As people age, they become at risk for a lot of different conditions and injuries. One of the most common dangers for the elderly community is falling. All falls are not preventable, but the risk of falls and the damage caused by falls can be minimized. By being educated on this topic, the risks can be reduced and overall health, wellness and quality of life can be improved.
Dangers of Falls
The reality is that falls are the leading reason for people over the age of 65 visiting the emergency room for injury-related accidents. The older a person is, the more damage these falls can cause. What’s alarming about this is that falls account for up to 70% of accidental deaths for people who are 75 and older. Risk factors for these dangerous falls may include sensory deficits, cognitive impairment, and aging.[i]
Why are these falls so dangerous and severe? When an older adult falls, they are more susceptible to various injuries than younger people. More than half of the falls in this age group will result in minor issues like sprained ligaments, a strained muscle, or bruises. However, some more severe injuries can occur as well, including torn ligaments, broken bones, or organ damage. Broken hips occur in about 2% of falls, and other broken bones account for 5% of falls. There also could be head injuries or loss of consciousness.[ii]
The biggest problems may occur if a person can’t get help quickly or cannot get up on their own. Then, in addition to the physical pain these injuries cause, there is also that feeling of loneliness and helplessness which can terrify the person and result in their losing confidence in their ability to independently function in the world. In these situations, additional physical problems that can follow include dehydration, pressure sores, and even pneumonia. A person may also experience muscle breakdown, also known as rhabdomyolysis. This condition can lead to problems such as kidney failure or kidney damage.
After the initial injuries, there can also be lasting physical and emotional consequences, which one can experience for an extended amount of time or even the rest of their life. Even after rehab, about 50% of people who fall and break their hip may struggle with walking. Often, a person who has been injured while falling may be too scared to risk getting hurt again. This fear may lead to the loss of confidence which leads them to them being less active, likely causing stiffness in the joints or weakness in the muscles. These results can reduce their quality of life, take away their independence, and significantly harm their emotional well-being.
Unfortunately, sometimes these falls can be severe, resulting in death. While this loss of life can happen immediately due to head trauma, it more often occurs after the fact due to complications arising from the fall.
Falls may not be a big deal for younger people, but falls can pose a very significant danger to the elderly. This risk is especially true for older adults who have pre-existing conditions or are frail. They are less likely to have the ability to withstand the trauma of the fall or recover from it. This inability to recover makes it extremely important for the elderly to do whatever they can to prevent or reduce the risk of falls to stay safe.
What Can Cause Falls in the Elderly
To adequately address how to prevent these falls, it can be vital to understand what can cause the elderly to fall in the first place. When the risk factors for falling are understood, a plan for prevention can be made. This plan can help prevent most falls so that older adults can enjoy their independence for longer.
A common cause of falls is the general process of aging. As adults age, their vision and hearing may decline, which can make them more likely to fall. Poor lighting can also affect visibility, possibly leading to a fall. Another common issue that causes falls is items such as throw rugs or carpets that are not adequately secured. Additionally, wet or recently polished floors, such as in a bathroom or in the kitchen, can be common scenarios that increase risk.
There are also health conditions that can increase the risks of falling primarily if these affect balance or muscle strength. Certain medications have side effects that can also impact stability. Medicines that can cause instability are those taken for such conditions as high blood pressure, depression, diabetes, heart conditions, or sleep problems. There is some evidence that if four or more medications are taken the likelihood of a fall is more prevalent.[iii]
As previously mentioned, reduced confidence with balance and reduced mobility due to related inactivity will continue to increase the likelihood of falling and increased injury risks.
A Closer Look at Common Causes of Falls of the Elderly[iv]:
Impaired Vision: As people age, their vision worsens. Various age-related eye diseases can limit a person’s eyesight. With this limited vision, people are less likely to see hazards that can cause them to fall, such as thresholds, steps throw rugs, or other home hazards.
