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Recurrent falls threaten older people’s independence, increase the risk of injury and result in increased dependence on carers. They also increase the chances of nursing home admission. Falls are often not a normal part of ageing and can be a sign of many chronic health problems. They can lead to hip fractures which cause long-term disabilities and can make it difficult for someone to live independently again. Biological risk factors for falls include the natural ageing process, lack of exercise, muscle weakness, impaired balance and vision, chronic health conditions such as arthritis, Parkinson’s disease, diabetes, incontinence and pain and use of drugs that affect attention (like antianxiety and psychoactive medications). Personal risk factors can also contribute to falling. These include fear of falling, poor nutrition and hydration, insufficient footwear, taking multiple medications including psychoactive drugs and living alone. Getting regular physical therapy can improve balance and strength. Asking your loved one to speak with their doctor about medication side effects, particularly dizziness and confusion, can be helpful too. Making homes safer by removing tripping hazards and clutter, adding grab bars in the bathroom and along stairs, and installing handrails on staircases can also reduce risk. Having a bed alarm can help if your loved one becomes confused or disoriented while sleeping. It’s important to get up immediately after a fall; staying on the floor for too long increases your risk of injuries such as hip fractures, rhabdomyolysis and dehydration. Most elderly people who fall suffer minor injuries such as bruises or abrasions. However, falls can cause serious damage and even death. A hip fracture is especially dangerous. Some seniors are so afraid of falling that they limit their activity and social engagement and withdraw from life, resulting in a decline in overall quality of life. In some cases, an older person’s recurrent falls are caused by an underlying medical problem such as paroxysmal rapid atrial fibrillation or sick sinus syndrome. A history and physical exam will often reveal these problems. But a busy physician may not order a specific test for these conditions, such as an electrocardiogram (EKG) or carotid ultrasound, that would help prevent future falls and other serious health problems.
Falling in the elderly is a common and serious health problem, leading to hospitalization for injuries such as hip fractures. The risk increases with each subsequent fall, and family physicians have a key role in screening older patients for falling risks and applying preventive strategies. Several studies have shown that a fall leads to a decline in cognitive function, even when adjusting for pre-fall MMSE score. This is consistent with the theory that falling affects balance, and this in turn impacts cognition. Interestingly, recurrent fallers have more diseases than non-fallers and one-time fallers (median of 4; interquartile range 2.0-5.0). These include rheumatoid arthritis, problems with blood circulation to the brain and legs, cardiac failure, osteoporosis, Parkinson disease, urinary incontinence, depression and dizziness. Those who belong to the multiple chronic disease cluster are also more frail and less active, and they have more geriatric conditions. https://www.personalmedicalalarms.co.nz/dementia-gps/ These factors contribute to a negative cycle in which fear of falling reduces activity levels, and in turn causes a further reduction in functional capacity and a higher likelihood of recurrent falls. For those with vision problems, tripping or misjudging distances can lead to falls. Getting regular dilated eye exams is important for spotting changes in vision early. Conditions like cataracts and glaucoma can lead to decreased vision. Other causes include age-related macular degeneration, which can cause a blind spot in the center of your vision and blurred vision. Peripheral vision loss can make it difficult to see things on either side of you or above and below your eye level. Blurred vision can hinder mobility and make it hard to read or watch TV. Some of these vision impairments can be corrected with medications, surgery or non-optical devices like magnifiers and binoculars. If your elderly loved one is experiencing any of these problems, have him or her get a medical evaluation. The physician can help determine whether there are any medications that could be contributing to the fall risk and recommend a safe plan of action. |
