Evidence
Alert

Getting up after a fall: training could encourage older people to get themselves back up

Most research into falls looks at how to prevent them from happening. The authors of this study wanted instead to understand more about getting up from a fall. They explored attitudes towards older people getting up by themselves and looked at measures that could encourage them to try.

Falls are common among older people and they often need help from ambulance staff to get up again. The study found that the older person’s environment, their physical ability and level of confidence affected whether they could get themselves up. Their knowledge about getting up from falls influenced whether they attempted it.

Health professionals such as physiotherapists and occupational therapists have limited time with older patients. It can therefore be difficult for them to play a proactive role in teaching techniques in case of future falls. Paramedics are driven by the pressing need to get the person up from the floor.

But carers, family members, and a broader range of health and social care professionals could support and teach older people how to get up from a fall and encourage them to practice.

What’s the issue?

One third of people over 65, and half of those over 80, will have at least one fall a year. Falls are the most common reason for ambulance callouts but most people who have fallen (11% - 56% in previous studies) do not need to go to hospital.

Older people are vulnerable to falls because they are likely to have long-term conditions such as heart disease or low blood pressure that cause dizziness and loss of consciousness. They may have balance problems, muscle weakness or poor vision.

Only half the people who fall without injury can get up again by themselves. Many stay on the floor for at least an hour. So even when they are unhurt by the fall, they can develop complications such as pressure sores or pneumonia. Carers can hurt themselves when trying to get the older person up again.

Formal techniques for teaching people how to get up from a fall include “backward-chaining”. This approach breaks the activity of getting up into small steps, with the trainer explaining the final step first. Because the learner does not have to start by lying completely on the floor, backward-chaining is said to reduce their anxiety.

Physiotherapy guidelines recommend that older people are taught how to cope with a fall. But this rarely happens, possibly because both older people and therapists lack confidence in the technique.

Researchers wanted to understand how older people felt about seeking help after falling. They also explored the attitudes of carers and health professionals towards using and teaching getting-up techniques.

What’s new?

Researchers interviewed 12 people aged 65 or older who lived at home. All had fallen more than once and not been able to get themselves up. Four spouses also contributed, along with 12 healthcare professionals who had experience of managing falls. A group made up of falls experts, people who had fallen, and a carer, helped interpret the findings.

The factors that affected older people getting up after a fall included:

  • their environment, such as whether they were indoors or outdoors, and whether there was anything or anyone nearby to help them. They were less likely to be able to get up without calling help if they were outdoors and alone, but many did not want to ‘bother’ anyone
  • their physical ability. For many, a lack of strength hampered their ability to move
  • confidence in their ability, which could be knocked by the initial shock of the fall and grow into a longer-term fear of falling
  • knowing how to get up and understanding when to attempt it.

Neither therapists nor ambulance staff routinely taught older people strategies on how to get up. Even if they were aware of techniques, they had limited time in which to teach them to others. They had to balance meeting an individual’s immediate needs with spending time teaching techniques to help manage future falls.

However, the health professionals came up with suggestions to overcome these barriers:

  • tailoring information to a person’s environment, such as who is likely to be around to help
  • teaching the backward-chaining technique to divide the process of getting up into a series of small movements; and encouraging exercises to increase strength in those who would not initially be able to learn
  • reminding people of the need to learn and practise the techniques, even when they have not fallen for some time, or do not think that they need to because they have forgotten that they cannot get themselves up
  • dealing with falls in a way that encourages independence by building skills and teaching people to get themselves off the floor. This is limited by time pressures and the urgent need to get people up from the floor
  • better timing of teaching people getting-up techniques, with earlier, proactive intervention before a fall occurs, or perhaps three months afterwards, once they have recovered.

Why is this important?

Although this is a small study, it is the first to explore the attitudes of patients and healthcare professionals about how older people get up following a fall.

Teaching getting-up techniques to older people and giving them clear sources of advice would be helpful. Interventions should take the older person’s environment, physical ability, and confidence into account.

Paramedics and ambulance staff may benefit from training in getting-up techniques that they can use with patients where appropriate. But they and therapy staff are under significant time pressure. Given this, other groups could be trained to provide getting-up advice to older people. These could be care workers and informal carers, exercise professionals, family members, and other healthcare professionals who work with older people.

What’s next?

Resources such as the film produced by NHS Inform in Scotland should be shared more widely with older people and their families as well as health and social care workers.

The researchers now want to find out whether teaching people how to get up after a fall would:

  • improve older people's independence and confidence, and reduce feelings of fear and anxiety about falling
  • reduce ambulance call outs
  • be cost-effective for healthcare services.

You may be interested to read

The full paper: Swancutt DR, and others. Knowledge, skills and attitudes of older people and staff about getting up from the floor following a fall: a qualitative investigation. BMC Geriatr. 2020;20:385

Training resources for healthcare professionals by Later Life Training, including Postural Stability Instructor training and Backward Chaining training

Practical resources from NHS Inform in Scotland: What to do if you fall

NHS advice on preventing falls

Advice on adapting your home from Age UK: Top tips for a more comfortable home

NHS Scotland video on what to do after a fall: Upwards and Onwards

Funding

The study was funded by South Western Ambulance Service NHS Trust and supported by the NIHR Applied Research Collaboration South West Peninsula.

Commentaries

Study author

The benefits of learning getting-up techniques are wide-ranging. Such knowledge could improve older peoples’ independence and quality of life. It comes with other benefits, such as enabling them to play games on the floor with grandchildren. I want to make older people and their families more aware that being able to get up after a fall is possible. I’d like to see them ask for help in learning to do it. Training staff and giving them the confidence to be able to teach getting-up techniques is also important.

Victoria Goodwin, Associate Professor in Ageing and Rehabilitation, University of Exeter

Carer

I thought well how do I get you up?…So, I thought let’s go onto YouTube … and looked it up and I said right you’ve got to get up on your knees and crawl to the chair or I might have put a stool or a kitchen chair there for him to use and get up. He said I can’t, I said you’re going to have to … Yeah, you’ve got to do it, and he did do it.

Spouse of a participant in the study

Paramedic

The COVID-19 pandemic has kept many people at home and has prevented them exercising as much. As a result, the rate of falls is likely to increase.

This paper highlights the high demand on care staff attending people who have fallen and cannot get up on their own. Many care staff are either in fear or are told “it’s policy” not to move the person in case they injure themselves. I hope this culture begins to change. Care staff need to realise that they do not have to wait for other healthcare providers to assist them.

Emphasising the older person’s responsibility to follow the recommended instructions may help. Care staff and older people need to learn the interventions that can be used to help people to get up on their own.

Matthew Shepard, Paramedic, North West Ambulance Service NHS Trust

Conflicts of Interest

None declared.