depression

■ Dementia

Memory loss, confusion or disorientation may make people less aware of their immediate surroundings and less able to respond to changes in surfaces or obstacles.

Some short term illnesses, such as the flu, diarrhoea or urinary infections, can also contribute to an increased risk of falls.

Action to take:

■ When you’re sick, take extra care when walking or getting up.

■ Stand up slowly after lying down or sitting and take care when bending down. Make sure you are steady before walking.

■ Make sure that your medical condition (long term or short term) is properly managed. Discuss any concerns with your doctor.

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■ Further information about your medical condition can be obtained by contacting a support organisation, eg Arthritis Australia, Diabetes Australia.

■ If you are momentarily confused or disoriented – sit down if possible and take time to gather your thoughts or ask for assistance – avoid rushing. Discuss these incidents with your doctor.

■ Some causes of memory loss, confusion, or disorientation are caused by health problems that are treatable. Speak to your doctor to identify causes of memory loss, confusion or disorientation and to discuss treatment options.

■ Speak to you doctor to identify and treat causes of dizziness. Some common causes of dizziness can be treated.

■ Look after your health, have regular check ups, keep active, eat well and if you drink alcohol, do so in moderation.

Take good care of your eyes

15

Vision problems and other sensory lossInformation from our senses allows us to safely navigate our environment. Sensory information for balance comes from the eyes, the inner ear and the sensation or feeling in the legs. As we age our eyesight is less sharp. Our eyes take longer to adjust to light and dark and they are more sensitive to glare. Contrast, distance and depth are also harder to judge. Poor vision and other sensory problems, such as poor hearing, numbness in the leg(s) or feet and dizziness, can increase your risk of falling.

Action to take:

■ Have your eyesight checked each year by your doctor and if you wear glasses have them reviewed by an optometrist every two years. Eligible veterans can also access DVA optical services.

■ If you notice a change in your eyesight talk to your doctor or optometrist. Early detection of eye problems can help prevent them from getting worse.

■ If you have cataracts talk to your doctor about an early referral for cataract surgery. There may be a long wait for this kind of surgery.

■ Keep your glasses clean and always wear the correct glasses, eg distance glasses for distance vision.

■ If you wear bifocal or multifocal glasses take extra care on stairs or steps and while walking. Looking through the wrong section of these glasses can obscure your vision. Some people have difficulty adjusting to wearing bifocals or multifocals when going up and down stairs or curbs. It may be safer to revert to using distance glasses for all outdoor walking.

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■ If wearing transitional glasses, that is glasses that automatically darken when you go out into light and vice versa, take time to allow your eyes to adapt to changes in light.

■ Make sure areas you walk in are well lit. Pulling back curtains, adding a lamp, or using a higher wattage (brighter) globe are simple methods of increasing lighting. First check the capacity of your light fitting before using a higher wattage globe. Take extra care in the evening and at night as more falls happen at these times due to tiredness and decreased light.

■ Turn on your bedside lamp before getting up at night and make sure your glasses are well within reach. The installation of sensor lights in your bedroom or corridor may be worth considering.

■ Make sure your home has adequate lighting throughout, especially in walkways, stairs and steps. An occupational therapist or HomeFront assessor can help. (See page 48 and 49 for DVA home modification programs, including HomeFront, Veterans’ Home Maintenance Line, home loans and insurance).

■ Allow your eyes time to adjust when moving from light to dark and vice versa. Avoid outside glare by wearing a wide brim hat and sunglasses. If you do not have prescription sunglasses, sunglass attachments are available to clip on to your ordinary glasses.

■ If you have vision difficulties, you may want to discuss further strategies for coping at home or in the community with your occupational therapist or contact your nearest Low Vision Clinic.

■ Have any hearing problem or loss of sensation in the leg(s) or feet reviewed by your doctor for potential causes and treatment.

17

Foot problemsTake care of your feet – they support your body. Painful feet and changes in the foot shape (eg bunions or hammer toes) can alter your walking pattern and may upset your balance.

Action to take:

■ Bunions, corns, heel spurs, aching or swollen feet or other foot problems need to be attended to. Your local podiatrist can assist you. Eligible veterans can access DVA’s podiatry service.

■ Exercising your feet regularly maintains circulation, flexibility and strength. Discuss this with your doctor, physiotherapist or podiatrist. A foot massage is also an enjoyable way to help circulation.

■ Wear comfortable, good fitting shoes with secure fasteners (shoe laces or velcro fasteners), a low heel and soles that grip. Make sure there is plenty of room for your toes.

