Falling is the commonest cause of accidental injury in the UK, with more than 2.7 million people affected each year. Falls can happen to anyone irrespective of age or medical condition, though having multiple sclerosis can increase the risk of falling.
In the majority of reported cases, falls cause no serious harm other than perhaps embarrassment and dented pride. However, the consequences of falls can be serious, ranging from distress and loss of confidence, through to injuries, pain and loss of independence.
Research shows, perhaps surprisingly, that in people with MS the majority of falls actually occur inside the home.
Why do people fall?
Many falls are caused by a combination of factors, both to do with objects in the environment - such as tripping over something - and health related issues. Some of the MS related factors that increase the risk of falling include:
- visual problems - double vision, blurred vision and nystagmus can make it difficult to focus or to see any hazards clearly. Optic neuritis can affect your balance if information from the eyes reach the brain at different speeds
- problems with mobility and/or balance - in particular foot drop, numbness, dizziness and fatigue may cause issues
- continence problems - rushing to the toilet if you need to empty your bladder or bowel more frequently or urgently can make you less careful than usual and lead to falls
- problems relating to concentration, attention span, poor memory or other cognitive symptoms - this might mean you find it more difficult to judge distances, you may trip over things that you'd forgotten were there, or if you're trying to do more than one thing at once you're not fully concentrating on walking
- side effects of medications - such as drowsiness or dizziness.
You are also more likely to fall if you've had previous falls or experience depression. Falls are also a concern for people with MS who use wheelchairs and scooters - especially if they're not used all the time. Risk factors include when transferring in or out of a chair, uneven pavements, or when someone inexperienced is pushing the chair.
Fear of falling
If you have experienced a previous fall, you may be concerned about falling again and become less active than you used to be, or limit what you do in an attempt to avoid situations where you feel you might be more vulnerable.
Even if you haven't fallen before, the fear of falling can itself be a risk factor. Reduced activity may mean your stamina levels and fitness are reduced as your muscles become weaker if you don't use them and your joints can become stiffer. As a result, everyday activities will be more physically demanding as your body isn't as used to moving and maintaining your balance, so your risk of falling increases. There is also a risk that you might become less motivated and increasingly dependent on others.
Ideas to reduce the fear of falling
- Talk about your concerns and share your worries with others.
- Consider getting a personal alarm system - this might be a simple pull-cord or there are alarms that can be worn around your wrist or neck.
- If you have one, keep your mobile with you at all times so that you can call someone for help.
- Consider what you would do in an emergency and who you would call - having a plan in place should you fall can take away some of the fear.
- Try not to let your fear of falling make you avoid social situations - the more you get out, the more fit and active you will be, and it can also benefit your emotional wellbeing.
- Learn and practise ways to get up if you should fall - a physiotherapist can teach you ways to do this. They can also help with exercises to help maintain or improve your mobility, posture and balance to reduce the risk of falling in the first place.
Ideas to reduce the risk of falling
- Make sure you have regular eye tests if visual problems are an issue. Simple things like giving your eyes time to adjust to sudden changes in light - for example, when going from a dark room to bright sunshine outside - can also be helpful.
- Keep your home well lit. Try to keep clutter around the house to a minimum. Consider placing sturdy furniture in strategic places at home so you can hold on to it if necessary. Walking aids such as a stick or frame may give an added sense of security or aid balance.
- Try not to rush to answer the door or a ringing phone.
- Think about your clothing and footwear. Low or flat-soled shoes might help. Boots can provide you with some ankle support. Clothing that is easy to undo if you have bladder or bowel problems might mean you don't have to rush as much to get to the toilet.
- Take care when bending down and stand up slowly after lying or sitting.
- Try not to do several things at once, focus your attention on one thing at a time. Plan ahead so you're not having to rush to do, or find, things at the last minute.
- Have regular medication reviews with your GP or pharmacist, especially if you're taking several medications, as drugs that may not affect drowsiness or cause dizziness on their own may do so in combination with other drugs.
- Stop, scan and plan - when moving about, concentrate and be ALERT - Assess your Location and Environment for the Risk of Trips.
- If you are prone to falling, consider keeping a falls diary so you can build up a picture of why they might be happening.
What to do if you fall
If you do fall, try not to panic. Although you may feel a little shaken and shocked, try to stay calm, gather your thoughts and remember what you need to do.
If you don't feel hurt and you feel able to get up:
- take your time and don't get up too quickly
- roll onto your hands and knees and look for something stable, such as a chair or bed
- holding onto the furniture, slowly get up
- sit down and rest for a while to recover.
If you do feel hurt or are unable to get up:
- try to get someone's attention, either by shouting or making a noise, or by using your personal alarm or mobile phone if you have one
- while you are waiting for help, get as comfortable and warm as you can. For instance, try to get to a carpeted area if you can, and try to reach something warm to put over you (particularly your legs and feet) such as a duvet, blanket, towels or a coat
- unless you suspect a fracture, try to change your position every half an hour or so. Moving regularly will keep you more comfortable and avoid pressure sores.
Where to seek further advice and assistance
If you have had a fall, or are concerned that you are liable to have a fall, there are a number of services that may be able to offer some help.
- GP - as well as assessing and treating any health issues, your GP can refer you to appropriate local services and can recommend a falls risk assessment, which will look at ways to improve safety in your home and reduce the risk of further falls.
- Physiotherapist - can suggest exercises to improve fitness, balance and posture and can also advise on walking equipment. Some services may provide training in transferring into and out of a wheelchair
- Occupational therapist - can help you to find easier ways of doing everyday tasks such as showering, cooking or to help make things easier at work. They can also advise on and provide some equipment and adaptations to the home.
- PLoS One 2014;9(9):e107620. Full article Falls in people with multiple sclerosis compared with falls in healthy controls.
- Journal of Rehabilitation Medicine 2013;45(5):452-457. Full article A population-based study of fall risk factors among people with multiple sclerosis in Stockholm county.
- London: National Patient Safety Agency; 2007. Full report Slips, trips and falls in hospital: the third report from the Patient Safety Observatory, PSO/3.
- Clinical Rehabilitation 2017;Sep 1:269215517730597. Summary Falls in people with multiple sclerosis: experiences of 115 fall situations.
- Medicine (Baltimore) 2017;96(35):e7860. Full article Fall prevalence in people with multile sclerosis who use wheelchairs and scooters.
- Disability Rehabilitation 2016;38(22):2193-2197. Summary Bladder function and falls in individuals with multiple sclerosis.
- International Journal of MS Care 2015;17(5):207-214. Full article Medications are associated with falls in people with multiple sclerosis: a prospective cohort study.
- Journal of Bodywork and Movement Therapies 2015;19(1):72-81. Summary Yoga therapy and ambulatory multiple sclerosis: assessment of gait analysis parameters, fatigue and balance.
- International Journal of MS Care 2014;16(3):117-122. Full article Clutter management for individuals with multiple sclerosis.
- BioMed Research International 2014;2014:281760. Full article The relationship between specific cognitive domains, fear of falling, and falls in people with multiple sclerosis.
Using your imagination to practice walking movements
18 April 2016
This study combines rhythm cues from music or a metronome and motor imagery to see if they had any effect on walking in people with MS.
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