How to Stay On Your Feet

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1 How to Stay On Your Feet strength Checklist health balance healthy eating independence medications

2 Published by the ueensland Government February 2014 ISBN: The State of ueensland, ueensland Health, 2014 The ueensland Government supports and encourages the dissemination and exchange of information. However, copyright protects this material. The State of ueensland has no objection to this material being reproduced, made available online or electronically, provided it is for your personal, non-commercial use or use within your organisation, this material remains unaltered and the State of ueensland (ueensland Health) is recognised as the owner. To enquire about commercial use or adapting this material, contact: or by mail to: The IP Officer, Office of Health and Medical Research, ueensland Health, GPO Box 48, BRISBNE ld n electronic version of this document is available at Citation: Falls Injury Prevention Collaborative, Education and Resource Working Group ueensland How to Stay On Your Feet Checklist. ueensland Health. State of ueensland based on version 2003 Ver. 04/2003H Falls - 11

3 Stay active, stay independent and Stay On Your Feet This checklist is designed to help you to stay active and independent and live in your own home for longer. Falls are one of the main reasons that older people are admitted to hospital or need to move to a higher level of care such as a nursing home. However, falls are not an inevitable part of the ageing process. You can help reduce your risk of falling by: knowing the risk factors for falling taking action to stay healthy and active creating a safe environment in and around your home. This checklist provides information and suggestions based on the latest research to help you manage your health and lifestyle, as well as make your home safer. It will help you Stay On Your Feet. The checklist covers information on wellbeing, nutrition, physical activity and health conditions experienced by people as they get older. It also includes information on the most common types of hazards found in and around the home. While some hazards may not be a problem now, they could become a problem in the future. How to use this checklist Make some time to either go through the checklist yourself or sit with a friend or helper and discuss the checklist together. The whole checklist does not have to be completed at once and you may like to break it up into sections. For example, you could start with the health section first and later move to the section about safety in and around the home. Complete the checklist by ticking yes or no in the circle next to the statements. If you answer yes to any statement, this indicates that you will need to make changes in this area. If you answer yes to a statement about health and wellbeing, talk to your doctor or health professional about these areas. Each section is marked by a symbol that indicates the type of issue it addresses. This checklist should be completed about once a year to make sure that you are familiar with any risk factors if your situation changes. There is an extensive list of useful government and community organisations and their contact details provided as an appendix to this checklist. i

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5 Contents Stay active and stay independent 1 Health conditions 4 Medicines 6 Foot care 9 Footwear 11 Vision 14 Strong bones, muscles and healthy eating 17 Continence 22 Safety in and around the home 25 Inside the home 25 Bedroom 26 Bathroom and toilet 27 Kitchen 29 Lounge room or living room 30 Floors, walkways and stairs 31 Outside the home 33 Home maintenance 34 Personal alarms and walking aids 35 What to do if you fall at home 36 cknowledgments 37 Contacts ppendix 38 iii

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7 Stay active and stay independent Our bodies are designed to be used and this becomes even more important as we get older. Being physically active is essential for health and wellbeing and will also help you to stay independent. Stay independent by being active and improving your strength and balance. Essential elements of physical activity include strength, balance and reflexes. While age can affect your strength and balance, this can be improved by regular exercise on most days of the week. It s never too late to start. To improve your level of physical activity, get professional help to design a program specific to your needs. If you have been inactive for a while, or have a health condition, check with your doctor before you begin. How active are you? I do less than 30 minutes of moderate physical activity on most days of the week Yes No Moderate physical activity increases your heart rate and breathing and may include sporting activities, brisk walking, swimming, cycling or group exercise. For overall health and wellbeing, it is advisable to do at least 30 minutes of moderate physical activity on most days of the week preferably every day. This can be split into three lots of ten minutes. How steady are you? I do less than two sessions of balance and strength exercises per week Yes No Balance and strength exercises could include Tai Chi, dancing or a specific program provided by a health professional. Balance exercises have been shown to be vital to reduce falls, so try to include balance and strength exercises in your physical activity routine at least twice a week. You could attend a Tai Chi class or obtain professionally prescribed exercises from a physiotherapist or exercise physiologist. 1