■ Avoid slippers, scuffs, thongs and other loose fitting shoes, including slip on shoes – they can cause a trip. Avoid walking in socks.

■ If you have difficulty finding shoes to wear because of your foot problems, there are specially designed shoes that might be suitable for you. Ask your podiatrist for contact details.

Enough room for your toes

FastenersFirm heel counter

Low heels and soles that grip

Correct size and fit

18

Fear of fallingLoss of confidence when walking, also known as a fear of falling, can occur after a fall, even when there is no injury. This fear sometimes results in avoiding similar and other activities. Over time, this reduced activity can lead to deconditioning – make you weaker and your balance worse – further increasing your risk of falling.

Action to take:

■ Talk to your doctor about your loss of confidence when walking, to see what can be done.

■ Building up your strength and balance through regular exercise and activity can help protect against falls and help build up your confidence in walking (see pages 8 and 9). It may be useful to work on improving your balance and strength initially under supervision (with a physiotherapist or family member), then progress to doing this by yourself. Gradually increase the distance and frequency of your walking.

■ A walking aid such as a stick or a frame may provide more steadiness when walking and increase your confidence and reduce your fear of falling. If considering using a walking aid, discuss this with your doctor or physiotherapist. They can help select the most appropriate walking aid for you and show you how to use the walking aid correctly.

■ If you are worried about being unable to get up after a fall, your doctor or physiotherapist can show you the best way to get up off the floor.

■ A personal alarm (worn as a wrist band or necklace, to press for assistance if a fall occurs) may also help improve your confidence and reduce concerns for your family and friends. If you do fall, you can easily call for help. Contact your

19

local council Home and Community Care service or state health department for more information. Eligible veterans can access the RAP.

■ Assistance in regaining your confidence can also be obtained from a psychologist (through the Vietnam Veterans Counselling Service, your local community health centre or hospital). They can work with you to help build your confidence in activities that you feel are challenging or cause you fear.

Other risk factors – being underweight inadequate nutrition, incontinence and alcohol useOther risk factors have also been shown to lead to falls and related injuries. Being underweight can increase your risk of injury. Inadequate nutrition (and fluids) can leave your weak, make you dizzy and leave you with little energy to keep active. The need to go to the toilet frequently, urgently or at night, can have you rushing to the toilet, or going when you are not fully awake or in the dark, increasing your risk of falling. Alcohol use can also lead to falls.

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Action to take:

■ Eat well to maintain your muscle strength and bone density, and to provide you with energy to undertake regular physical activity.

■ Make sure you have adequate calcium intake to maintain healthy bones. Have three serves of high calcium foods every day – a cup of milk or soy milk, two slices of cheese, a tub of yoghurt or a can of sardines or salmon with bones.

■ If you are unable to eat three serves of high calcium foods daily talk to your doctor about calcium supplements.

■ Spend at least 20 minutes outdoors, 4 to 6 times a week, to get enough vitamin D from the sun. Vitamin D, in combination with calcium, helps maintain bone strength and reduce the risk of fractures. Your doctor can test for vitamin D deficiency and provide supplements if necessary.

■ To prevent dehydration it is important to drink sufficient fluids (6-8 glasses a day).

■ Before getting out of bed to go to the toilet, take a minute to sit on the bed to orient yourself to where you are, then slowly rise from the bed. Turn on a light or a lamp by the bed – to avoid walking in the dark.

■ Reduce fluid intake at night to lessen the need to go to the toilet at night. To avoid rushing to the toilet, don’t delay toileting. Keep pathways to the toilet free of clutter.

■ Eligible veterans can access DVA’s dietetic service. Dietitian services can also be found by contacting your local community health centre or health service.

■ If you drink alcohol, do so in moderation. If drinking is a problem for you, that is drinking too much or in dangerous situations, contact the Vietnam Veterans Counselling Service.

21

Where to get help at a glanceThese are some of the people and organisations that can help you reduce your risk of falling. You can contact them for more information about the range of services they provide.

Department of Veterans’ Affairs (see pages 48–52):

■ HomeFront Program

■ Veterans’ Home Maintenance Line

■ Defence Service Homes Subsidised Loans and Home Support Loans

■ Defence Service Homes Insurance

■ Rehabilitation Appliances Program (RAP)

■ Veterans’ Home Care

■ Vietnam Veterans Counselling Service (available to all Australian veterans)

■ Podiatry, Optical and Dietetic services (doctors referral needed)

Health professionals:

Local medical officer or general practitioner (doctor): management of chronic conditions and acute illness, medication reviews (including a Home Medicines Review), advice about exercising.

