I never thought a simple fall could be so devastating

She lost her confidence, suffered panic attacks and was left with a limp. No wonder agony aunt VIRGINIA IRONSIDE says ...

WhEN we fall down as children, it’s usually no big deal. There are a few tears, a lot of kissing better, the badge of pride — a plaster — and, in the coming days, an interesting scab to pick.

Most people’s knees still bear the scars of early falls, reminders of an active past.

But fall when you’re over the age of 65, as I am, and it’s a different kettle of fish. You haven’t just fallen, you’ve ‘had a fall’ — and it can be very serious indeed.

Falls are the most common cause of accidental injury in older people and the most common cause of accidental death in the over-75s.

A third of people over 65 fall once a year and, of those falls, 6 per cent result in a fracture, usually of the wrist, knee or hip.

Those statistics don’t include the number of falls we oldies have that aren’t so serious. Usually, if we can, we just struggle up and stagger on.

That was my initial instinct after I fell a couple of months ago. I was on my own in Leamington spa, miles away from my London home, seeing an exhibition.

I’d just had a sandwich and was on my way to see the house I lived in as a child, when — bam! — I must have tripped, and was suddenly face-down on the pavement.

I was helped up by kindly passers-by and taken to Boots, where a pharmacist took one look and told me to go to A&E.

Blood was dribbling down my cheek, as my glasses had broken and cut into my temple, and my knee had taken such a bashing that I could only limp.

I rang the person I had planned to meet at my old house and, even though I’d never met her before, she heroically came to Boots and drove me to hospital.

Initially, they used a kind of glue to seal up the wound in my temple but, an hour later, it was still bleeding badly.

Then they put in five stitches, but I later had to return yet again because the blood still refused to clot.

In the coming days after I’d got home, my knee remained so painful that I continued to limp — and even now, I can still feel where the bruise was.

For

the next six weeks, I felt terrified. I found myself crying, suffering panic attacks and extremely fearful of leaving the house. I’m not the only one so affected. Falls commonly have a huge psychological and physical impact on older people.

Because broken bones don’t always heal completely when you’re older, a break can lead to long-term disability. A serious injury could mean you would no longer be able to live without support.

Indeed, the cost to the Nhs of patients having a fall, losing independence and needing residential care is estimated to be more than £2.3 billion a year.

I’m now bolder, but still cling to walls and tables to make my way around, and clasp the banister very tightly as I go downstairs, one by one. I fear going out at night because I can’t see well — and find my heart beating fast if I come across any bumpy ground.

I’ve even invested in a stick, although I’ve been told that, in an ideal world, I should try to get around without it in order to keep up my confidence.

But I know it’s better to walk with a stick than to become sedentary and isolated without one.

Because I’d fallen twice in a year — the first time was just a shock, no more — I was referred by my GP to a ‘ falls clinic’, something I previously had no idea existed.

There are falls clinics all over the country, usually attached to big hospitals (there are also community services in some regions, to which you can refer yourself).

They’re like medical detective agencies — because falling isn’t an illness in itself. ‘Falls should be considered a symptom, rather than a diagnosis, so that when a patient presents with a history of falls, every effort should be made to find the cause,’ says Dr Colin Mitchell, a consultant geriatrician at st Mary’s hospital in London.

‘A fall is not only a marker, but also a cause of decline and frailty. The more fearful you are, the more likely you are to fall. If you take two people who’ve had falls, the one with confidence to go ahead bravely is less likely to fall again than the one who’s nervous.’

At the falls clinic, you’re given a reassuring battery of tests. They test your blood and heart. They’ll check your eyesight, medication and blood pressure and watch how you get up from a chair. You’re questioned closely about your lifestyle, footwear and, if necessary, someone will come round and check your home for hazards. so what are they looking for? First of all, how’s your eyesight? Cataracts or damage to the macula (responsible for central vision) can cause falls, particularly if your home is poorly lit or you can’t gauge depth as well as you used to.

‘Varifocal and bifocal lenses can sometimes be the cause,’ says Dr Mitchell. ‘ I recommend longdistance glasses when walking.’

or could your heart be the culprit? when you fall, you tend to reach out to protect your head, which is why falls often involve fractures of the wrist and knee.

But if the head is cut, doctors suspect a blackout, which could be due to a drop in blood pressure.

‘some people deny they’ve had a blackout as our brains often create reasons to justify what’s happened to us,’ says Dr Mitchell. ‘But we can induce blackouts in people for up to 30 seconds and, when they come round, they’re insistent they’ve been conscious throughout.’

DEhYDrATIoN

or urinary tract infections ( UTIs) can cause confusion and instability, as can illnesses such as Parkinson’s, diabetes — due to the risk of blood sugar lows — and dementia. Certain medications seem to encourage falls, too: the worst culprits are sedatives, anti-psychotics, blood pressure medications and antidepressants.

Doctors will also check that it wasn’t alcohol that caused your fall — or just a tendency to faint. They compare your blood pressure lying down to when you stand up; the best way to prevent falling could just be taking care when you rise from the bed or a chair.

And, of course, they will check your legs. Are your muscles weak? or do you have arthritis in your feet, knees or hips?

‘so many people have bad knees and, as a result, they walk with an unsteady gait to take the pressure off the bad knee, which can result in a fall,’ says Dr Mitchell.

‘Many people are shocked when I recommend painkillers, but I point out that their wobbly posture is a kind of DIY painkiller.

‘And it’s always important to look at feet. I have had patients whose toenails are so long that they curl over and dig in, making it painful to put weight on the toes. A chiropodist can sort that out.’

Balance issues can also result from labyrinthitis, an infection of the inner ear. shoes may also play a part — flip-flops in particular.

‘I had one woman who’d spent her life at gallery openings and parties wearing heels, who toppled over the minute she started to wear flats. her feet just weren’t accustomed to them,’ says Dr Mitchell.

And as for environmental factors, they’re obvious. Could your fall be due to a rug sliding on a floor? or wet surfaces? And, after a certain age, it’s important never to step on a chair to reach for something high up.

In my case, the problem was my sight — impaired due to macular damage after a retinal detachment — and my balance. so now, I must attend ‘steady and stable’ classes. These consist of exercises to improve your balance.

Many friends of mine have toppled over and laughed about it — as I used to — but I’m not laughing now. I feel a lot more vulnerable and know it could have been worse.

really, I should not have been so stoic after my first fall. It was a warning of things to come.

so, learn from my mistakes. If you’re over 65, next time you fall, don’t just congratulate yourself on getting right back up.

Instead, check yourself in at a falls clinic to find out whether there’s a simple reason behind what happened that could help you prevent something more traumatic happening in future.