Fall down six times
Get up seven
- Buddha
"I've fallen down and can't get up." How many times have you heard this phrase in a commercial or a funny skit on the comedy channel? It is not a laughing matter for an elderly person living alone today.
For people over the age of 65, falls are the leading cause of accidental deaths and injury-related visits to the ER. One in three persons over 65 will fall at least once per year increasing to one in two by age 80. Falls are the 7th leading cause of death in individuals 75 or older and associated with 9500 deaths annually.
Serious injuries including head trauma, soft tissue injuries, fractures and dislocation occur in 5 to 15 % of elderly fall victims. Hip fractures account for 90% of fall fractures in the elderly and are the leading cause of extended hospitalization and loss of mobility. A shoulder or wrist fracture is painful but a hip fracture can often result in permanent disability or nursing home placement when the victim is unable to care for themselves. Picture your grandmother hopping around on a pair of crutches; ludicrous and unsafe. Even with a walker, many elderly people lack the upper body strength to effectively use their arms and walk non-weight bearing on the affected limb.
Etiology
Accidental falls can often occur in the home or community without significant injury other than a few scrapes or a bruised ego to most of us. An older person who falls, even without injury, may self-limit his mobility and activities to prevent future falls. A deep seated "fear of falls" becomes the
modus operandi. Physical strength, endurance and flexibility correspondingly decrease with decreased activity.
Normal physiological changes accompany increasing age and can lead to decreased balance and increased risk for falls. Other physiological changes are NOT normal consequences of aging but result from certain disease processes and are considered pathological.
Age related changes include:
- Decreased range of motion (ROM) and flexibility – especially in the lower extremities(LE) and spine
- Weakness – LE strength can decrease up to 40% from ages 30 to 80
- Increased postural sway and thoracic kyphosis
- Decreased step length – i.e. short shuffling steps
- Balance deficits from changes in the three sensory systems which coordinate to provide postural control
-Vestibular – Decreased hair cells in the semicircular canals affect vestibular control
-Visual – Decrease in acuity, depth perception, cone cells and accommodation
-Somatosensory – Increased threshold of excitability for sensory receptors results in decreased reaction time
Pathological diseases which affect balance include:
Risk Factors
The causes of falls in the elderly are multifactorial and additive including environmental, physiological and psychological factors. Risk factors are divided into two categories: Intrinsic and Extrinsic.
Intrinsic risk factors are inherent to each individual and concern the person's age, gene's, physiological and psychosocial condition.
Intrinsic factors include:
- Postural instability
- Orthostatic hypotension
- Sensory deficits
- Foot problems – toenail length, callouses, bunions, deformities
- limited ROM
- Cognitive deficits
- Depression
- Acute illness – dizziness, syncope
- Muscle weakness/deconditioning
Extrinsic risk factors arise from external forces acting upon the individual.
Extrinsic factors include:
- Environmental hazards
-Cluttered hallways and stairways
-Loose rugs
-Poor lighting
-Wet surfaces
-Small pets- Prescription Medications – use of 4 or more is a red flag
- Alcohol or mind altering drugs
Fall prevention
The single most predicative factor for falls is
a previous history of falls. Every elderly person should have a thorough physical exam by a physician schooled in fall prevention including a detailed history of the last 6 months of activities. Many Senior health centers are opening around the country with
Geriatric specialists who can help a great deal in keeping our elderly safe and in good health. When appropriate, a referral to a
physical therapist for strengthening, balance and advanced
gait training can help prevent falls. Other steps to reduce fall risk include:
- Medication modification
- Family education on risks and fall prevention
- Home safety inspection with modifications where needed – installing grab bars, use of non-slip mats in tubs and showers, elevated toilet seats, removal of clutter or throw rugs
- Use of an assistive device when appropriate
However the best prevention for falls in the elderly remains an active lifestyle. Maintaining strength and flexibility with a good exercise program will carry you through the twilight years able to enjoy the things you love.
Sources:
Falls in the Elderly ,George F. Fuller, COL, MC, USA http://www.aafp.org/afp/20000401/2159.html
Preventing Falls and Reducing Injuries,Mary E. Watson, MSN,RN,CS,clinical seminar
Predicting the probability for falls in Community-dwelling older adults.Shumway-Cook a, Baldwin M, Polissar NL, et al. Phys Ther 1997;77:812-819.
Falls in the elderly: part II, balance, strength and flexibility. Gehlson GM, Whaley MH. Arch Phys Med Rehabil.1990;71:739-41.