Community nurse: provide supportive nursing care and advice at home.

Physiotherapist: balance and walking assessment, recommend or develop an exercise program or physical activity options, advice and exercise to improve walking, provision of appropriate walking aid and training in its use.

22

Occupational therapist: home safety assessment, advice and organisation of home and community modifications for independence and safety (including aids and equipment requirements), community mobility, community access and physical activity and recreational options.

Podiatrist: footcare, advice and management of foot problems, footwear orthotics, and advice on footwear for safety and individual need.

Pharmacist: medication reviews, advice on side effects of medications – develop a relationship with a good local pharmacist who gives you both verbal and written advice.

Dietitian: advice on ways to increase your dietary calcium intake; nutrition advice to increase or decrease weight and ensure adequate nutrition for activities.

Psychologist: counselling for anxieties or fear of falling.

Optometrist: vision assessments, eyewear prescription; eye care advice and referral.

Audiologist: hearing assessments, hearing aid prescription, hearing care advice and referral.

Local community health centre / health service:

■ Allied health services (for example, physiotherapist, occupational therapist, dietitian, podiatrist, psychologist)

■ Exercise and other activity programs

■ Home modifications

Local council:

■ Local exercise and other activity programs

■ Home modifications

■ To report outdoor (public) environmental safety hazards (eg uneven surfaces)

23

Commonwealth Carelink (call 1800 052 222):

■ Allied health services in your area (for example, physiotherapist, occupational therapist, dietitian, podiatrist, psychologist)

■ To find physiotherapists or fitness instructors, exercise or physical activity programs in your area

■ Information about support groups and other community services

Other organisations:

■ Australian Psychological Society for psychologists in your area

■ Dietitians Association of Australia or Nutrition Australia for dietitians in your area

■ OT Australia for occupational therapists in your area

■ Optometrists Association of Australia for optometrists in your area

■ Podiatry Association Council for podiatrists in your area

■ Therapeutic suppliers (listed in the yellow pages), including the Independent Living Centre

■ Low Vision Clinic for assessment and advice for coping with low vision at home and moving about outdoors and in the local neighbourhood

■ Australian Hearing

■ Continence Helpline

■ Diabetes Australia

■ Arthritis Australia

■ Other chronic condition support organisations

24

Some tips to help you when talking to your doctor or health professional:

■ Write down what you have been feeling and any questions you want to ask before you see your doctor.

■ Bring your medication card with you so that you have a complete record of all the medications you are taking.

■ Do not be afraid to ask your doctor, or other health professional, questions about your health. If you do not understand their advice, ask them to explain it again in a different way.

■ If your doctor suggests that your problem is due to “ageing”, whether it is your balance or confidence in walking, ask them what can be done to improve or prevent any further decline. If need be, seek a second opinion from another doctor or other health professional.

Completing a personal falls risk checklist and action planWe have discussed the many personal risk factors that can lead to a fall and the actions you can take to reduce them. To help you further we have included a personal falls risk checklist and an action plan. The checklist helps you identify the risk factors that apply to you and the action plan allows you to list the actions you can take to deal with each risk factor.

When you complete your Personal Falls Risk Checklist and Action Plan you can take them to your doctor or other health professional to discuss them in greater detail.

25

To complete your Personal Falls Risk Checklist: Tick each risk factor that applies to you (see example below). For more information about the risk factor refer back to the page number listed. Note: Even if the risk factor is present in a mild form it is worth noting and doing something about it. Early detection makes dealing with the problem easier and the results will be better.

Falls risk factor Tick if they apply

Have you fallen more than once in the previous year or sustained an injury as a result of a fall. (see page 4)

Are you unsteady when walking or turning, or use furniture to support yourself while walking, or have difficulty getting in or out of bed or chairs. (see page 5)

To complete your Action Plan: Read each section about your identified risk factors to see the range of actions you could consider. Turn to your action plan and list as many actions as you feel would be appropriate for you to put in place. You can then use the action plan to record which action(s) you implemented, and the date this was done. Note: It is worth reading all sections of this booklet. Even if the risk factors are not relevant for you today, the information may be useful as a preventative measure.

26

Personal falls risk checklistRefer to page 25 for instructions if unsure how to complete this checklist.

Tick the boxes to indicate action needed.

