Falls and the Elderly
Statistics on Falling and the Elderly
Falling and its resulting injuries are an important public health problem for older adults. The National Safety Council estimates that persons over the age of 65 have the highest mortality rate (death rate) from injuries. Among older adults, injuries cause more deaths than either pneumonia or diabetes. Falls account for about one-half of the deaths due to injury in the elderly.
Several epidemiological studies have looked at the rate of falls in the elderly at home, in outpatient settings and institutions.
- Among 65 year-old women nearly one in three (30 percent) will fall; after age 85, over half of women will suffer a fall.
- For men, the proportion who fall increases from 13 percent in the 65 to 69 age group to a peak of 31 percent in the 80- to 84-year age group. For those over the age of 85 there is a slight decrease.
- It appears that for the elderly living at home one-third to one-half tend to fall or do fall.Those who are more aged, female, single, divorced or widowed have an increased rate of falling.
- In the younger, healthier elderly, environmental factors are more important, with stairs and floor obstacles being common causes of falls.
- For the older, sick elderly, falls are often associated with dizziness and syncope (brief loss of consciousness; "passing out"), cardiac and neurologic disease, poor health status and functional disability.
Complications of Falls
The complications of falls are numerous and significant.
- Fear of falling can be a very real reason for loss of mobility in the elderly. After a few falls, some people become so frightened and anxious that they will not attempt to stand even when there is adequate help and support. Fractures of the hip or forearm are common results of falling.
- Hip fractures carry high morbidity (health problems related to a disease or condition) because of prolonged immobility, surgical risks and functional disability, possibly related to hospitalization.
- Hypothermia, dehydration, bronchial pneumonia and pressure damage to the skin are all possible complications resulting from exposure in patients who are unable to get up once they have fallen.
Older persons are likely to fall for several reasons. The environment can be particularly dangerous as one gets older. Steps, throw rugs and poor lighting can all lead to increased falling when combined with physical instability.
|Physical instability has many causes in the elderly
- Osteoarthritis, muscle wasting and slowed reflexes are very common
- Poor vision from cataracts or macular degeneration
- Postural hypotension (abnormally low blood pressure) also contributes to unsteadiness.
Finding the Cause
A person who has fallen will be asked to give the care provider:
- An exact description of the accident and how they were feeling before it happened.
- A complete drug history is also needed.
- If the fall was a recent one, is there some underlying disease or new drug that may be the cause?
- If falling is an ongoing problem, could this be related to repeated accidental falls?
- If not, then other things to consider as sources of the problems might be orthostatic hypotension, heart problems, or Parkinson's disease.
To prevent falls you have to find the underlying cause and treat it. Therapists, nurses and the family can help the elderly person who has fallen regain or maintain his or her mobility. They can also help lessen the risk of falls by creating a safer living environment and improving awareness of environmental dangers. For example:
- Outside lighting can be improved
- Night-lights can be installed in hallways, near stairs, and in bathrooms
- Throw rugs can be removed or replaced with wall to wall carpeting
- Be especially careful when starting a new medication to be certain that it doesn't cause dizziness. If it does, call your health care provider.
- Keep telephone cords and other wires out of the way where you might trip on them.
Many elderly people have repeated falls without harm. The importance of falls as a cause and as a consequence of ill health in the elderly is now recognized. Although little is known about the increased risk of falls with age, studies are being done to improve the care available to older adults at risk for falls and injury.
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Last Reviewed: Apr 10, 2006
Gregg Warshaw, MD
Director, Office of Geriatric Medicine
College of Medicine
University of Cincinnati