Falls are common in older people and the risk of falling increases with increasing age. A third of those aged 65 years and over, rising to over 40% in those aged 80 years and above, fall each year, compared with 8% in middle age
A fall may be the result of a simple “trip” due to an environmental hazard, such as poor footwear, wet and slippery floors, loose rugs and poor lighting, but often it is caused additional factors affecting the person themselvesPhysiological changes associated with normal ageing reduce balance, increase reflex times and thus, increase the risk of fallingSpecifically, we rely on our vision, sensation from the feet and legs, the inner ear and processing of all these inputs by our brain. Even in healthy old age, all of these systems show physiological decline, putting us more at risAdditionally, without regular , we lose muscle strength with normal ageing and our blood pressure control on changing position (e.g. standing up) becomes less effective and may causing us to feel unsteady or even dizzyChronic problems, such as arthritis and eye and inner ear problems are also often present and increase the risk of falling. Acute problems, such as infection, heart problems, Thus falls may be caused by a single factor, but much more commonly by a combination of environmental, physiological and pathological factors in the elderly person.
Common Risk Factors
Neurological
- Dementia and Alzheimer's
- Delirium – acute confused states, caused by infection, metabolic disturbance, certain drugs or drug withdrawal (including alcohol), environmental change (e.g hospital)
- Strokes and transient ischaemic attacks
- Parkinson's disease
- Peripheral neuropathy – loss of sensation particularly in feet with multiple causes
- Pressure on spinal cord or nerves leaving spinal canal often due to disc disease or spinal osteoarthritis
Vestibular
- Benign paroxysmal positional vertigo
- Previous vestibular insult – e.g labyrinthitis
Medicine
Many drugs are capable of increasing the risk of falling, but only a careful medical history will help establish if this is likely. There are many possible side-effects:
- Lowering blood pressure, particularly on standing, e.g. diuretics, ACE inhibitors, some antidepressants
- Drowsiness and increasing reflex times, e.g sleeping tablets, some antidepressants
- Confusion, e.g anti-Parkinsonian drugs, sudden withdrawal from certain drugs and alcohol
- Changes in movement, which resemble Parkinson’s disease, e.g. antipsychotic drugs
- Slowing the heart rate, e.g. beta blockers,
- Causing a low blood sugar, e.g. insulin
This list is by no means exhaustive and just highlights some of the more common groups of drugs, which can cause problems for some people
Visual defects
- Cataracts
- Macular degeneneration
- Glaucoma
Musculoskeletal
- Osteoarthritis
- Foot deformities
- Rheumatoid arthritis
- Muscle wastage
Heart rhythm and blood pressure control abnormalities
- Abnormal fall in blood pressure on standing
- Abnormal fall in blood pressure for up to 90 minutes after eating, often accompanied by abnormal fall on blood pressure on standing
- Failure of the natural electrical generator in the heart to produce enough impulses leading to slow the heart beat
- Poor conduction of the electrical impulses through the heart
- Over sensitivity of one of the mechanisms of blood pressure control leading to low blood pressure and slow heart rate
Home Environment
- Poor lighting
- Unsuitable footwear
- Lose rugs
- Steps
- Unsuitable walking aids
- Unfamiliar environment
What are the complications associated with the elderly falling?
- Fear of further falls and thus limitation of activities. This is one of the most important effects, as unchecked it can lead to isolation, further physical decline, depression and even institutionalisation
- Head injury
- Soft tissue injury
- Fractures – wrist, hip, pelvis, rib and vertebral fractures are common
- A lengthy lie on the floor if unable to get up potentially leading to muscle breakdown and kidney damage, pressure sores, hypothermia, missed medication effects
- Multiple falls may lead to hospitalisation with its own complications
What should you do if your elderly parent falls?
Don’t ignore it – it could be an early symptom of a treatable condition(s)
Consider making an appointment with your GP who will assess risk factors, give advice and may refer you to a falls service in hospital or the community
What treatment may be given when the elderly fall?
- If an underlying medical condition is found, treatment options will be offered
- A drug review may be necessary
- A strength and balance programme through the physiotherapy service may be offered
- Membership of a falls education programme may be offered, providing education and support
- A home assessment to optimise independence and safety at home may be offered
- An alert system such as a pendent alarm may be offered
- Advice on footwear may be given
What to do if your older relative falls often
- The first call is to get your parent to visit their GP.Their bone health should also be assessed, so that osteoporosis can be detected and treated resulting in a lower chance of fracturing a bone in a fall. This may require answering some questions, but in some cases may warrant a bone density scan
- Everyone, regardless of whether or not they have fallen will benefit from regular exercise this will increase mobility and balance
- Do a home safety check and ensure all trip hazards are minimised
- Make sure lighting is good
