Falls in older adults
Encyclopedia
Every year, many older people suffer from falls. These falls in older adults are a significant cause of morbidity and mortality
, and can have a serious effect on the person who falls. Falls can be caused by many things, and often the cause is multi-factorial, and require a multi-disciplinary approach to treat any injuries sustained during the fall, and to prevent any future falls.
A person can also come to rest inadvertently at a lower level due to a faint or syncope
, a stroke
, transient ischaemic attack or some other cause of sudden paralysis.
Falls are one of the giants of geriatric medicine
.
Falls are the commonest presenting complaint to A&E in patients over the age of 65.
Risk factors grouped into intrinsic and extrinsic factors.
Important features to ask about include:
, and electrolyte imbalance, and to perform an ECG and a chest x-ray
. Other tests should be tailored to the cause of the fall.
Possible interventions include:
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
, and can have a serious effect on the person who falls. Falls can be caused by many things, and often the cause is multi-factorial, and require a multi-disciplinary approach to treat any injuries sustained during the fall, and to prevent any future falls.
Definition
The medical definition of a fall is: An event which results in a person coming to rest inadvertently at a lower level, other than as a consequence of a violent stroke, loss of consciousness, or a sudden onset of paralysis.A person can also come to rest inadvertently at a lower level due to a faint or syncope
Syncope (medicine)
Syncope , the medical term for fainting, is precisely defined as a transient loss of consciousness and postural tone characterized by rapid onset, short duration, and spontaneous recovery due to global cerebral hypoperfusion that most often results from hypotension.Many forms of syncope are...
, a stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
, transient ischaemic attack or some other cause of sudden paralysis.
Falls are one of the giants of geriatric medicine
Geriatrics
Geriatrics is a sub-specialty of internal medicine and family medicine that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician, or...
.
Incidence
Every year, the following proportion of people suffer from a fall:| >65 years | >75 years | Institutional Care | Recurrent Fallers | Healthy Elderly |
|---|---|---|---|---|
| 28-35% | 32-45% | >50% | 60-70% | 15% |
Falls are the commonest presenting complaint to A&E in patients over the age of 65.
Causes of falls
Falls are often caused by a number of factors. The faller may live with many risk factors for falling and only have problems when another factor appears. As such, management is often tailored to treating the factor that caused the fall, rather than all of the risk factors a patient has for falling.Risk factors grouped into intrinsic and extrinsic factors.
Intrinsic Factors
- Balance and Gait
-
- As a result of strokeStrokeA stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
disease, ParkinsonismParkinsonismParkinsonism is a neurological syndrome characterized by tremor, hypokinesia, rigidity, and postural instability. The underlying causes of parkinsonism are numerous, and diagnosis can be complex...
, arthritic changesArthritisArthritis is a form of joint disorder that involves inflammation of one or more joints....
, neuropathy, neuromuscular diseaseNeuromuscular diseaseNeuromuscular disease is a very broad term that encompasses many diseases and ailments that either directly, via intrinsic muscle pathology, or indirectly, via nerve pathology, impair the functioning of the muscles....
or vestibular disease.- Medications
- PolypharmacyPolypharmacyPolypharmacy is the use of multiple medications by a patient, especially when too many forms of medication are used by a patient, when more drugs are prescribed than is clinically warranted, or even when all prescribed medications are clinically indicated but there are too many pills to take ....
is common in older people - Sedatives significantly increase the risk of falling
- Cardiovascular medications can contribute towards falls
- Polypharmacy
- Visual imparement
- GlaucomaGlaucomaGlaucoma is an eye disorder in which the optic nerve suffers damage, permanently damaging vision in the affected eye and progressing to complete blindness if untreated. It is often, but not always, associated with increased pressure of the fluid in the eye...
, macular degenerationMacular degenerationAge-related macular degeneration is a medical condition which usually affects older adults and results in a loss of vision in the center of the visual field because of damage to the retina. It occurs in “dry” and “wet” forms. It is a major cause of blindness and visual impairment in older adults...
and retinopathyRetinopathyRetinopathy is a general term that refers to some form of non-inflammatory damage to the retina of the eye. Frequently, retinopathy is an ocular manifestation of systemic disease.-Pathophysiology:Causes of retinopathy are varied:...
increase the risk of falling - BifocalsBifocalsBifocals are eyeglasses with two distinct optical powers. Bifocals are most commonly prescribed to people with presbyopia who also require a correction for myopia, hyperopia, and/or astigmatism.-History:...
can increase the risk of falling as the lower portion of corrective lenses are optimized for distances approximately 18 inches, thus precluding clear vision of one's feet/floor, approximately 4.5 to 5.5 feet below one's eyes.