8 I feel unsteady when walking or I become unsteady when I turn around Yes No Talk to your doctor about what might cause you to feel unsteady. You can have a balance assessment to help identify the cause/s of your unsteadiness. You can ask your health professional to suggest exercises that will strengthen your thigh and bottom muscles and improve your balance. I find it difficult to get up from a chair Yes No This can be a sign of decreased leg muscle strength. Talk to a health professional about exercises that strengthen leg muscles. sk if you need a more detailed assessment. Do you have a plan for your physical activity? I have not discussed physical activity with a health professional in the last 12 months Yes No It is advisable for older adults to: discuss physical activity with a health professional at least once a year have a plan for physical activity which aims to improve your strength and balance and is tailored to suit you. This plan should aim to increase your level of activity gradually over time. 2 Tips to improve strength and balance to stay independent É ÉChoose activities that reduce the risk of falling by helping to improve strength and balance. Ideal activities are group exercise programs that include strength and balance such as Tai Chi, or you can have a health professional design a program that best suits your needs. É ÉDiscuss a tailored physical activity plan with your health professional every year. This plan outlines your intended level of physical activity and how this will be achieved. É ÉTo be effective, your physical activity needs to gradually become more challenging. Be active on most days of the week and include balance exercises at least twice every week. É ÉConsider what shoes are appropriate for the activities you do (for further information, see footwear section on page 11).

9 Who can help? É ÉDoctor É ÉExercise physiologist É ÉFitness instructors É ÉGeneral practice nurse É ÉOccupational therapist É ÉPhysiotherapist What physical activity options are available? There may already be activities available in your local area. You can find out about these activities by contacting your local council. For example, some programs operating in parts of ueensland include: É ÉTai Chi É ÉSteady Steps É ÉOlder and Bolder É É60 and Better É ÉTai Chi for rthritis. Many more activity options are available and can be found on the Department of National Parks, Recreation, Sport and Racing: Get ctive website and 60 and Better Program (details available on page 39). The Commonwealth Respite and Carelink Centre provides free and confidential information on community aged care, disability and other support services across ustralia (details available on page 38). For further information on how to Stay On Your Feet, visit: É Éueensland Stay on Your Feet at: I plan to take action by 3

10 Health conditions Many health conditions can increase your risk of falling, especially anything that reduces your level of activity or makes you feel unsteady on your feet. Work with your health professional to develop a management plan that suits you and helps you to manage any health conditions that increase your day-to-day risk of falls. Take action to manage and maintain your health develop a plan with your health professionals. Do you have a health condition that could increase your risk of falling? I have been diagnosed with a health condition such as diabetes, stroke, arthritis, Parkinson s disease, depression or a heart condition Yes No Have a regular check up with your doctor and/or health professional. Learn as much as you can about your condition by talking to your doctor or a health professional. sk them for relevant and reliable brochures, information booklets and websites. They can also provide you with contact details for a support group. Seek early treatment if your symptoms change. I experience feelings of dizziness or light-headedness Yes No If you are dizzy or light-headed, visit your doctor to discuss your symptoms. Have you lost your confidence because of worrying about falling? I have had a trip, slip, stumble or fall in the last six months (even if it did not cause an injury) Yes No previous fall, even a minor one, increases your chances of having a more serious fall in the future. Falls are preventable, so take action and see if you can work out why you fell. Complete this checklist and talk about any yes responses with your doctor or health professional. 4

11 I limit my daily activities because I worry about falling Yes No Worrying about falling is common, particularly after a previous fall. fter a fall, many people try and reduce their activity so they do not fall again. However, if you limit your activity then this reduces muscle strength, mobility, and social contact all of which increases your falls risk. Talk to your doctor or health professional if you have concerns about falling or can t go about your normal daily activities. Tips to manage your health É ÉWork with your doctor or other health professionals to develop an understandable and achievable personal health care plan. É ÉBe aware that your state of mind can contribute to your risk of falling. Who can help? É ÉDoctor É ÉSpecialist É ÉGeneral practice or community nurse É ÉPhysiotherapist Psychologist É ÉOccupational therapist É ÉSupport group eg. arthritis support group Further information on support groups in your area is available from 13 Health and the Commonwealth Respite and Carelink Centres (further information available on page 38). For further information on how to stay on your feet, visit: É Éueensland Stay on Your Feet at: I plan to take action by 5