Falls risk factor Tick if applicable

Have you fallen more than once in the previous year or sustained an injury as a result of a fall? (see page 4)

Are you unsteady when walking or turning, or use furniture to support yourself while walking, or have difficulty getting in or out of bed or chairs? (see page 5)

Are you generally inactive, that is you do not exercise, walk regularly or do any other physical activity (at least 30 minutes a day, five times a week)? (see page 10)

Do you take four or more medications and / or medications that can make you drowsy, dizzy or affect your balance? (see page 11)

Do you have one or more chronic medical conditions that affect your balance? (see page 13)

Do you get dizzy when you stand or walk or take certain medication? (see page 13)

Do you sometimes get confused or disoriented or forget important things? (see page 13)

27

Falls risk factor Tick if applicable

Do you have difficulty seeing objects or steps even when wearing your glasses? (see page 15)

Do you have a hearing problem or touch sensation problems that affect your day to day activities? (see page 15)

Do you have corns, bunions or other foot problems that cause you pain or affect your balance? (see page 17)

Is your footwear generally ill fitting, have little traction (worn soles), have heels that are too high or have no fasteners? (see page 17)

Do you have a fear of falling that is restricting the activities you undertake even though you are capable of more? (see page 18)

Have you lost weight recently, have poor appetite, or are very underweight for your height? (see page 19)

Do you often have an urge to rush to the toilet or do you get up several times at night to go to the toilet? (see page 19)

On average do you drink more than four standard alcoholic drinks per day (or two standard drinks for women), or more than six standard alcoholic drinks on any one day (or four standard drinks for women) and have no alcohol free days (both men and women)? (see page 19)

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My action planList the actions you intend to take to reduce your risk of falling. We have added some actions to help you get started. Some may not be relevant to you. If not, cross them out. Otherwise, be as specific as possible in the actions you need to take (eg Make a doctors appointment to discuss my arthritis, exercises to help my arthritis and whether I need to consider a walking aid).

Actions I need to take to reduce my risk of falling

Date to do by / completed

Make doctors appointment to (eg talk about falls, my medication, exercising, etc)

Make doctors appointment to organise a medication review

Talk to the pharmacist about (eg medication side effects, obtaining consumer information about medication etc)

Make appointment for an eye test

Make appointment to see a physiotherapist to (eg talk about exercise, walking aid etc)

Make appointment for a home safety checklist (include who to contact, and any areas of concern etc)

Make appointment with a podiatrist

Buy new shoes

Find out about activity / exercise programs in the area

Contact the local Veterans’ Affairs Network about DVA services and eligibility

Develop a “falls plan”

29

Other actions I need to take to reduce my risk of falling

Date to do by / completed

Additional notes:

30

Environmental hazards are often involved in falls by older people living independently at home. Many falls (up to 60 percent) occur in the home. Environmental hazards include:

■ Step and stair hazards

■ Clutter and other obstructions

■ Poor lighting

■ Uneven or slippery pathways

■ Tripping hazards (eg cords, rugs)

■ Using furniture for climbing, or support while walking

■ Wet or slippery floors

■ Items kept in places too high / too low or out of reach

■ Inappropriate (wrong type or height) or poorly maintained walking aids

■ Other inappropriate or poorly maintained aids and equipment (eg rails, commodes)

■ Items of clothing that are too long and loose

■ Inappropriate (unsafe) footwear

■ Inappropriate chair or bed height (too low or too high)

■ Undertaking activities that are associated with a high risk of falling

Part 2: The Environment and Falls

31

Obstacles can cause falls

To help make your environment safe, we have provided a checklist describing some common hazards that can lead to a fall in your home (pages 34 to 43). If you are planning to build, extend or renovate see page 44.

Even when you consider that an environmental hazard, such as a slippery floor, may be the main cause of your fall, it is important to discuss the circumstances of the fall with your doctor. Often falls are due to a combination of factors so there may be other actions that need to be taken to reduce future risk of falling.

An occupational therapist or HomeFront assessor can help you identify falls hazards in your home and discuss ways you can be safer at home. Refer to page 21 for general information about where to get help and page 48 for information about HomeFront.

32

Environmental hazards are also present away from the home, including:

■ Uneven, broken footpaths or loose pavers

■ Cracks and potholes on the road

■ Leaves on footpaths

■ Overhanging branches, shrubs and trees obstructing footpaths

■ Poor lighting

■ Shiny or slippery floor surfaces in shopping centres and other public buildings

■ Poorly contrasted steps in shops and other public buildings

Improving your balance and strength and making sure your vision is corrected where possible will help protect you in at-risk situations in public places.

If you experience a fall, slip or trip that involves an environmental hazard in a public place (eg – footpath, shopping centre) you should report it to the appropriate authority (eg – council, shopping centre management). Many councils and shopping centres will act on this information. It can prevent someone else falling in the same situation.

