Risk of Fall in Elderly
An old woman aged 70 years fell on her face during early morning hours causing severe bruise and swelling in her cheek. When you assess this particular lady you gather so many pre-existing fall risk factors for her. A patient with rheumatoid arthritis for 25 years, taking psychiatric medications for many years, diabetic, post R breast removal cancer prevention medicines, thyroid medicine with inactivity resulted in muscle weakness, poor balance and giddy/dizzy/syncope spell due to multiple medicines. This is a perfect example of a few risk factors for falls in elderly.
Out of 1.27 billion people in India, 60 and over population contribute 7.7%. Falls are the major problem and in medical terminology it is known as ’Geriatric Giants’.
What are the reasons for the fall in elderly?
There are two main reasons. They are intrinsic factors and extrinsic factors.
1. Intrinsic factors:
1 .Balance and Gait (ambulation): Legs and spinal muscle weakness due to stroke, parkinsons, arthritis, neuropathy, neuro-muscular disorder, vestibular disorder etc.
2. Medications (Polypharmacy): Taking more than 4 medicines and sedatives increases risk of fall.
3. a. Vision: Visual impairment like glaucoma, macular degeneration, retinopathy, bifocals etc.
b. Visual motor reaction time is extended
4. Cognition: Dementia, confusion etc.
5. Cardio-vascular causes: Orthostatic hypotension, carotid sinuses syndrome, neuro-cardiogenic syndrome, cardiac arrhtmias, valvular disease etc.
6. Urinary Incontinence
2. Extrinsic factors:
1. Poor lighting
2. Stairs with inadequate handrails.
3. Rugs and floor surfaces with low friction.
4. Loose clothing
5. Poorly fitting footwear
6. Lack of equipment(assistive devices) like walking sticks, walking frames, Zimmer frames, etc to assist them in ambulation.
Consequences of fall:
1. Black eyes and soft tissue injuries suggest that the faller was not conscious as they fall.
2. Fracture & Dislocation: 5% of falls end up having a fracture out of which 1% will be fracture neck of femur.
3. Disuse atrophy and muscle wasting during recovery period.
4. Long term bedridden patients develop pneumonia, pressure sores, dehydration and hypothermia.
5. Psychological : Fear of falling falls under the Psychological category.
Multi-disciplinary approach to assessment and treatment results in best outcome. Provisions of safety devises such as grab handles, high friction/non-slippery floors, selection of proper footwear , high power lighting to name a few, hip protector, regular exercises, monitoring medications and addressing the environmental issues are the key.