12 Medicines Medicines include those prescribed by a doctor and those bought from a pharmacy, supermarket or health food store. They also include natural or complementary products. Taking certain types of medicines, or a combination of medicines, can have side effects that can make you dizzy or drowsy which can increase your risk of falls. Manage your medicines safely and effectively and have them reviewed annually. Do you know enough about your medicines and any possible side effects? I take medications that can affect mental alertness or cause dizziness or drowsiness Yes No Talk to your doctor or pharmacist about the type and quantity of your medicines and regularly ask them to review your medicines. This is especially important if you are experiencing side effects of medicines, feel at all unsteady on your feet, or if you have fallen over recently. Consider talking with your doctor about alternative remedies to help you get a good night s sleep. Some people get more sensitive to sleeping tablets as they get older and so experience more side effects from these medicines. These side effects can include confusion and unsteadiness which can increase the risk of falling. I have trouble remembering all of my medicines and what they are for Yes No Keep a list of LL your medicines, even ones that you have purchased at the supermarket, from a health food shop or any other natural medicines you may be taking at the moment. Your doctor or pharmacist can print a list of your prescribed medications which includes the strength, dose and directions for these medicines. Take this list to any appointments with doctors or other health professionals. 6

13 I forget to take my prescribed medicine correctly eg. at the right time of day, with or without food Yes No Talk to your pharmacist if you are unsure about your medicines or if you are unsure if you are taking them correctly this may help limit any side effects. Do you store your medicines correctly? I tend to remove my medicines from their original containers Yes No To make sure you are taking your medicines correctly, leave them all in their original containers, or have them packed into a medicines organiser such as a webster pack or dosette box. Do you have your medicines reviewed regularly? During a doctor s appointment, there never seems enough time to discuss all my medicines with my doctor (including things that are not prescribed, like vitamins) Yes No It can be useful to make an appointment with your doctor just to review all your medicines, vitamins, herbals and non-prescribed medicines. It would be helpful to either bring all your medicines with you or take your up-to-date list of medicines to this appointment. I have not had my medication reviewed in the last 12 months Yes No To make sure you are receiving the most up to date treatment, and to avoid taking any unnecessary medicines, have your doctor review your medicines once a year. This is important as your health conditions can change, different medicines may come onto the market, and new research about treatments may become available. 7

14 Tips to help with managing medicines so they are safe and effective É ÉMake an appointment to see your doctor if you: É Étake medicines that affect mental alertness or cause dizziness or drowsiness É Éhave fallen over in the last 12 months É Éfeel at all unsteady on your feet É Éhave concerns about falling. É ÉHave your medicines checked É Ésk your doctor or pharmacist to arrange a Home Medicines Review. This means a specially trained pharmacist visits you at home to discuss and review all your medicines. You will not have to pay for this service. If this service is not available in your area, contact the Medicines Line (Phone : Monday to Friday, 9am to 5pm EST). É ÉSome side effects from your medicines can increase your risk of falling. If a medicine makes you dizzy, unsteady or drowsy, check with your doctor if there is a different medicine that is just as effective but without those side effects. É ÉSeek further information É ÉMost medicines have consumer information on the label or in the packet. You can also ask your pharmacist for a copy of the Consumer Medication Information leaflet, which contains easy to understand information about each of your medicines. É ÉCheck the label on your medicines there may be a warning that the medicine may cause dizziness or that it should not be taken with alcohol. É ÉDo not use other people s medicine. Check the tools and tips for consumers on the NPS MedicineWise website (further details available on page 41). Who can help? É ÉDoctor É ÉPharmacist É ÉNPS MedicineWise (further information available on page 41). I plan to take action by 8