Some additional points to keep in mind in public places or other people’s homes:

■ Don’t rush – take your time

■ Pay attention to your surroundings, including unsafe surfaces, obstacles, animals, children, cyclists. Scan the area before walking

■ If you use a walking aid, glasses or hearing aid, always remember to take them with you

■ Wear safe shoes – well fitted, with low and broad heels, slip resistant soles and fasteners

■ Take extra care on buses, trams, trains and ferries – have your fare ready before getting on

In addition to falls prevention strategies there are some other general home safety tips in this section.

Keep pathways free from overhanging bushes

33

34

Home hazard checklistThis checklist covers all areas of the home and around the home. It also highlights some specific environmental risks related to floors, walkways, lighting, stairs and steps. Pay particular attention to rooms or areas that you use regularly.

Tick the boxes to indicate action needed.

Floors and internal walkways Action Needed

Keep walkways free from clutter or other obstructions.

Keep cords away from walkways.

Make sure walkways have adequate lighting.

Make sure your carpets and mats lie flat without wrinkles or curled edges.

Make sure any loose mats or rugs have a slip resistant backing or remove altogether.

Make sure floor surfaces are non-slip or not highly polished.

Immediately repair carpet, vinyl or tiles that have lifted, or are torn or broken.

Clean up spills as soon as they occur. Use detergent if oil is spilt.

Have uneven floor surfaces corrected/ repaired.

35

Lighting and powerpoints Action Needed

Make sure there is adequate lighting throughout the house. Lighting should be bright enough to allow you to see clearly, especially in walkways, stairs and steps and where you keep your medication. Use of a lamp, installing additional light fittings or brighter (higher wattage) globes and opening blinds or curtains can increase lighting and reduce the risk of falls. First check the capacity of your light fitting before using a higher wattage globe.

Light switches should be easy to reach and near doorways. Powerpoints should be easy to reach.

If glare is a problem for you, on particularly sunny days reduce glare by drawing curtains. Low sheen paint on walls may also help reduce glare.

Hallways, stairs and internal steps Action Needed

Install two-way light switches at the top and bottom of stairs and at the end of long hallways. A skylight may be another option.

Have a secure and stable handrail or bannister that extends beyond the bottom step.

Remove or replace any unsafe covers on stairs.

Make sure you can easily see the edges of steps – contrasting coloured non-skid tread strips along the edges will help. Make sure that there is also adequate lighting.

36

Hallways, stairs and internal steps continued Action Needed

Have uneven stairs corrected / repaired.

Take extra care if you wear bifocal or multifocal glasses when climbing stairs and be wary of long flowing garments on stairs.

Avoid using steps or hallways for storage.

Make sure that the stair treads have non-skid or non-slip surfaces.

Living/dining room Action Needed

Remove or replace any unsteady furniture or furniture with splayed legs.

Chairs should be in good condition, comfortable, give support, have armrests and be at a height that is easy to sit and rise from. A safe chair gives support and comfort while sitting and allows for balance and thrust when rising.

Keep walkways free from clutter.

Run electrical cords over architraves rather than over or under rugs, carpets or traffic areas. Put in extra power points rather than overloading them or using extension cords. If you are using extension cords make sure they do not cause a tripping hazard.

Make sure access to the telephone and telephone socket is free of clutter and unnecessary furniture. If need be, consider relocating the telephone socket and telephone to improve access.

37

Living/dining room continued Action Needed

Try not to rush for the telephone, a second phone outlet may be worth considering.

Make sure there is adequate lighting.

Wall phones may be a concern. If you fall, you may not be able to reach the phone. A bench top phone may be more appropriate. Have emergency numbers next to the telephone or programmed into your phone.

Other safety hints:

Replace any frayed or brittle electrical cords.

Use screens in front of an open fire and have chimneys cleaned regularly.

Have a safety switch installed on the main power board.

Bedrooms Action Needed

Make sure the bed is the right height so that you can easily get in and out of bed.

If you have difficulty getting in or out of bed an occupational therapist or HomeFront assessor could suggest aids and equipment to help you.

Make sure you can turn the light on or off without getting out of bed. A light or lamp by the bed is worth considering.

Avoid using bedspreads with looped fringes, and make sure that bedding covers do not hang loosely on the ground around the bed.

38

Bedrooms continued Action Needed

Place a phone with emergency numbers, a torch and a lamp next to the bed. Emergency numbers can be programmed into the phone.