Medications: As previously mentioned, over the counter and prescription drugs can have an impact on balance and muscle strength which could lead to falls. The side effects include dizziness, low blood pressure, and drowsiness. The medications that are most likely to contribute to falling accidents in the elderly include anti-depressants, sedatives, cardiovascular drugs, and opioids. The more medicines that are taken, the more likely the chances of a mishap.
Behavioral Hazards: There are activities that an older person may do that may increase their chances of falling. It depends on their level of activity, what types of movements they engage in, and how they make it safer to complete these tasks. An example of this is when an older adult does their laundry. Washing clothes can be a physically taxing job for an older person, especially if it requires going up and down the stairs. When lugging a heavy laundry basket full of clothing, proper precautions such as wearing non-skid footwear, or perhaps carrying a lighter load may not be taken, which could result in a fall. By not adjusting behaviors when doing the laundry, it can lead to problems that will increase the risk of falls.
Chronic Diseases: Many conditions can lead to an increase in your risk of falling. Certain conditions like Alzheimer’s, arthritis, and Parkinson’s disease can cause a variety of issues including weak grip strength, weakness in the extremities, cognitive impairment, and problems with balance. Sometimes effects like peripheral neuropathy, a type of nerve damage, can interfere with one’s ability to sense hazards and can lead to falls.
A Decline in One’s Physical Fitness: When people get older, they tend to become less physically active. The problem is that when the elderly are less energetic and moving less, this worsens the adverse effects on their body caused by aging. When the elderly don’t regularly participate in even light physical activity, they may end up with decreased bone mass, reduction in flexibility, decrease in coordination and balance, and an increase of muscle weakness.
Medical Procedures: Various surgeries can have an impact on the risk of falling. After hip replacement or other operations, people are often less mobile than they were before they had these procedures. It can also cause a person to feel much muscle weakness as well as much pain and discomfort. Sometimes these issues resolve themselves over time and through treatment and rehabilitation. However, in many instances, these issues can lead to lasting problems.
Environmental Hazards: Hazards in the home cause many accidents involving falling. Clutter, loose carpets, poor lighting, and slippery floors can be the calls of such falls.
These are just some of the common causes of falls in the elderly community. In many cases, there is more than one contributing factor for a fall occurring. It is a good idea to walk around the home, and any other frequented environments, to see what you can do to make the home safer.
Fall Prevention
After the causes for falling are understood, look with fresh eyes around the home to see what can be done to prevent a fall. Environmental hazards are just one cause of falls. Every fall may not be preventable, but knowledge of the hazards that often cause falls will create awareness and the best opportunity to take action to reduce the risk of falls as much as possible thereby increasing the likelihood that you, or your loved one, stay safe. In this section are tips and tricks to support preventing falls and general fall prevention guidelines to make those at risk both feel, and be, as safe as possible.
Better Lighting: Any area that a senior will be should be very well-lit. Proper lighting can help prevent accidents. There should be adequate lighting in any area where it’s needed. It is also crucial for people to remember to turn the lights on when they get to poorly lit areas.[v]
The Right Footwear: The right footwear is vital, meaning that shoes need to be supportive and fit correctly. Ideally, shoes will offer the right amount of friction to make them safe. Low heels can help to prevent tripping. Wearing slippers or socks that provide skid-free protection is also a good idea as slippery socks, stockings, or slippers can pose potential hazards.
Regular Vision Exams: The elderly need to get regular vision exams not only to ensure that they have the right prescription but also to catch any age-related issues. The earlier these problems are detected, the quicker they can be treated. Regular eye exams and treatment can often help to retain better vision for a more extended amount of time.
Regular Exercise: Exercise should be a priority for people of any age. As a senior, getting regular exercise can make a huge difference in stability and muscle strength. There are plenty of activities that you can participate in that are safe and also offers plenty of benefits. These exercises include balance improvement exercises, walking, Tai Chi, and weight lifting. Exercises that will increase your endurance, improve coordination and stability, and strengthen your bones are best. The better one’s physical condition, the less likely they will suffer a fall and the better they can recover should they have a fall.