15 Foot care If your feet are sore, aching or tired, it makes it difficult to stay active and independent. Foot problems and foot pain are not a natural part of the ageing process. Some foot problems can be the first sign of more serious medical conditions such as diabetes, circulation or nerve conditions. These problems may require treatment from a podiatrist or other health professionals. Take care of your feet each day and have regular podiatry checks. Do you have healthy feet? I have not had my feet checked by a podiatrist in the last 12 months Yes No Visit the podiatrist annually to keep your feet in their best shape. I have ingrown toenails or painful feet and ankles Yes No Ingrown toenails or painful feet and ankles can change the way you walk and can increase your risk of falling. If you have painful feet or other foot problems, seek help from a podiatrist or health professional. Tips to help with foot care If you have problems with your feet, visit your doctor or podiatrist at the first signs of redness, swelling or infection in the feet, as they can help you to treat and prevent foot problems. Make sure that you look after you feet by undertaking daily foot care. É ÉCheck feet daily for dry cracked skin, blisters, sores and changes in colour. É ÉFoot exercises, such as walking barefoot in the sand, can help to strengthen your toes and improve the condition of your feet. sk your podiatrist for additional foot exercises. É ÉUse toenail clippers to cut toe nails. Trim them straight across, do not round off the corners and cut them no longer than the tip of the toes. If you cannot cut your own toenails, seek assistance from a podiatrist. 9

16 Who can help? É ÉDoctor É ÉPodiatrists Information on the ustralasian Podiatry Council can be found on page 40. For further information about services in your local area, contact: Commonwealth Respite and Carelink Centres (further information available on page 38). I plan to take action by 10

17 Footwear Some types of footwear can increase your risk of falls by making you trip, slip, or stumble. Choose and wear shoes that are appropriate for your feet and suit the activities you do. Consider shoes that will help you to Stay On Your Feet. Your shoes need to fit well and be in good repair. Features of good shoes include: É Éa broad, slightly rounded heel less than one inch (2.5cm) high this will make you more stable as it distributes your weight better, and has better contact with the ground É Éa firm, flat, non-slip sole that bends mainly at the ball of the foot É Éshoes with soles that have the right amount of grip not too slippery but not too resistant É Éa shape that conforms to the shape of your foot and are held on by laces, zips or velcro fastenings. heel collar height fixation heel height midsole flare outersole slip resistance midsole thickness and density void loose fitting sling backs, slippers, thongs or scuffs. re your shoes going to help you Stay On Your Feet? I wear shoes with a sharp, square shaped heel edge Yes No Consider the heel of your shoe. heel with a rounded or bevelled edge is less likely to slip. 11

18 What sort of soles do your shoes have? I wear shoes that have a very thick (1¼ inches or 3cm) or a very soft cushioned sole Yes No Shoes that have thick, very soft soles may reduce your ability to read the ground or floor surface when you walk. I am unsure if my shoes have a flexible sole Yes No To test the flexibility of your shoe sole, hold one shoe with two hands and bend it to see how well the sole flexes. The sole should be firm but flexible at the ball of the foot. The firmness helps to grip the ground and the flexibility makes walking comfortable. Do your shoes fit well? I wear shoes that are too loose or too tight Yes No I wear sling backs, slippers, scuffs, or thongs Yes No to either question Consider the fit of your shoe. Shoes need to fit comfortably and suit the shape of your foot. They also need to have ankle support. Styles that don t fit firmly or have ankle support (such as sling backs, slippers, scuffs or thongs) are a common cause of people being hospitalised for falls. How worn are your shoes? I wear shoes that are well worn or in bad repair Yes No Consider the state of your shoes. If they are worn down, this can increase your risk of falls. It is best to fix them or discard them it may seem costly but not as costly as recovering from a fall. 12

19 Tips to help you select and wear safe footwear É ÉCheck the style of your shoes and make sure that they are suited to the types of activity you do in terms of their heels, soles and fit. É ÉCheck the state of your shoes are they still safe? É Évoid wearing socks without shoes. É ÉTalk with a health professional, such as a podiatrist or physiotherapist, about any concerns you have about your feet or footwear. sk them about specialist shoe stores that may have shoes that would be suitable for you. Who can help? É ÉPodiatrist É ÉSpecialist shoe retailer É Refer to page 40 for futher contact information. I plan to take action by 13