Have whatever you need for safe walking by your bed, for example spectacles, walking aid, safe footwear.

Locate heaters out of traffic areas and make sure they are clear of curtains, furniture and other flammable materials.

Other safety hints:

Keep electric blankets smooth and flat and do not tuck them under the mattress.Turn off electric blankets before going to bed or before leaving the house.Have electric blankets checked regularly (check the yellow pages for appliance repairers).

Kitchen and laundry Action Needed

Place frequently used items at waist level (not too high or too low) to avoid having to lean too far or use a safety step stool.

When having to reach for high items use a safety step stool that has a safety grip rail or ask someone else to do it for you. Consider purchasing a safety step stool.

If you use a walking aid and need to move plates of food or drinks around the kitchen or to a dining room, consider using a trolley to increase safety.

Install good lighting over work areas.

39

Kitchen and Laundry continued Action Needed

Wipe up spills straight away. Use detergent if oil is spilt.

Other safety hints:

Turn off appliances before leaving the house.

Do not have electrical appliances or cords next to the sink.

When cooking keep pot handles turned inwards and cover frying pans with lids.

Keep pot holders, dish towels, plastic utensils and curtains away from the stove.

Install a fire extinguisher and a fire blanket where it can be reached easily in an emergency.

Make sure hot and cold taps are easily identified.

Make sure taps are easy to turn on / off.

Bathroom, shower and toilet Action Needed

Use slip-resistant mats in the bathroom and shower.

Slippery tiles could be replaced with slip-resistant tiles. Alternatively, bathroom and toilet floors, showers and baths can be treated with slip-resistant products.

Handrails installed in the bath, shower or beside the toilet can assist you and make it safer. Your occupational therapist or HomeFront assessor can help with placement of rails that is best for you.

40

Bathroom. shower and toilet continued Action Needed

Don’t balance on one leg when washing or drying yourself. Have a seat to sit on for these activities.

Make sure that shower doors are made of safety glass and swing or slide freely.

Keep the soap, shampoo and towel within easy reach.

Make sure walkways from the bedroom to the toilet are well lit, especially at night. A night light may be worth considering.

Other safety hints:

Keep electrical appliances away from the sink and bath.

Dry your hands before using electrical switches.

Check water temperature before entering the bath or shower.

Make sure hot and cold taps are easily identified.

Make sure taps are easy to turn on/off.

Garage Action Needed

Store items appropriately, keeping walkways free of clutter.

Discard items no longer required or broken to avoid unnecessary clutter.

Install good lighting over work areas.

Place frequently used items within easy reach or store at waist level for easy access.

Keep concrete floors clean and clear of oil and grease.

41

Garage continued Action Needed

Other safety hint(s):

Do not store flammable or volatile liquids near open flames (eg cigarette lighter, welding equipment).

Outside your house Action Needed

Edges of steps should be clearly marked by painting the front edge of the step with a contrasting colour.

Repair any cracked, broken, worn, loose or unstable steps.

If steps are too high or too narrow consider having these modified.

Make sure step surfaces are non-slip.

Remove moss, lichen and wet leaves or any built up soil or dirt from pathways and mop up any wet areas.

If water pools on any external surfaces have the cause investigated and corrected if possible.

Trim shrubs and overhanging branches from pathways.

Repair any uneven, cracked or broken paths.

Do not leave water hoses, garden equipment or other obstructions on lawns or pathways, return them to their storage areas.

Handrails installed on steps or pathways make it safer. Make sure they are well maintained.

42

Outside your house continued Action Needed

Make sure there is adequate lighting around steps and pathways.

Make sure all ramps, decks and verandahs are in good condition, have non-slip surfaces and sturdy, well maintained handrails.

Make sure clotheslines are in good condition, easy to raise and lower (to avoid over reaching), and easily accessed.

Access to the front, back and sides of your home should be well lit.

Other considerations Action Needed

Avoid wearing loose or long clothing that can get caught on furniture.

Wear comfortable, good fitting shoes with secure fasteners (shoe laces or velcro fasteners), a low heel and soles that grip.

Avoid wearing slippers, scuffs, thongs and other loose fitting shoes (they can cause a trip).

Avoid walking in socks.

Take care around pets, their movements may be unpredictable. Make sure the pets’ bowls are not near access ways or in walkways.

Avoid carrying large loads that obstruct your view ahead.

Avoid climbing unsteady ladders or climbing up on the roof. Consider asking a family member for assistance. Make sure ladders are in good condition.

Non-slip pads placed under step ladders or stools can stop them from sliding or moving.

