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Falls clinics, set up by public hospitals, evaluate patients aged 65 years and above who have a history of falls or who encounter walking difficulties.
Mr V. Sivanandan, 83, has had one fall too many. In December last year, he took a tumble in his study as he was rising from his chair. The loud thud of the television set-top box he knocked over gave his wife, who was in the kitchen, quite a jolt.
Rushing to his aid, Mrs R. Sivanandan, 72, was relieved to find him unhurt. A previous fall that year had left a deep cut on the back of his head, but he had refused to seek treatment for it.
Falls in the elderly can give rise to a fear of falling and lead to reduced mobility and increased dependence on caregivers.
However, there is help for fall-prone seniors. Public hospitals in Singapore have set up falls clinics over the past decade to address the growing problem. There are now a total of five in the city and these clinics have reported seeing an increasing number of patients as a result of Singapore’s ageing population. Changi General Hospital’s (CGH) Falls Clinic has seen a five-fold increase in patients in the last two years – from 41 in 2007 to 223 last year.
Improper footwear a frequent cause
A spokesman for CGH said that more than half of the patients fell because they were using footwear with insufficient grip. Other causes of falls include drowsiness from medication and poor vision and hearing.
Dr Reshma Merchant, the head of general medicine and a geriatrician at National University Hospital (NUH), said these patients may arrive at the hospital with hip fractures, head injuries or serious lacerations. Depending on the seriousness of their injuries, they may require physiotherapy sessions that last from three weeks to six months, she added.
Clinics charge consultation fees of $24 upwards for Singapore citizens eligible for government subsidy. Physiotherapy sessions are charged separately. Fees vary according to the patient’s needs. These clinics evaluate patients aged 65 years and above who have a history of falls or who encounter difficulties while walking. However, they need to be referred by doctors in private practice, polyclinics or hospitals.
A holistic approach to fall prevention
Dr Lim Si Ching, a consultant at the Department of Geriatric Medicine at Singapore General Hospital (SGH), said that patients referred to the clinic are assessed holistically.
They go through physical examinations of their heart and lungs, are screened for vision and hearing and assessed on their functional status, such as their gait with a walking aid or their ability to use public transport. There is also a review of any medication they are taking. If the assessment puts the patient in the moderate to high-risk group, he or she is referred to a physiotherapist for an exercise programme, she added.
In May this year, Mr V. Sivanandan was placed in the Mobility and Falls Management Service at SGH. Ms Yong Limin, a senior physiotherapist at SGH, identified Mr Sivanandan, who has hypertension and a urinary tract infection, as a high-risk fall patient because of his poor vision, weak knees and unsteady gait.
He was also judged to be twice as slow in his reaction times when compared to others in his age group. This would make him less able to prevent or break a fall. Ms Yong taught him how to control his posture when he needed to move from a sitting to a standing position. She also improved his balance through exercises.
Ms Yong said that after two-and-a-half months of weekly physiotherapy sessions, Mr Sivanandan is now able to walk unaided for about 30m. Previously, he could manage only 5m with the support of his wife or his maid. Mrs Sivanandan said that her husband has not fallen since he started physiotherapy sessions at SGH. He has also become more outgoing.
“His quality of life has definitely improved and as his caregiver, I find it easier to take him out,” she said.
Besides intervention after falls, NUH has gone a step further and earlier this year, set up a falls-free model flat. Members of the public can visit the model flat to help them identify potential fall areas in their homes and learn how to make the home environment safer for the elderly.
Falls clinics
■ Singapore General Hospital Mobility and Falls Management Service
Tel: 6321-4132
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