Danger of Falls for Elderly

Why elderly people tend to fall (Watch our video with key tips on fall prevention)

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 themselves

Physiological changes associated with normal ageing reduce balance, increase reflex times and thus, increase the risk of falling

Specifically, 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 risk

Additionally, without regular exercise or training, 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 dizzy

Chronic problems, such as osteoarthritis, eye disease and inner ear problems are also often present and increase the risk of falling

Acute problems, such as infection, heart rhythm disturbances and drug problems, can also present as a fall or loss of consciousness.

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

The following represent some of the more common conditions, which may led to falls, either in isolation, but more commonly in combination

Neurological

• Dementia – Alzheimer’s, vascular, Lewy body disease
• Delirium – acute confusional 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

 Drugs

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 mechanisms:

• By lowering blood pressure, particularly on standing, e.g. diuretics, ACE inhibitors, some antidepressants
• By causing drowsiness and increasing reflex times, e.g sleeping tablets, some antidepressants
• By causing acute confusional states, e.g anti-Parkinsonian drugs, sudden withdrawal from certain drugs and alcohol
• By causing Parkinsonism, i.e. changes in movement, which resemble Parkinson’s disease, e.g. antipsychotic drugs
• By slowing the heart rate, e.g. beta blockers, digoxin, certain calcium antagonists
• By causing a low blood sugar, e.g. diabetic drugs and 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

• Cataract
• Macular degeneration
• Glaucoma

 Musculoskeletal

• Osteoarthritis
• Foot deformities
• Inflammatory arthritis
• Myopathies
• Disuse of muscles leading to muscle wasting and weakness

 Heart rhythm and blood pressure control abnormalities

• Abnormal fall in blood pressure on standing – many causes including drugs
• 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 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

 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 institutionalization
• 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
• 2-5 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 elderly parent falls often

If your elderly parent is having recurrent falls, the first call is to get your parent to visit the 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