The statistics don’t make great reading. Each year, one in three Irish adults aged 65 and over will experience a fall. Falls are the most common reason for older adults attending emergency departments – and for admission to long-term care facilities.

The Irish Longitudinal Study on Ageing (TILDA) has shown that almost 40% of older adults involved in an ongoing study reported at least one fall during a four-year period, while almost 50% had ‘fear of falling’.

That’s why preventive measures, medical and environmental, are important. If more people don’t take this advice on board, TILDA experts say, the numbers of injuries caused by falls is projected to be 100% higher in the year 2030, with the associated healthcare requirements spiralling also.

One way to get help, if vertigo is an issue, is to seek an assessment by a chartered physiotherapist who has specialist training in what’s called vestibular rehabilitation.

Rachel Allen is one such chartered physiotherapist, based at Mid-West Physiotherapy Clinic in Castletroy, Co Limerick. To keep things simple, she often uses the term vertigo rehab specialist.

“That’s because vestibular isn’t a familiar word to many,” says Rachel, who is from New Hampshire in the USA but has been living in Limerick for seven years. “People know the word ‘vertigo’ better so it’s easier to explain what I do.”

Statistically women are slightly more prone to vestibular problems, although it is not known why.

“I have seen young people affected too,” she says, “but, in general, it’s more common in 60 and 70-year-olds.”

Rachel has seen many patients who have already fallen or are worried about their balance.

Rachel Allen chartered physiotherapist

“Vestibular dysfunction affects a lot of people. Your vestibular system is in your inner ear and it basically tells you how fast your head is moving. If something is going wrong with that sensor, it can make you dizzy and feel ‘off balance’. People with this dysfunction are eight times more likely to fall.”

Impact of vertigo

Not feeling properly balanced or suffering from vertigo can lead to loss of confidence and isolation through not moving about or going out as much.

“It’s huge, the fear of falling element. This leads to guarding and avoidance which is nearly the opposite of what we want people to do.

“It is an understandable fear and a very normal response but we can help the person slowly build their strength back up and therefore their confidence to get back doing what they love.”

It’s a ‘use it or lose it’ situation, Rachel believes.

“If people stop moving, they lose even more balance. The aim of vestibular rehabilitation is to get you back to your strength slowly, under guidance, to build up strength in your legs and strength in your inner ear.”

For those in this situation, vestibular rehab physio has been shown to be effective.

“An eight to 12-week programme helps to reduce dizziness and improve people’s balance and mobility, strength and walking speed,” she says.

Treats many farmers

Rachel treats many farmers who present with this condition.

“They are usually referred by their GP who have ruled out blood pressure issues. It’s important to rule those out first. When people are experiencing dizziness or vertigo many of them just try to get on with it even if, when they stand up quickly, the room spins for 10 to 30 seconds. While they tend to blame their blood pressure, in most cases it’s an inner ear issue.”

With farmers who have vertigo problems, it’s not usually a strength issue, she says.

“They are strong and active but no matter how strong or active you are, if the sensor in your head isn’t working right to tell you how balanced you are, you can get vertigo. If it’s vertigo, the beauty of that is that you can help it quite easily by being shown exercises to correct it.

Assessment – what’s involved?

“It takes about an hour, with the first part of that taken up with listening to the patient’s history. I hear about their concerns, their falls or near misses and past injuries,” says Rachel.

“I also like to know if they are worried about falling and what they are missing out on because of this fear. Is it affecting their job? Their social life? I assess the strength in their legs and their balance, also, using tests that can detect that.”

A person’s physical fitness is also tested. “This could include finding out how many times they can get up off a chair in 30 seconds. We’d compare that to the international average for that age.”

Balance check

“We would ask the person if they can walk in a straight line, if they can walk when looking left and right, or when looking up and down, or while they are distracted, for example when counting backwards from 100 in three seconds. “We would compare all these results to normal ranges. If you are slower than normal doing these things, then you are at increased risk of falls.”

Programme of exercises

Patients are then shown how to do some exercises and they continue the programme at home with pictures of the exercises printed off or, what many prefer, with short videos showing them how to do them properly.

“You’re told what to do, for example getting up off a chair, and how many of each exercise to do. Improvement comes week on week, eight times building up to 10 times, etc. It really can make a difference to people’s lives. ”

Falls prevention: Rachel’s advice

Footwear – soles should have ridges. In icy weather, wear appropriate footwear so you don’t slip. If you wear high heel, remember you’ll need good balance to back them up.

Avoid rugs – especially if they are the same colour as the carpet or if they are slippery or have a ‘lip’.

Advice from the HSE

The HSE has more advice related to fall prevention. Making small change can lower your chances of injury.

Keep active and exercise.

Ask your GP to review your medicines. Some medicines can make you feel faint or light-headed. Check with your GP for advice.

Have your vision checked regularly. Poor vision can increase your chances of falling.

Floors – arrange furniture so that you can move around easily. Keep floors clear of papers and books that you could trip over. Make sure there are no trailing cords or wires from lamps, etc.

Stairs – don’t leave objects on the steps of the stairs. Have a light switch fitted at the top and bottom of the stairs. You may need brighter lights as you get older as well. Install hand rails on both sides of the stairs, making sure they reach the top.

Bathroom – fix grab rails next to your toilet, bath and shower and use a non-slip mat in the bath or shower.

Kitchen – keep items you use often within easy reach. Use a steady step stool rather than a chair to reach high shelves.

Bedroom – have a lamp within reach of you in bed and make sure there is a light between your bedroom and the bathroom. Have a phone extension in the room if you don’t have a mobile and wear a personal alarm. Check with your public health nurse, GP or local Garda station for information about this alarm.

Did you know?

  • Each year, one in three Irish adults aged 65 and over will experience a fall.
  • Falls can lead to long hospital stays, expense and long-term care.
  • The most common fractures resulting from falls are of the hip, (back) vertebrae and wrist.
  • Fall injuries in the elderly currently cost Irish society €500m annually.
  • Rollercoaster Conundrum

    Feel sick and dizzy while on a rollercoaster? Why is that?

    “Young people are usually fine on rollercoasters because they are constantly doing back flips and cartwheels and using playground equipment and moving quickly,” says Rachel. “In adults, however, we never move that quickly so on a rollercoaster we feel awful because the sensor in our brain isn’t used to us doing that anymore.”

    Lightbulb moment

    Jolene Cox social entrepreneur and founder Family Food Made Easy One Yummy Mummy with daughter Lily-Mae.

    Have you an idea that could make Ireland a better place? If so, why not apply for Social Entrepreneurs Ireland’s Ideas Academy Class of 2024?

    Applications are open from Tuesday, 13 February until Tuesday, 12 March. You can also register to attend an online information event featuring contributions from programme graduates on Tuesday, 20 February. For full information, visit

    Social Entrepreneurs Ireland, the national charity dedicated to harnessing the cumulative power of people to enable lasting social change on the island of Ireland, is 20 years in existence.

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