Evaluate the Home Environment: It’s a good idea to take a walk around the home to see what obstacles may exist that can lead to a fall. Check for any rugs that may have edges that stick up or are loose. These can cause a fall. Remove any unnecessary clutter to reduce the risk of falls. Make sure to have railings on both sides of any stairs as well as adequate lighting where needed. In the bathroom, add grab bars in the tub/shower area as well as by the toilet.
Learn More About Medications: Medications can have side effects that may increase the chances of falling. It is crucial to ask the doctor and pharmacist about prescriptions to see if these can cause symptoms such as drowsiness or dizziness, which are the main side effects responsible for falls. If a person is taking medications that have these side effects, they should consider asking the doctor for a safer alternative.
Stand Up Slowly: When sitting down or laying down, it can be a good idea to get up slowly. By moving into a standing position gradually, the body has more time to adjust to the position change. Slowly standing will prevent any dizziness that may be experienced by getting up too quickly.
Consult with a Physical Therapist: Physical therapists are great people to advise the elderly, especially if they need to use a device such as a cane or walker. A PT can help to determine the best mobility aids that fit the needs of each elderly client.
Stay in Good Health: To better recover should something happen, it is best to be in good physical shape. One way to do this is not to have more than a couple of drinks a day, don’t smoke, and try to eat as healthy as possible.
Ask for Help: It can be essential for an older person to ask for help. It is best if they don’t try to do things that require too much effort and risk a fall injury. Also, when as with anyone, when an older adult feels like there is something wrong, they should discuss this with their doctor to see how they can help you. Asking for help can be an important way to stay safe.
Preventing falls is essential. All falls cannot be averted however, it is crucial to help the senior citizen feel safe and retain their independence by taking the fall prevention advice given above. Such preventions will help ease everyone’s mind.
What to Do if There Is a Fall?
Unfortunately, no matter what measures are taken to prevent a fall, it may still happen or have already happened. If this is the case, knowing how to handle that situation becomes the next critical area of focus.
If you are an older adult and you have a fall, then try to stay as calm as possible. Taking a few breaths to relax, exhale slowly and collect your thoughts will help. It would be best if you stayed where you are for a few moments. By doing these things it will help you get over any initial shock you may be suffering from after the fall. Before trying to get up, trust your instincts to determine if you are injured. If you are too hurt to move, you shouldn’t try to get up. If you move too quickly or move the wrong way, this can make your injury even worse. [i] Try to remain calm and not inadvertently cause yourself more harm.
After analyzing your injuries and deciding that you can get up, you should roll over to your side before trying to get to your feet. Take a moment after rolling over, as this can help your blood pressure and body to adjust to the position change. From this position, you can slowly try to get up by getting on all fours, on your hands and knees. It would be best if you stayed in this position as you crawl to a stable, sturdy chair. Use this chair to help you get into a semi-standing position and adjust to a sitting position. If it is an option, it would be a good idea to call for help to ensure that you get checked out for injuries.
If you can’t get up, try calling out for help, if there are others nearby, to get someone to call 9-1-1 for you. It is a good idea to carry a phone or wear an emergency alert bracelet/necklace. If you do have a fall, you can use these items to call for help right away. If you can’t get up safely, then get yourself into as comfortable of a position as possible and wait for the situation to change so that you can call for help or get together enough strength to get up safely.
Treatments after a Fall
The top priority after a fall is to treat any injuries. Next is to determine any underlying ailment or circumstance that may have caused the fall. Some injuries need to be addressed right away, including strained muscles, fractures, sprained ligaments, and head injuries. There may be tests that will get performed by the doctor to determine the extent of the damage to advise on the best treatment for recovery. Sometimes there may be a need for surgical intervention or it may be that you will need some time and rest to heal.
Seeing a Doctor after a Fall
After a fall, it is best to see a doctor to get assessed and treated if necessary. This medical assessment is crucial to determine any injuries after a fall as well as if there is an underlying medical condition that may have contributed to this fall. Older people who have fallen in the past will be more likely to fall again in the future, so the medical assessment can also help you prevent future falls. The question becomes: “What should be checked after a fall?”[vii]
One of the first things that the doctor will do is determine if there is a new illness or circumstance that may have contributed to the fall. It is vital at this point to mention any new or worsening symptoms to the doctor so they can get the best information to make their assessment. Some common health problems that can lead to a fall include heart problems, anemia, stroke, dehydration, pneumonia, and a urinary tract infection.