20 Vision Many changes in vision are gradual and may go unnoticed. These changes begin at around 40 years of age and can make it difficult to judge distances, see the edges of stairs and objects on the ground or adjust to changes in light. It is important to have your eyes checked by an optometrist every two years. Have your vision checked every two years. Some eye conditions can affect your vision and make it difficult to see. These pictures show how some eye conditions can affect your vision. Normal Cataracts Glaucoma ge-related maculopathy Stairs viewed through bifocals 14

21 Do you maintain your eyes and glasses? I have not had my eyes examined in the last two years Yes No Ideally, it is best to have your eyes checked by an optometrist every two years or more regularly if recommended by your eye care practitioner. Medicare covers this. I have not checked my eyeglasses prescription in the last two years Yes No Your optometrist can check if the prescription for your glasses is still correct and that they still fit properly. If you get new glasses or a stronger prescription, it may take time for you to get used to them. Make sure you take extra care while they are new. Do you have trouble seeing as you walk around? My eyes take a long time to adjust to different light levels Yes No s you walk around, your eyes take time to adjust to different levels of light. Sudden changes in light levels may make it hard to see clearly or make you unsteady. To reduce this, you can wear a hat and sunglasses when outside to reduce glare and make it easier to see. When moving to or from bright to dim areas, you can stop, hold onto something and wait for your eyes to adjust. I have trouble seeing the edges of the stairs clearly in my home Yes No Contrast strips applied to the edges of stairs can help you to better judge the height and depth of stairs. These strips can be purchased from a hardware store and applied to stair edges. You should also have your eyes checked by an optometrist every two years or more regularly if recommended by your eye care practitioner. 15

22 I wear bifocal or multifocal glasses when walking around Yes No If you wear bifocals or multifocals while walking, your perception of depth can be distorted, particularly when walking up or down stairs. Talk to your optometrist about whether you need a separate pair of distance vision glasses for walking around. Tips to help with vision É ÉCheck your glasses regularly to make sure the lenses are clean and not scratched. É ÉKeep your eyes and glasses in good working order by having them both checked regularly by an optometrist. É ÉEnsure your stair and shelf edges are obvious by applying contrast strips to the edges. É ÉIf you need cataract surgery, talk with your doctor or specialist about how soon you can have them removed. There are often waiting lists for this type of surgery so talk to your doctor as soon as possible. Who can help? É ÉOptometrist É ÉOrthoptist É ÉOphthalmologist Further information on the health professionals listed above is available on page 41. I plan to take action by 16

23 Strong bones, muscles and healthy eating balanced diet and weight bearing exercise is important to maintain good health, strong bones and muscles as well as provide sufficient energy to undertake the day s activities. Eat well every day and enjoy sharing meals with others. Weight bearing or resistance exercises are important as these help to build and maintain strong bones. Such exercises include activities where you support your own body weight like brisk walking, dancing, hiking, stair climbing, jogging and exercises using resistance or weights. If you have been inactive for a while or have a health condition, check with your doctor before starting physical activity. Do you look after your bones? I have not done thirty minutes of weight bearing exercise today eg. walking Yes No Each day, you need to be active in as many ways as you can. t least twice each week, you need to include some weight bearing or resistance exercises as these help to build and maintain strong bones. I have back pain that started suddenly Yes No If you experience sudden back pain for no apparent reason, this could be a sign of osteoporosis. Visit your doctor for medical attention as soon as you can. I have become shorter over the years Yes No Becoming shorter over the years could be a sign of osteoporosis. Visit your doctor for medical attention as soon as you can. 17

