Falls in Elderly People

Falls and fall-related injuries have increasingly become an integrated part of old age in today's society and present a leading cause of unintentional injury in the elderly. Globally, one in three elderly aged 65 years and above, and one in two aged greater than 80 years will have at least one fall within a year. This increasing injury trend among elderly is a potentially serious issue, especially when Singapore approaches a greying population. Many elderly people also do not report a fall they may have suffered, nor seek medical assistance unless they are injured. In Singapore, falls account for 40% of injury-related deaths. Falls not only bring suffering, inconvenience and psychological trauma to the individual but also worry and bother to families and caregivers. This can even lead to the increased medical and economic burden on society as a whole. 

Falls usually happen because gradual changes to our bodies as we grow older make walking and moving about difficult, and additionally falls can be caused by hazards in and around the home. Falls can result in hip fractures and other injuries that require lengthy hospital care and long-term effects. According to the National Registry of Diseases Office (NRDO) of Singapore, the crude incidence rate of unintentional falls in 2012 was 277.7 per 100,000 for adults aged 60 years and older, and the incidence rate increases sharply with age.

Common Places Falls Occur

Many falls in older persons take place in the home. Some of the places in the household which are most risky for falls include:

  • Bathrooms and Toilets - Soap, water, sometimes natural oils used in bathing can present slippery surfaces that increase the risk of slipping and losing grip with surfaces, resulting in a loss of balance and hence resulting in a fall. There may also be a lack of safety equipment such as grab bars and rails, and non-slip bath mats.
  • Bedrooms and other living spaces in the home - These places can have obstacles and tripping hazards when walking and moving about, as they may contain furnishings items such as rugs, bedsheets aggravated by low lightings. 
  • Kitchens - Kitchens are places where oil and water are used frequently, and there are opportunities for spills on the floor, as well as kitchen equipment that may cause passageways in the kitchen to be narrow and difficult to navigate through 
  • Other places in the home - Any location within the home can become a potential danger zone if it is cluttered with items on the floor, or contain trip hazards like rugs, floor mats and electrical cords. Steps and uneven surfaces are also potential places where the elderly may stumble.
  • The elderly should also take note or areas where some form of cleaning was recently done in the area. Slippery surfaces, such as wet or polished floors, or places that have spills can present common unsafe situations that can result in falls.

The elderly also need to take note of unsafe footwear, such as loose slippers or narrow heels, or even wearing loose clothing, that can get caught on furniture and cause falls to happen. 

Risk Factors for Falls

Falls in the elderly can be multifactorial, resulting in the confluence of several intrinsic, medical, physiological, situational, behavioral, and activity-related factors. Living alone can amplify the risk associated with falling, as help may not come in time to these elderly patients. Some of the main factors that play a part include:

  • Visual problems – Older people tend to suffer from cataracts, or eyesight problems caused by conditions such as presbyopia (eye condition in which your eye slowly loses the ability to focus quickly on objects that are close)
  • Slow reflexes and response - The reflexes and bodies of older people may have a diminished response to a slip as they have slower changes in their reactions and postures. This can be coupled with weakness of muscles that maintain balance, adding to joint problems and pain. Sometimes even using assistive devices such as canes and walkers in an improper manner can do more harm than good and lead to a fall. 
  • State of the mind – Older people may sometimes be distracted by deep thoughts, or are oblivious to their surroundings, and can be caught in a state of disconnect, such as when they first awake from sleep and move off from the bed. Fatigue in the day may also set in if seniors do not sleep well in the night and this can lead to trips and falls.
  • Medication and surgeries - Should the elderly be on medication that results in drowsiness or other side effects, it can decrease alertness and psychomotor function. Synergistic effects among multiple drugs that might interact with each other can increase instabilities in gait and posture, and increase the risk of falling. Even seemingly minor surgeries can leave the older person feeling weak, in pain and discomfort, and less agile than they were before the surgery took place.
  • Lack of physical activity - Failing to exercise regularly can lead to poor muscle tone, reduction in bone mass, loss of balance, and reduced agility and flexibility.