Safety strips prevent slips and trips

Other considerations continued Action Needed

A checklist of things to do before leaving home may help you avoid leaving on lights, forgetting to take your keys or lock the back door.

Doors and windows should be easy to open and close.

Locks and handles should be easy to reach.

Uneven doorway lips should be repaired.

Make sure smoke detectors are installed, are appropriately located, especially near bedrooms, and in working order. If your house is more than one storey make sure there is at least one detector on each floor.

Make sure all electrical cords are in good condition.

43

Planning for the futureIt makes good sense to think about safety and ease of access in and around the home before building, extending or renovating. It is easier (and less expensive) to include these changes in your building or renovation plans than to make structural changes later. Useful information, including fact sheets about this concept, called “Housing for Life”, is available from the Master Builders Association of the ACT.

(Website: http://www.mba.org.au/hfl/index.shtml phone (02) 6247 2099)

44

45

What to do if you were alone and had a fallHave a plan to get help:

■ Have some means of calling for assistance. Consider a personal alarm (worn around the neck or wrist), or keep a mobile or cordless telephone with you at all times, or carry a whistle or “screamer alarm” around your neck.

■ Leave a spare key with a family member who lives near by, a neighbour or friend so they can get to you quickly.

■ Learn and practice how to get up off the floor if you are uninjured. A physiotherapist or occupational therapist can help you.

Illustrated instructions are provided on pages 46–47 on how to get up after a fall. If you are injured, assess if it is safe to try and get up from the floor without assistance. If you are able to get up, remember to rest at any time and if you don’t succeed the first time, rest and try again.

Part 3:Other helpful information

46

If you cannot get up:

■ Don’t panic – use one of the strategies in your plan to get help.

■ Make yourself as comfortable as possible and try to stay warm.

■ Gently move around to stop one part of the body getting too much pressure.

Let your doctor know you have had a fall and also tell someone else, a family member, friend or neighbour. They may be able to drop by to see how you are managing.

Getting up after a fall:

1 Calm down. Catch your breath and compose yourself after the shock.

2 Check your body: If you are not badly injured you can think about getting up. If you are injured, e.g. a broken bone, you need to stay where you are and call for assistance.

3 Look around for a sturdy piece of furniture (preferably a chair).

4 Roll onto your side.

5 Crawl or drag yourself over to the chair.

47

6 From a kneeling position, put your arms up onto the seat of the chair.

7 Bring one knee forward and put that foot on the floor.

8 Push up with your arms and legs, pivot your bottom around.

9 Sit down. Rest before trying to move.

We gratefully acknowledge the Stay On Your Feet – Adelaide West falls and injury prevention project for this information (modifications have been made to the format and content). This information was prepared for education and information purposes only. Readers should not act on this information without first seeking personal professional medical advice.

Department of Veterans’ Affairs ServicesHomeFront

HomeFront is a program the DVA has developed to make the homes of eligible veterans and war widows / widowers safer from falls and accident hazards. A free HomeFront assessment is available each calendar year. The DVA makes a financial contribution towards the cost of recommended items and modifications. Call 1800 80 1945 for a free HomeFront assessment.

Veterans’ Home Maintenance Line

The Veterans’ Home Maintenance Line (VHML) can advise the veteran community (veterans and war widows / widowers) on general home maintenance matters, can arrange a home inspection to identify current or possible future maintenance problems and can also provide referrals to reliable and efficient tradespeople. The VHML also provides a 24 hour, 7 days a week service for property emergencies and utility breakdowns. Where possible, the help line will link veterans to government-subsidised services. The VHML is free, but the recipient of this service must pay for work done by tradespeople, including call-out fees. The number to call is 1800 80 1945.

“I was starting to have trouble managing the front and back steps at home. I stumbled a couple of times, then had a pretty

bad fall. I’m a war veteran so I called my local VAN office. They told me about the HomeFront program. The HomeFront assessor came out and checked the whole house for hazards. They installed handrails and painted the edges of the steps so I can clearly see them. They made a number of other changes

that have made my home safer.”