24 I have had broken bones in the past few years Yes No Broken bones can be a sign of osteoporosis. Visit your doctor as soon as you can and ask if you qualify for an osteoporosis risk assessment (bone mineral density test). This test will determine your bone strength as well as possible treatment options to help to reduce your risk of fractures in the future. Do you eat healthy meals that help you to keep strong and active? Each day, I eat less than three to four servings of high calcium foods (such as milk, yoghurt, cheese, salmon, sardines or calcium enriched products) Yes No For adults, the recommended daily intake of calcium per day is 1000mg. For women (post-menopause) and men aged over 70 years, the recommended daily intake of calcium is 1300 mg per day. To achieve this daily intake, you need to eat three to four servings of high-calcium foods. One serving is 250 ml of milk, 40g cheese, 200g of yoghurt or 100g of tinned salmon or sardines. If you do not eat enough calcium-rich food, see your doctor or dietician for further advice on calcium supplements. I do not take any Vitamin D supplements Yes No Being deficient in Vitamin D can affect your bone and muscle strength as this vitamin helps our bodies to absorb calcium from food. While Vitamin D comes from sunshine this is not always straightforward (and carries a risk of sunburn or skin cancer). It s best to consult your doctor, pharmacist or dietician to see if you need Vitamin D supplements. I sometimes skip meals, meaning I do not eat three meals a day Yes No Skipping meals means your body misses out on important protein, fibre, vitamins, minerals and other nutrients that support a healthy active body. Sharing meal times with friends and family may help improve your appetite and be more enjoyable than eating alone. 18

25 I have difficulty chewing or eating food Yes No Talk to your dentist about any problems with your teeth, gums or false teeth. Other problems in the mouth may need a referral from your doctor to a speech pathologist. I have a reduced appetite so am often not hungry Yes No Living alone, depression, some health conditions and some medications can reduce your appetite. Your doctor may be able to help if there is an underlying reason for the loss of appetite like a medical condition or a medication issue. You can also ask your doctor for a referral to a dietician. I have experienced unplanned weight loss Yes No If you experience sudden or unplanned weight loss, you may need a nutritional assessment. Make an appointment with your doctor to get a referral to a dietician. Do you have difficulties preparing meals? I find it difficult to shop for food Yes No It can be difficult to buy food if you can t get to the shops. This may be due to a number of reasons such as not being very mobile, the public transport system isn t adequate, the shops are limited, or you have a low income. To see if you are eligible for assistance with shopping and to find out what services can help you contact your local council or Commonwealth Respite and Carelink Centres (details available on page 38). 19

26 I find it difficult to prepare food Yes No There are many factors that can make preparing food difficult. These include living alone, cooking for one, being recently bereaved and never having had to cook before, and having trouble with daily activities. You can overcome some of these issues by talking to a dietician about simple recipe ideas or by looking at options such as frozen meals or Meals on Wheels. Contact Commonwealth Respite and Carelink Centres to discuss options available in you local area (details available on page 38). Tips for healthy eating each day Take the time to eat a wide variety of nutritious foods including: two serves of fruit: one serve is one medium piece of fruit, two small pieces of fruit or one cup of chopped or canned fruit five serves of vegetables: one serve is ½ cup cooked vegetables or one cup of salad three to four serves of high calcium foods: one serve is 250ml of milk, 40g cheese, 200g of yoghurt or 100g of tinned salmon or sardines (if you are unable to eat dairy products, discuss alternative sources of calcium with your doctor or dietician) one serve of protein: one serve is 100gm of meat, poultry, fish or meat alternative or two eggs, ¹ ³ cup nuts or ½ cup legumes. É ÉRemember to drink eight glasses (8 x 250ml) of fluid each day unless your fluid intake is limited. Water is best and you can flavour it with fresh mint or lemon. É ÉTry to boost your fibre by choosing wholegrain cereals. É ÉConsider supplementing your calcium and vitamin D intake in consultation with a health professional. É ÉDrinking alcohol increases the risk of falls and injuries, as well as some chronic conditions. Therefore a low alcohol intake is recommended. The ustralian lcohol Guidelines recommend that older people consult with their health professional about the most appropriate level of drinking for their health. For more information on the guidelines for low-risk alcohol consumption, visit É ÉSharing meal times with family and friends may help to improve your appetite. 20

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