A doctor should also check to see what the blood pressure is while sitting down and standing up because if someone experiences low blood pressure when standing up, they will become dizzy and they will be more likely to fall. This test can be one of the most important to be done after a fall, but one that often doesn’t get performed as much as it should.
Blood tests should also be performed after a fall. There could be a problem that can be diagnosed by a blood test, such as low blood sugar or blood sodium, that is too high. After blood work, make sure to follow up with the doctor to see if any issues are of concern or if there is anything that may be responsible for the fall. If there are any problems, then the doctor will be able to advise what the next best steps are to overcome these issues.
A frequent contributing factor is the medication a senior is taking. A lot of older adults have prescribed medication that can increase the risk of falls. What you may not know is that often these prescriptions can be reduced or even replaced with drugs that have fewer side effects. This medication includes medicines like sedatives, blood pressure/diabetes medicines, and medications known as “anticholinergic” medications. These are medications that are used for vertigo, overactive bladder, and allergies. It is useful to have a compiled list of all medications being prescribed by any and all doctors to prevent contraindications and to allow the doctor doing the assessment to have the full picture.
Doctors can also do an assessment on the gait of an older adult as well as their balance. If there is something wrong, the doctor should first ask to see if there is any pain or discomfort that the person is experiencing as well. Sometimes this gait and imbalance problem can happen as a result of an underlying cause, such as pain in the joints, back, or feet. If the primary care doctor doesn’t help, then a visit to a physical therapist for an evaluation may be in order. The physical therapist will offer advice on the various exercises that can be done to strengthen muscles or help outfit someone with the proper mobility aid.
Another assessment that should take place is to check for underlying neurological conditions or heart conditions that may have caused the fall. Many doctors tend to only check for immediate and acute illnesses rather than something chronic. Such ailments may be the more common cause, but there could be a chronic underlying illness that caused the fall and will cause falls in the future if left untreated. Sometimes falls can be brought about as a result of a chronic heart condition, like paroxysmal rapid atrial fibrillation or a neurological condition like Parkinson’s disease. The physician should include this perspective in the assessment to rule them out as factors.
These evaluations are necessary and vital because by determining what the cause of the recent fall, steps can be taken to help avoid this problem in the future.
Statistics for Falls in the Elderly Community
There are some daunting statistics to consider when it comes to falls in the elderly community[viii]:
- Three million older adults are treated for fall injuries in emergency rooms annually.
- Three hundred thousand older people are hospitalized annually for hip fractures.
- 800,000+ older adults are hospitalized annually due to fall injuries, particularly for hip fractures and head injury.
- 1 out of 5 falls lead to severe injuries like head injuries and broken bones.
- Fall death rates in the United States have increased by 30% between 2006 and 2017.
- These are also very expensive. Just in 2015, the total medical costs for the falls was about $50 billion. Medicaid and Medicare did cover about 75% of these costs.
Conclusion
Falls in the elderly community can be very dangerous. However, many accidents are entirely preventable. Falls can be both physically and emotionally damaging for an older adult, drastically reducing their quality of life. By doing everything that you possibly can to prevent falls, you can help yourself, or someone you love, to retain their independence and quality of life for as long as possible.
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REFERENCES
[i] https://www.aafp.org/afp/2000/0401/p2159.html
[iii] https://www.aafp.org/afp/2000/0401/p2173.html
[iv] https://www.agingcare.com/articles/falls-in-elderly-people-133953.htm
[v] https://www.hearthsideseniorliving.com/why-are-falls-so-dangerous-for-the-elderly/
[vi] https://www.nia.nih.gov/health/prevent-falls-and-fractures
[vii] https://betterhealthwhileaging.net/8-things-to-check-after-fall-in-aging
[viii] https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
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