Vern, 8548

49

Veterans’ Home Care

Veterans’ Home Care extends the range of home support services provided by DVA to eligible veterans and war widows/ widowers to include domestic assistance, personal care, home and garden maintenance and respite care. Other services, such as delivered meals, are available through arrangements with State and Territory Governments. A small co-payment may be payable for home care services. Partners and carers are not eligible for Veterans’ Home Care services unless they have their own Gold or White Card. For more information about Veterans’ Home Care, call DVA on 133 254 or visit the Internet at www.dva.gov.au/health/homecare/mainvhc.htm

Rehabilitation Appliances Program

The Rehabilitation Appliances Program (RAP) provides aids and appliances to eligible members of the veteran community to help them maintain their independence. The provision of aids and appliances is based on assessed clinical need and other social and functional criteria as set out in the relevant Departmental Guidelines. Through the RAP, DVA may pay for home modifications to assist a person to live safely within their own home. Requests for home modifications must be accompanied by an assessment and report by an occupational therapist. The home modifications that are available address safety and access in the home and may include internal and / or external rails, or a ramp to access your home. For further information about the RAP you can contact any DVA Office or call the RAP hotline on 133 254 or 1800 555 254 for regional callers.

Defence Service Homes (DSH) Subsidised Loans and Home Support Loans (HSL)

The Defence Service Homes Subsidised Loans and Home Support Loasns provide loans for home purchase, home modifications, repairs or renovations. Call 1800 722 000 for more information.

50

Defence Service Homes (DSH) Insurance

Defence Service Homes (DSH) Insurance offers insurance policies that give you the cover you need together with the care you want and deserve. Call 1300 552 662 to access the service.

Home Medicines Review

Home Medicines Review is a service provided to all Australian citizens living at home in the community and is funded by the Commonwealth Government. A Home Medicines Review involves the general practitioner and the preferred community pharmacy working in conjunction with the veteran or war widow /widower. For people who are taking many medicines or who have complex medical conditions, the doctor may decide to order a Home Medicines Review. The doctor will then make a referral to the preferred community pharmacy to arrange for an accredited pharmacist to organise a time to undertake a Home Medicines Review in your home. This service is available once a year and is a great way for people to improve knowledge of their medicines, check that the various medicines they are taking do not interact, and to be actively involved in their treatment. For further information on Home Medicines Review talk to your doctor or pharmacist.

Vietnam Veterans Counselling Service (VVCS)

The Vietnam Veterans Counselling Service (VVCS) is a specialised, free, confidential Australia wide service for Australian veterans and their families. VVCS staff are professionally qualified with skills in working with life problems faced by veterans and their families. They can also provide a wide range of programs and treatment for war and service-related mental health conditions.

If you need more information about VVCS contact National Veterans Line on 1800 011 046 or visit the DVA web site at www.dva.gov.au.

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Optical services

Under the DVA Optical Supplies Program eligible veterans can access regular optometric assessments and obtain spectacle frames and lenses to suit their clinical need.

Eligible veterans are entitled to one initial and one subsequent optometric consultation in a two–year period unless they have a significant change in refraction or develop a new condition. Also over a two-year period, veterans may receive either one pair of reading and one pair of distance spectacles (two frames and two sets of lenses); or one pair of spectacles with multifocal lenses (ie one frame with either bifocal, trifocal or progressive lenses).

Veterans must obtain their frames, lenses and miscellaneous optical supplies from DVA-contracted optical dispensers. These dispensers have agreed to stock a minimum selection of frames from the DVA / Defence range of spectacle frames and to also carry the DVA / Defence colour catalogue. If, after viewing this range, veterans are not satisfied with the choices available they may then select frames outside the DVA / Defence range. In such circumstances, DVA will make a co-payment to the value of a standard DVA / Defence frame.

For more information about DVA’s optical program please contact your nearest State Office on 133 254 or 1800 555 254 for non-metropolitan callers.

Podiatry and dietetic services

Under DVA’s health care arrangements eligible members of the veteran community can access podiatry and dietetic services to suit their clinical needs.

These services are provided by podiatrists and dietitians contracted with DVA. Gold and White cardholders are eligible to receive these services. White Card eligibility is related to accepted disabilities only. Treatment is based on assessed clinical need.

A referral is required for podiatry and dietetic services and can be provided by a Local Medical Officer (LMO), a general practitioner, a medical specialist, a hospital discharge planner, a treating doctor in a hospital or another podiatrist / dietitian with a current referral.

For more information about DVA’s podiatry and dietetic services phone DVA on 1800 555 254 (non-metropolitan callers) or 133 254 (metropolitan callers).

“My doctor looks after my health, and with the pharmacist, help me manage my medications, my podiatrist looks

after my feet, I do the exercise the physiotherapist recommended, and I have regular eye checks. It’s been 2 years since my last fall. There are so many people who

can help you, falls can be prevented, I’m living proof.”

June, 73

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Home Front Guide to Preventing Falls for Older People Reply Paid 21 WODEN ACT 2606