Consequences from Falling

Regardless of the seriousness of the fall, it can lead to injuries that may result in a debilitating effect on the person’s quality of life.  Some injuries that can result from falls include:

  • Fractures - In general, fractures of the hip, wrist, humerus, and pelvis are the common serious injuries that can result from the combined effects of falls, osteoporosis, and other factors that cause injury in older persons.  Fractures can present themselves in the form of severe pain, deformity, swelling, loss of function in limbs and should not be missed in severe trauma. 
  • Head injury - Falls are a common cause of traumatic brain injury, and this poses an especially serious risk for older adults. The effects of the injury sustained may result in long-term cognitive changes, reduced ability to function and changes in emotional health. These effects can range from short-term to long-lasting or even permanent. The injuries can bring about unconsciousness, confusion, difficulty in recalling the traumatic event, issues with coherence, unsteadiness, lack of coordination, and may even present problems with vision or hearing. In serious cases, the injury could lead to an increased risk of developing Alzheimer's or dementia.
  • Contusions and sprains - Bruises such as hematoma, dislocated joints, sprains and incapacitating tissue injuries can take a long time to heal and bring disruptions to the individual’s quality of life.
  • Abrasions and cuts - Cuts and scrapes that are sustained from falls can lead to infection, and especially in the case of older adults that may have chronic health conditions such as diabetes or heart disease, infections can lower their immune system’s defenses against infections.
  • Internal bleeding - In serious falls, impact from the fall may lead to ruptured organs such as the spleen, gallbladder, small-intestinal perforation, and even the brain may suffer hemorrhage. Such injuries may be difficult to locate and ascertain, which can lead to delayed or misleading diagnosis.

What to do in the event of a Fall in the Elderly

If you or someone in your care has experienced a severe fall, a quick response will always go toward a better recovery. On inspection of the elderly person who had suffered the fall, perform first aid on minor injuries, and call 995 if the patient is unconscious or injury is serious. Caregivers of the elderly should also equip themselves with some training with CPR so that they can perform this if needed. One can also check for vital signs such as breathing, heartbeat, consciousness, and examine the elderly person for external injuries to stop bleeding or splint fractures.

Should there be no head injury, suspected fractures, lacerations and fall was witnessed to be not serious, then there may not be a need to visit the doctor but if there are doubts on the severity of the fall, then it would be advisable to seek medical advice.

How Falls are Treated

Doctors will first try to understand the circumstances surrounding the fall, such as how the fall occurred, how the patient responded after the fall, whether there was any loss of consciousness, and associated symptoms such as fits. Falls sometimes may be the consequence of a fit or a faint due to low blood pressures, so falls arising from such conditions may have to be excluded or treated separately.

As for injuries sustained from the fall itself, a thorough physical examination may be required to ensure that none of the injuries, internal, external or otherwise, are missed out. Lacerations need to be stitched to facilitate wound healing and reduce scar formation. Fractures need to be set right to enable optimal healing to regain function in the areas with broken bones. Early rehabilitation in joint function is particularly important in the elderly because if they become bedbound, their prognosis may be less favourable.

Recovery from the Fall

While falls can be a scary event that brings about pain and injury, the elderly can recover from the fall event, albeit over a longer course of time. As such, early rehabilitation is recommended, appropriate medication, plenty of rest and vitamins and supplements can go toward the recovery journey. The duration of recoveries can be as short as days for cuts, and longer in the span of weeks for sprains and months for fractures. 

How to Reduce the Chances of Falls at Home

In addition to constant supervision of the elderly whenever possible, here are some recommendations on how to reduce falls at home include:

  • Well-lit rooms and toilets
  • Non-slip mattresses and hand railings 
  • Removal of obstacles on the floor

You can also make your home safe and save with the EASE subsidy that covers up to 95% of the cost of home modification. Here's where you can learn more about EASE.

How to make home safe for senior and use EASE subsidy to save

How Medical Technology can Help

Some technology solutions help to detect when patients have gotten off their beds, alerting caregivers to a potential fall. While it is important to be able to detect falls when they occur, it is also important to identify when patients are unwell and hence at higher risk of falling. Ninkatec’s personalized home care solutions can help patients and families to monitor their health in this way.

Other improvements to the home can be in the form of movement sensors that control lights in the room, as well as communication tools that can enable elder patients to contact their caregivers remotely in the case of emergencies.

Article contributed by Dr Choo Kay Wee, A Life Clinic Pte Ltd

Dr Choo Kay Wee is a registered physician with the Singapore Medical Council, and a diplomate member of the College of General Practitioners, Singapore since 1990. He has been in active private general practice since 1991. A Life Clinic Pte Ltd provides services that covers general illness, acute and chronic medical conditions, preventive medicine, travel medicine, immunization and vaccination procedures, health screenings, and anti-smoking, snoring and weight management. Connect with A Life Clinic Pte Ltd through apps available for download from the Apple or Android app store.

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