Falls In The Elderly

Injuries from falls are a significant hazard for older people, and often they are the precursor to significant decline in function. An NIH white paper on falls in the elderly had this to say about some of the consequences of falling:

Each year, more than 1.6 million older U.S. adults go to emergency departments for fall-related injuries. Among older adults, falls are the number one cause of fractures, hospital admissions for trauma, loss of independence, and injury deaths.

Fractures caused by falls can lead to hospital stays and disability. Most often, fall-related fractures are in the person’s hip, pelvis, spine, arm, hand, or ankle. Hip fractures are one of the most serious types of fall injury. They are a leading cause of injury and loss of independence, among older adults. Most healthy, independent older adults who are hospitalized for a broken hip are able to return home or live on their own after treatment and rehabilitation. Most of those who cannot return to independent living after such injuries had physical or mental disabilities before the fracture. Many of them will need long-term care.”

One-third of community dwelling elderly fall each year, and up to 60 percent of those residing in nursing homes fall each year. Falls account for over 90% of hip fractures, most of them occurring in people over 70. Falls are a marker of declining function and also the cause of declining function. People who fall have a greater functional loss, greater social and physical impairment, and a greater risk of institutionalization. Most falls occur in the home or in close proximity to it.

Over 50% of elderly who survive a hip fracture, are discharged to a nursing home and one half of those are still in the nursing home one year later. Falls are very serious contributor to physical decline in the elderly and are a significant cause of death.

There are many risk factors for falls. Some are the following:

Hazards in the environment particularly the home Muscle weakness and balance problems

Visual impairment

Vertigo

Medications (particularly anti-anxiety, sedative and anti-depressant)

Alcohol misuse

Poly-pharmacy (14% increase risk for every medication above 4 medications)

Confusion or cognitive impairment

Acute illness (such as pneumonia or urinary tract infections)

Neurologic disease (stroke, Parkinson’s disease or neuropathy)
Loss of consciousness for any reason.

Drop Attacks – Sudden collapse due to falling blood pressure, early stoke or heart problems such as arrhythmias.

It’s not unusual for more than one of these conditions to be operative in elderly individual, and a minority of people over 70 years do not have at least one.

Falls are obviously a serious threat to one’s health, mobility and independence. I have had two falls in the last year, probably contributed to by my Parkinson’s Disease. In one, I didn’t lift my foot high enough to clear a curb and fell on my left side. I was fortunate enough not to fracture anything, but I had prolonged pain from a muscle tear in my left hip. The other fall occurred when I was on a path and turned suddenly to look behind me, lost my balance and landed on my right side with much less in the way of injury. They were enough to make me pay attention when I am walking. No one whom I saw medically provided me with systematic counseling about fall prevention.

It is difficult to summarize what one should do to prevent falls. The list above is a brief summary of the factors to explore, but each of those categories has many subcategories for specific conditions. However, I believe that the primary factor that has to be overcome is mental. It is reluctance to admit that falls are a serious threat and to take action. I’ve watched my own procrastination in doing some of the things that obviously make sense. I now use a walking stick when I walk on an uneven surface, use a handrail when going up or down steps, exercise regularly for balance and strength and have started taking up carpets on which I could and have tripped, but I avoid using a cane which I probably should.

Here is a list of some of the common, general preventive measures for avoiding falls leaving aside treatment for specific diseases:

If you have fallen, talk to someone knowledgeable (doctor, physical or occupational therapist) about the specifics of your fall in order to focus your preventive efforts. If your fall involved loss of consciousness, this mandatory

  • Fall-proof your home.
    1. Keep small objects such as clutter, electrical cords or low furniture off the floor and out of walking paths.
    2. Throw rugs or small carpets should preferably be removed or have non-skid backing or non-skid mats. Use non-skid wax for hardwood floors.
    3. Stairs should be well lit and have handrails.
    4. Bathrooms should have grab bars in showers, tubs and by the toilet
    5. If you live in an environment where it freezes, be careful when stepping out of doors onto a deck or stairs, Sand or salt icy surfaces.
  • Exercise regularly. This should include exercises to improve balance as well as maintain muscle strength.
  • Be cautious about alcohol. Alcohol plus diminished inherent abilities can be a lethal combination.
  • Wear sensible shoes.
  • Avoid sedatives and tranquilizing medication that can alter your sense of consciousness. Work with your doctor to reduce the number of medications that you take. There is a 14 percent increase risk of falls for every additional medication above four. Be especially cautious with medication for blood pressure. These can cause of sudden drop in blood pressure when moving from sitting or lying to standing. Dehydration can cause the same phenomenon.
  • Have your vision checked regularly.
  • Be conscious of what you are doing. It is easy to do things suddenly assuming that your body will remain in balance while the reality is that you have lost the reflexes, strength or capacity to do so.

This is a quick tour of falls. Hopefully readers will better understand the potential seriousness of the problem and can avoid some of t he hazards discussed above.

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About Albert

I am a 75 year old retired physician. My life now includes various volunteer activities, out of doors activities like hiking and biking, travel and photography. I, like others my age, am trying to make sense of the physical and emotional changes that come with growing older. Rather than trying to avoid or ignore the changes, I chose to be active in exploring them, and I invite others to join me on my adventure.

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