PREVENTION OF FALLS IN THE ELDERLY
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Fall injury is responsible for countless injuries all over the world. A fall can result in a trivial injury like minor bruises and scratches to something more life-threatening like a severe head injury. The elderly population are more likely to suffer from life-threatening complications resulting from minor falls.
Read more to find out the outcomes, risk factors, and simple steps to mitigate fall injury issues, especially in the elderly population.
A fall is a complex multifactorial phenomenon. The mechanism involves quite a complex network between various tissues and cells in the body. (1)
To explain it in a simplified form, your brain along with a network of nerves, spinal cord, eyes, ears, individual muscle fibres and your sense of touch, maintain the normal walking and balance. Effective coordination between these components, along with adequate cognition and concentration, is needed to prevent falls and maintain gait. (1)
When any one of these components is hampered, it can result in a fall or tripping.
Besides, with ageing, there is a decline in overall function and strength in most of the body parts and components. This results in more risk of falling down in the elderly population. (1)
Most of the time the causes of fall in elderly people is related to the age-related changes that occur in the body. (2) These could be
- impairment of vision and hearing
- reduction of proprioceptive and vibratory sensation
- altered gait
- poor positional control.
- Other problems like physical ailment, cognitive decline, medications, and environmental hazards may be responsible factors for it.
We also need to understand that fall is merely a symptom itself and not a disease. Therefore there are various multifactorial causes of falls. These factors have been scientifically grouped as (2)
- Extrinsic factors (factors which lie outside one's own body).
- Intrinsic factors (factors that relate to one's own).
- Situational factors (related to the activity done).
Extrinsic factors denote factors not related to the body of the person. Some of the examples of extrinsic factors are (2)
- Poor lighting and glare from the lamps
- Poor or no personal aid equipment
- Unfavourable flooring (e.g., loose carpets, uneven and slippery floors, low lying objects)
- Obstacles (e.g., electric cords, steps, hedge, low lying furniture, etc.)
- Slippery shoes
Intrinsic factors include those factors which lie within our body. These are (2)
- A disease which alters the gait and mobility (e.g., Parkinson’s disease, Knee and Hip arthritis, Feet problems, Neuromuscular and Vestibular diseases)
- Several medicines (e.g., sedatives and cardiac drugs)
- Visual impairment (e.g., Cataract, Glaucoma, Macular degeneration and Retinopathy)
- Hypotension (e.g., cardiac or postural causes)
- Increasing age
Situational factors denote scenarios relating to a certain condition. Some examples are (2)
- Walking while talking
- Being distracted by multitasking
- Failing to notice an environmental hazard (e.g., a curb or step)
- Rushing to the bathroom (especially at night)
- Rushing to answer the telephone
Fall injuries are relatively very common in the elderly.
According to research by Appeadu MK et al, over 30% of individuals who are over the age of 65 falls every year. In approximately half of the cases, the falls occur again and again. This percentage increases to around 40% in individuals aged 85 years and above. (3)
Therefore as we age, there is a greater chance of falls and fall-related injury to occur. The result of the fall injury can be trivial or could result in serious health issues like fractures, brain injury and brain bleeding.
Fall injury in the elderly can cause significant health ailments and even be fatal sometimes. The outcomes from a fall injury could be (4)
- Minor injuries and bruises
- Fractures of bones like the hip bone
- Dislocation of joints
- Muscle and joint pain, sprain or strain
- Head injuries like concussion, bleeding in the brain, fracture of the skull bone
- Open wounds like cuts, abrasions and lacerations
Preventing falls in the elderly is a challenging topic. Because there are multiple factors involved, it is essential to address these factors systematically. Addressing the preventable causes of falls can be significant in decreasing fall injury in the elderly.
Some steps that can be taken are: (1, 3, 5)
- Timely and regular health check-ups to work up factors like eyesight, medications and screening and early diagnosis of disease.
- Physical activity and exercise to improve the overall tone of muscle and bone strength. These could be simple stretch exercises, physiotherapy, yoga, practising Tai Chi or even guided weight lifting.
- Wearing proper shoes with proper fitting and good grip can also help in some cases.
- Removal of potentially harmful objects like tiles, slippery carpets or rugs, unwanted tables, chairs or anything that is causing a hindrance in movement around the house.
- Proper lighting of the environment can help in better visualisation of objects and prevent potential crashes or collisions.
- The use of assistive devices like a walking stick, crutches, cane, and handrails in the bathroom can prevent potential fall injuries.
The severity of an injury and its outcome are determined by an individual’s frailty or weakness and not the age. For example, the ability to walk up a flight of stairs or carry a bag of groceries can be different in two elderly people of the same age. (2)
A frail elder has a higher likelihood of falling and a greater risk of injury from a fall. (2)
A study showed that approximately 10% of falls result in serious injuries, including fractures of the hip, other fractures, traumatic brain injury, or subdural hematoma. These injuries are quite serious and can result in other complications during the course of treatment and are associated with higher mortality. (2)
Another study by Yee G et al found that elderly patients between the ages of 60 to 99 with severe head trauma have a greater than 80% chance of death and/or long term disability. (6)
Since head injuries are often seen with fall injuries, fall injuries can therefore be fatal in some instances. (6)
Survivors of traumatic brain injury may also suffer from chronic neurological complications. (6)
The elderly population have a high risk of sustaining fall injury and various complications related to it. Fall injuries also have a significant impact on the daily functioning and quality of life of the elderly population.
Therefore, knowing the potential and common causes of fall injury can be helpful to prevent fall injury from occurring.
For the prevention of fall injuries in the elderly, a multi-factorial approach is required. You should work with your doctor to decide on the programs suitable for your needs.
- Al-Aama, Tareef. “Falls in the elderly: spectrum and prevention.” Canadian family physician Medecin de famille canadien vol. 57,7 (2011): 771-6.
- Vaishya, Raju, and Abhishek Vaish. “Falls in Older Adults are Serious.” Indian journal of orthopaedics vol. 54,1 69-74. 24 Jan. 2020, doi:10.1007/s43465-019-00037-x
- Appeadu MK, Bordoni B. Falls and Fall Prevention In The Elderly. [Updated 2022 Feb 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560761/
- Verma, Santosh K et al. “Falls and Fall-Related Injuries among Community-Dwelling Adults in the United States.” PloS one vol. 11,3 e0150939. 15 Mar. 2016, doi:10.1371/journal.pone.0150939
- Prevent falls and fractures. National Institute on Aging.https://www.nia.nih.gov/health/prevent-falls-and-fractures. Accessed Jun. 3, 2022
- Yee G, Jain A. Geriatric Head Injury. [Updated 2022 Apr 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553101/
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