When a person grows older, mobility concerns come in to play. Falls are one of the major health problems amongst senior citizens and a common cause of injury in this age group; an event which is most of the times accidental and seen mainly in elderly individuals.
Recurrent falls are a critical cause of morbidity and mortality in elderly and a marker of poor physical and cognitive status. Studies in Indian population have shown that incidence of falls in elderly (60 years of age and above) ranges from 14 per cent to 52 per cent.
An Indian study has found that after a fall, fracture is seen in 21 per cent and other forms of injury in nearly 80 per cent. Falls in elderly are one of the major contributors of hip fracture, spine injuries and severe head trauma. They are also major cause for hospitalisation of elderly and need for long-term institutional care.
Medications are one of the most common causes of falls in elderly. Taking five or more medicines (Polypharmacy) has been shown to be directly related to increased risk of falls.
Medicines that act on the nervous system, particularly, sedatives, psychoactive drugs, anti-depressants, anti-histamines, medications affecting BP are some of the common reasons contributing to falls.
Falls are generally a combination of several risk factors which can affect and threaten the ability of a person to continue with daily routine activities for a living.
Physical risk factors:
- Previous history of having fallen
- Chronic medical conditions like diabetes, thyroid problems, anaemia
- Neurological problems like stroke, Parkinson disease
- Vertigo and Balance disorders
- Muscle weakness
- Mood disorders like depression and psychiatric issues
- Impaired mental status like cognitive impairment and dementia
- Visual problems like cataract
Environmental risk factors:
- Poor lighting
- Slippery floors
- Cluttered walkways
- Wearing improper footwear
- Incorrect use of the walking aids such as canes or walkers
- Lack of grab bars in bathrooms
- Uneven and broken sidewalks
- Irregular steps
- Unpredictable level changes
Falls can range from trivial to major injuries in the elders which are mentioned below:
- Physical injuries like (muscle pains, scratches and wounds, hematomas, lacerations, fractures, head injuries leading to intracranial bleeding) and in severe cases can lead to death.
- Self-imposed limitation of activity
- Social isolation
- Loss of independence
- Poor quality of life
It is of utmost importance that the elderly report any fall that they may have had, when visiting their doctor for a check-up. Consultation with a Geriatrician (Elderly Care Specialist Physician) may benefit, as they are experts in preventing and managing falls.
Gait and balance training, medication optimisation, muscle strengthening exercises, home hazard modifications, correction of underlying problems like cataract are some of the preventive measures. An efficient preventive strategy is to educate patient and caregiver.
The patient at risk and family members should be educated about the multifactorial nature of falls, the specific risk factors and recommended interventions. Vitamin-D supplementation has been shown to be effective in preventing falls; but it should be taken only after reviewing with a doctor.
Depending on the severity of the fall and associated injury, the treatment options may vary. If there is a fracture, orthopaedic intervention and corrective surgery is needed.
Every individual with a fall needs to undergo detailed evaluation and assessment like review of medications, gait and balance assessment and other tests as per the need, medication optimization, gait and balance training, muscle strengthening exercises, using assistive devices like walkers, vitamin D supplementation, better home safety measures like hand rails, grab bars and raised toilet seats.
Treatment of underlying cardiovascular or neurologic disorder and education of patient and caregivers regarding falls are important steps.
- Frequent discussion with them about their current health conditions
- Take them for regular eye check-up
- Keep a watch on whether they are holding onto walls, furniture or taking help of someone when they are walking or face any difficulty in walking or getting up from a chair
- Talk about medications
- Eating healthy and food those provide nutrition
- Wiping up the spills immediately
- Keeping pathways in a good and clean condition
- If they have difficulty in their daily activities or have balance problems or have fallen in the past, seek a consultation with a Geriatrician
- Ensure that the elderly people are using assistive devices like canes or walkers, as prescribed by doctors
The author is a Consultant Geriatrics at Fortis Hospital, Mulund