Preventing Falls in MSA

In this factsheet we look at the causes of falls, how to try to prevent them and where to go for help.

Causes of falls

Whilst people living with MSA are at an increased risk of falling, due to poor balance or low blood pressure (postural hypotension), there are many other causes of falls, particularly as we age.

Whilst we cannot stop the ageing process, we can offset some of its effects by making small changes to our lifestyle. After having a fall you are more likely to fall again. Guidelines suggest that if you have fallen, you should ensure that you are reviewed by your healthcare professional. If this has not been done automatically, speak to your GP as soon as possible.

Key points to consider

Balance

Our balance reaction times reduce as we age, as do our reflexes. This makes it harder to regain our balance, particularly when moving quickly or turning. Balance is vital in ensuring you stay upright when over-reaching for items or if you trip up. Many people can improve their balance through regular exercise. However, the progressive nature of MSA means balance gets worse over time.

Bone Health

As we age our bones will naturally become more brittle, making the possibility of fractures significantly more likely if we do fall. Weight–bearing activities are good for maintaining healthy strong bones. A healthy diet helps ensure that sufficient calcium is taken to maintain bone strength. Vitamin D will help you absorb calcium and can be obtained through sunlight and from some foods such as:

Oily fish – including salmon, sardines, herring and mackerel
red meat
liver
egg yolks
fortified foods – fat spreads and breakfast cereals

During the autumn and winter, you need to get vitamin D from your diet because the sun is not strong enough for the body to make vitamin D. It’s difficult for people to get enough vitamin D from food alone, so everyone should consider taking a daily supplement containing 10 micrograms of vitamin D during the autumn and winter.

If you fall often your GP may refer you for a “DEXA” scan which looks at bone density. You might be prescribed Calcium and Vitamin D or other medications if you are at risk of Osteoporosis.

Muscle Strength and Joints

Between the age of 50 years and 70 years 30% of muscle strength is lost. By regularly doing strengthening exercise whatever your age, you may begin to feel a little stronger and more stable. It is recommended that you exercise for 30 minutes five times a week, if possible.

Footwear and Foot Care

While falls sustained at home are a major cause of disability, they can be prevented by taking quite simple actions. Shoes or slippers that are poorly fitting and poor foot health may contribute to risks of falling. Properly fitted footwear with a low, wide heel, firm supportive sole and a secure fastening can reduce this major risk factor. Practice good foot care by washing and drying your feet carefully each day, moisturise skin if needed, keep toenails cut short and straight across. If your feet swell, elevate them on a footstool during the day.

Check your feet regularly. If you feel you require a chiropodist (foot care specialist), please speak with your GP who can refer you to the appropriate service, providing you meet the criteria.

Eyes

It is not just ‘old age’ that can contribute to vision impairments. As we age, sensitivity to contrast decreases which makes it more difficult to see the edge of kerbs. Our depth perception also changes and may cause disturbances within our visual field, all of which will increase our risk of falls. Blurred vision can also occur in MSA and many people have difficulty negotiating spaces or can ’freeze’ when walking through a doorway or walking from one floor surface to another- i.e. carpet to wooden flooring.

Having an eye examination yearly is advised, as the Optician will check for glaucoma, cataracts, macular degeneration and diabetic retinopathy. For blurred vision, an orthoptist may be helpful (accessed via your GP). If you struggle to visit your Optician, they may be able to visit you at home as some do offer domiciliary visits.

Around the Home

Lighting

As we age, we require more light to see clearly. Consider branch or task lighting (specific areas lit where you are sitting or working or reading) to increase light without suffering from glare. Try to reduce your risk of falls from trailing wires from items such as lamps by using wire covers.

Contemplate having two-way switches on the hall and landing area. Bedside touch lamps are useful should you need to get up in the night so that you can see your path more clearly (don’t walk around in the dark). Yellow is the easiest colour to see, so you might want to consider having yellow door handles or yellow stickers near to door handles or switches. Motion activated lighting can be helpful, especially if you have to get up at night.

Kitchen and Bathroom

Reduce your risk of losing your balance through over-reaching or bending down by rearranging your cupboards so that items you use frequently are within easy reach. Aim to clear up any spillages immediately. Consider using a non-slip mat in the bath or shower and fitting grab rails. Your occupational therapist can advise you on equipment that can be useful when eating, drinking or preparing meals.

Garden

Ensure your front and back doors and garage are well lit and clutter free to avoid falls. Keep pathways free from moss or leaves and repair any cracks in your paving slabs. An occupational therapist can advise on wheelchair ramps and access to and from your home and garden.

Other Factors

Sixty per cent of falls happen within your home environment. To reduce your falls risk either remove rugs or ensure that all rugs have a non-slip underlay and that you replace any worn ones. Cable tidies will allow you to organise jumbled cables by your TV, computer or radio. Ensure walkways are free from clutter especially in your hall, landing, stairs and doorways. Companion animals have a habit of staying close to us and people do at times fall over them. Consider purchasing a brightly coloured collar or a bell to alert you to their location or presence. Long or baggy clothing can also be a risk factor.

Your physiotherapist can advise on any walking aids or equipment that might benefit you.

If you do fall and have difficulty getting up, ask your physiotherapist for advice. They might suggest an easy lift inflatable cushion, a stand assist aid or a handing belt for your carer to use.

An alarm call system can be reassuring if you live alone as you can summon help if you fall and are unable to get up unaided. By pressing the button on a small wearable device, you alert an emergency response centre who can then send you help. Consider installing a key safe outside your house so that people you trust can access your home if needed.

Factors that can also influence falls include: gait, freezing of gait, fluid intake, postural instability, dyskinesias and/or side effects of medications. Your Parkinson’s Nurse Specialist or MSA Health Care Specialist can discuss this with you and your physiotherapist to see if any medication changes can improve the symptoms.

Reduce Falls with Exercise

Impaired strength and balance contribute to most falls and therefore improving your strength and balance will require a commitment to a specific and safe exercise programme. Exercise needs to be regular, but you may fatigue easily so try to do short sessions every day if you can.

People with MSA experience muscle stiffness and rigidity, feeling unsteady (especially in crowds), feeling clumsy, and may have difficulty initiating movement (a Parkinson type symptom).

Ensure that you exercise in a safe environment:

Use a sturdy and stable knee height chair, for seated exercise
Wear comfortable clothes and supportive footwear

While exercising, if you experience chest pain, dizziness or severe shortness of breath, stop immediately and contact your GP. If you are not able to do regular exercise, discuss with your physiotherapist to see if there are alternatives that you can manage. Most physiotherapists can provide you with an individualised exercise programme. If you are a wheelchair user, but still able to weight bear, it is good to try to stand for a few minutes every hour during the day (with assistance if needed) to prevent discomfort and stiffness and prevent fragile skin breaking down over pressure points.

1 in 3 people who are aged 65 or over fall each year
25% of all hospital admissions are due to falls
6 people who are over 65 fall every minute
87% of fractures in an older person are due to falls
1 in 5 hospital beds are occupied by an older person with a fractured hip.

Getting Support

Whilst we recognise falls are a common symptom in MSA, there is specialist help available. If you are having issues with poor balance, do ask your GP to refer you to a local falls clinic. Services are varied across the UK and Ireland.

Falls clinics are run by a team of professionals including physiotherapists, occupational therapists and nurses. They identify why someone is falling or is at risk of falling. They provide intervention to help maintain independence and prevent hospital admissions.

If you have any questions regarding falls do contact the MSA Health Care Specialist for your area.