- Glaucoma
- Cognitive problems
- DementiaDementiaDementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
increases the likelihood of falls
- Dementia
- Cardiovascular causes
- Orthostatic hypotensionOrthostatic hypotensionOrthostatic hypotension, also known as postural hypotension, orthostasis, and colloquially as head rush or dizzy spell, is a form of hypotension in which a person's blood pressure suddenly falls when the person stands up or stretches. The decrease is typically greater than 20/10 mm Hg, and may be...
- Postprandial hypotensionPostprandialPostprandial means after eating a meal while preprandial is before a meal.-Usages of the term:This term is used in many contexts but also in relation to blood sugar levels, which are normally measured 2 hours after and before eating in a postprandial glucose test...
- Carotid sinus syndrome
- Neurocardiogenic syncope - the commonest cause of syncope in A&E patients
- Cardiac arrhythmias
- Structural heart disease, such as valvular heart diseaseValvular heart diseaseValvular heart disease is any disease process involving one or more of the valves of the heart . Valve problems may be congenital or acquired...
- Orthostatic hypotension
- Urinary incontinenceUrinary incontinenceUrinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
- Medications
- As a result of stroke
Extrinsic Factors
- Poor lighting
- Stairs
- Rugs/floor surfaces
- Clothing/footwear
- Lack of equipment/aids
Consequences of falls
- Trauma
- Soft tissue injuries. Bilateral orbital haematomas (two black eyes) suggests that the faller was probably not conscious as they fell, as they did not manage to protect their face as they hit the ground.
- FracturesBone fractureA bone fracture is a medical condition in which there is a break in the continuity of the bone...
and dislocations. 5% of fallers end up having a fracture as a result of their fall, and 1% fracture their neck of femurHip fractureA hip fracture is a femoral fracture that occurs in the proximal end of the femur , near the hip.The term "hip fracture" is commonly used to refer to four different fracture patterns and is often due to osteoporosis; in the vast majority of cases, a hip fracture is a fragility fracture due to a...
.
- "Long Lies"
- PneumoniaPneumoniaPneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
- Pressure sores
- DehydrationDehydrationIn physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...
- HypothermiaHypothermiaHypothermia is a condition in which core temperature drops below the required temperature for normal metabolism and body functions which is defined as . Body temperature is usually maintained near a constant level of through biologic homeostasis or thermoregulation...
- Pneumonia
- Psychological
- A fear of falling
Presentation and assessment
When assessing a patient who has fallen, it is important to try to get an eye-witness account of the incident. As the faller may have had some loss of consciousness, they may not give an accurate description of the fall. However, in practice, these eye-witness accounts are often unavailable. It is also important to remember than 30% of cognitively intact older people are unable to remember a documented fall three months later.Important features to ask about include:
- The number of falls
- Eye witness account
- Associated features
- Risk factors for falling
- What drugs the faller is taking
- How much alcoholAlcoholic beverageAn alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
the faller drinks
Investigations
It is good practice to exclude anaemia, renal failureRenal failure
Renal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...
, and electrolyte imbalance, and to perform an ECG and a chest x-ray
Chest X-ray
In medicine, a chest radiograph, commonly called a chest X-ray , is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures...
. Other tests should be tailored to the cause of the fall.
Interventions
A large body of evidence shows that a multi-disciplinary approach to assessment and treatment results in the best outcome.Possible interventions include:
- Hip protectorHip protectorA hip protector is a specialized form of pants or underwear containing pads along the outside of each hip/leg, designed to prevent hip fractures following a fall...
s - Regular exercise
- Treatment for osteoporosisOsteoporosisOsteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered...
- Review - monitoring of medications and ongoing medical problems
- Tackling environmental issues
External links
- Falls Among Older Adults: Brochures and Posters (in English, Spanish, and Chinese) US Centers for Disease Control and Prevention
- Falls Among Older Adults: An Overview US Centers for Disease Control and Prevention
- Costs of Falls Among Older Adults US Centers for Disease Control and Prevention
- Hip Fractures Among Older Adults US Centers for Disease Control and Prevention
- Falls in Nursing Homes US Centers for Disease Control and Prevention
- CDC Fall Prevention Activities US Centers for Disease Control and Prevention
- Preventing Falls: What Works―A CDC Compendium of Effective Community-based Interventions from Around the World US Centers for Disease Control and Prevention
- Preventing Falls: How to Develop Community-based Fall Prevention Programs for Older Adults US Centers for Disease Control and Prevention
- Public Health Grand Rounds: Help Older Adults Live Better, Longer: Prevent Falls and Traumatic Brain Injuries US Centers for Disease Control and Prevention
- CDC’s Division of Unintentional Injury – Podcasts US Centers for Disease Control and Prevention