Don’t fall for it – preventing falls

When undergoing cancer treatment, the last thing you want is to have added stress and injury by experiencing a fall. Wendy Vermaak shares advice on how to prevent falls.


At some point in your life, you have had a fall. Falls are usually inadvertent, however, are not random events. Intrinsic risk factors, such as age; certain chronic conditions like diabetes, osteoporosis and arthritis; functional abilities; balance problems, muscular weakness and slow-reaction time all increase the risk of falling. 

Undergoing cancer treatment is also a risk factor. This is often attributed to the actual cancer treatment, specifically chemotherapy and other medication or the side effects. 

Chemotherapy can induce neuropathies (nerve damage that results in numbness, tingling, muscle weakness and pain) or affect vision which disturbs balance. 

Other medications can cause drowsiness, or may affect actual muscle wasting and weakness, increasing the risk of a fall.

Elderly cancer patients are at a higher risk of falling by up to a further 15%.

Non-cancer patients

Interestingly, women tend to fall more often than men (40% and 28% respectively), and one in three individuals over the age of 65 fall once a year. And of those who fall, half will fall recurrently. 

Consequences of falling

Falls in older adults lead to significant morbidity as well as mortality and are considered a major burden on society. There are consequences to falls, such as injury, disability and possible costly medical care which may include hospitalisation.

There are also psychological and psycho-social consequences of falling. Oftentimes after a fall, you may develop a fear of falling. This in turn produces an over-cautious approach to mobility, walking and movement. 

This avoidance of activity leads to deconditioning of muscles, reduced cardiovascular fitness, decreased flexibility and general physical activity capacity. This can then affect a person’s gait and capacity for daily activities of daily living which may further increase the risk of falling. 

Fear of falling leads to health deterioration, decreased physical and social functioning and loss of independence. Therefore a reduced quality of life. 

When to see a biokineticist 

Since biokinetic treatment is a ‘late-phase’ rehabilitation, the patient would be advised to seek treatment after the acute phase of injury, and also after having been cleared by a doctor for exercise. 

Doctors are very pro physical activity not only for health, function, and well-being, but also for ‘feel-good’ hormones (endorphins) which might help with cancer treatment side effects, such as pain and nausea, and psycho-social benefits as well.

A patient would also likely see a biokineticist for any rehabilitative treatment for injuries and orthopaedic complications. This is to build strength and regain flexibility and mobility. 

Biokineticists are helpful in overcoming the ‘fear of falling’ through specific balance training and specific individualised exercise prescription. Should you be concerned about your capacity to move or perform activities of daily living, or to help with the effects of the disease or medication, then a biokinetcist is the medical professional to contact.

Practical tips on how to avoid a fall 

  • Exercise balance training.
  • Practicing activities of daily living, such as standing up from a seated position.
  • Practicing getting down onto the floor and back up again.
  • Precautionary measures, such as anti-slip rugs, or rugs that don’t have lifted corners that could cause a trip.
  • Grab bars and handles in high-risk areas, such as showers and bathrooms.
  • Walking aids, such as walking sticks/walkers.

Balance training exercises to do at home

  • Practice of balancing on one leg. 
  • Walk in a straight line down a passage. 
  • Walking heel-to-toe in a straight line pretending as though one was walking on a tight-rope. 
  • Walk in a figure of eight.
  • Dancing.

These exercises, and others prescribed should preferably be performed under supervision to aid a patient should they struggle with balance, and should also be performed in a safe environment, such as near something to hold onto, where a fall and therefore injury could be prevented. 


To find a biokineticist near you, go to biokineticsSA.org.za.

References:

  • Brouwer, B.J., et al., Reducing fear of falling in seniors through education and activity programs: a randomised trial. J Am Geriatr Soc, 2003. 51(6):p. 829-34
  • Carter, N.D., P. Kannus, and K.M. Khan, Exercise in the prevention of falls in older people: a systematic literature review examining the rationale and the evidence. Sports Med, 2001. 31(6): p. 427-38
  • Chang, J.T., et al., Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trails. BMJ, 2004. 328(7441): p. 680
  • Cristian, A., Patient safety in the practice of rehabilitation medicine. 2012: Physical medicine and Rehabilitation Clinics of North America
  • Fuller, G.F., Falls in the elderly, Am Fam Physician, 2000. 61 (7): p 2159-68, 2173-4
  • Kalula, S.Z., A World Health Organisation (WHO) Global report on Falls Among Older Persons: Prevention of Falls in older persons:Africa case study. 2008, University of Cape Town
  • Kalula, S.Z., Prevalence of and risk factors for falls in older people in an urban community in South Africa, in Medicine.2012, University of Cape Town: Ph.D Phil.
  • Kinselle, K. and W. He, U.S. Census Bureau, International Population Reports, P95/09-1, An Aging World U.S. Government Printing office, Washington, DC. 2009, US: National Institute on Ageing
  • Lawson, K.A. and E.C. Gonzalez, The Impact of fear of falling on Functional Independence Among Older Adults Receiving Home Health Services.The Open Journal of Occupational Therapy, 2014. 2(3)
  • Liu-Ambrose, T., et al., Resistance and agility training reduce falls risk in women aged 75 to 85 with low bone mass: a 6-month randomised, controlled trial. J Am Geriatr Soc, 2004. 52(5): p. 657-65
  • Sminkey, L., 2020 [online] Available at: http://www.who.int [ Accessed 14/02/2020 ]
  • Antoun S, et al: Association of skeletal muscle wasting with treatment with sorafenib in patients with advanced renal carcinoma. J Clin Oncol 28:1054-1060, 2010.
  • Poterucha T, Burnette B, Jatoi A: A decline in weight and attrition of muscle in colorectal cancer patients receiving chemotherapy with bevacizumab. Med Oncol 29:1005-1009, 2012.
Wendy Vermaak is a biokineticist in private practice in Johannesburg, Gauteng. She has a keen interest in falls prevention and balance rehabilitation, and is also the marketing director for Biokinetics Association of South Africa (BASA).

MEET THE EXPERT – Wendy Vermaak

Wendy Vermaak is a biokineticist in private practice in Johannesburg, Gauteng. She has a keen interest in falls prevention and balance rehabilitation, and is also the marketing director for Biokinetics Association of South Africa (BASA).


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