Falls: A growing problem which can be preventedFalls are a grave threat to the health of people over 60 years and can reduce their ability to remain independent. Falls are said to be the second most common cause of deaths due to accidents or injury globally. Falls can result in fractures, hospitalization, and sometimes even death. According to the statistics, there is an elderly person receiving treatment for a fall in the emergency department every 11 seconds.

However, falls don’t have to be inevitable as you age. You can reduce your chance of falling or help a loved one prevent falls. There are proven ways to reduce and prevent falls.

How do falls affect us?

Falls are not a normal part of ageing. Falls among senior citizens are the leading cause of injuries. This can ultimately result in a decreased lifespan of these older adults. Fall-related injuries can lead to increased morbidity and decreased mobility. The financial costs occurring due to the fall-related injuries are substantial. It also results in decreased confidence and increased dependence on others. A person who has had a fall is at a higher risk of falling again which greatly increases the health risk.

Who is at higher risk for injury due to falls?

People with difficulty in walking, patients suffering from vertigo or other balance disorders, people with memory problems or those suffering from depression or mental illnesses are more susceptible to falls. Older people with loss of hearing have also been seen to have a higher risk of falls.

It is seen that older people who are scared of falling restrict their daily activities. This leads to reduced mobility, loss of physical fitness and this can ultimately result in subsequent increased risk of falling. Most of the falls are due to the combination of many risk factors. The higher the risk factor, the greater the chances of falling for an individual.

How can falls be dangerous?

Falls are a very scary experience for older people. Not only does it shatter their confidence, but it can also result in grave injuries. The most common type of fractures due to falls are hip, spine, ankle, leg and hand. Hip and spine fractures can leave the person bed-ridden for months. Brain injuries can lead to disorientation, balance problems and reduced cognition.

What conditions make one more likely to fall?

There are many risk factors that can increase the frequency of falls. These includes – balance disorders, visual problems, undiagnosed illnesses, Vitamin D deficiency, muscle and nerve weakness, malnutrition, dehydration, postural hypotension, or some kind of medications. These are some of the reasons but there are many others that could result in severe injury.Apart from the musculoskeletal issues leading to falls, falls could also occur due to the slowing down of the brain.

The doctor will need to do a detailed evaluation of the person to assess for the reason for a fall. This will be done by –

1. Assessment for a new illness: In patients having generalized weakness or other signs of feeling unwell, a detailed systemic evaluation will be required. Some common ones include:

Urinary tract infection
Dehydration
Anaemia, which can be due to bleeding in the digestive system
Pneumonia
Heart problems
Strokes

2. A blood pressure and pulse reading when lying down and standing:



Postural hypotension or orthostatic hypotension occurs blood pressure drops when you go from lying down to standing position by more than 20mm Hg. When blood pressure drops on a change of position, less blood reaches the brain. This can make you more likely to fall.

People who take medication for high Blood pressure or prostate problems are at a higher risk of this sudden drop in blood pressure which can result in unsteadiness on standing up or even a fall. This is a very simple yet important test to be done in all elderly patients.

3. Blood tests: Checking an older person’s blood tests is often a good idea after a fall. Haemoglobin, fasting blood sugar and electrolytes should be evaluated.

4. Medications review: Many older adults take medications for various medical problems. Sometimes these medicines may adversely interact with each other. Some of the more important medications to be considered include -

Sedatives- can cause drowsiness, disorientation, and increased fall risk. Blood pressure and diabetes medications- it is important for these medicines to maintain the BP and blood sugar at optimum levels, neither too high nor too low. “Anticholinergic” medications. They include medications for allergies, overactive bladder, vertigo, nausea, and certain types of antidepressants which may also be given for nerve pain. They can increase the risk of fall.

Excessive pain medications
5. Vision: Proper correction of eyesight with spectacles is important for the correct orientation of the body. Conditions like cataracts and glaucoma adversely affect the vision and should be treated. Bifocal or progressive lenses can make things seem closer or farther away than they really are.

What are Fall Clinics?

Fall clinics specialize in preventing falls and fall-related injuries. These clinics perform various tests to identify the reasons causing the fall and address the risk factors and provide ways to avoid these falls. Cognitive rehabilitation in also included helping make the patient mentally more active as well. They provide more information about the cause of the fall, help avoid its repetition in the future and devise a plan to protect the people who are at high risk. Thus these clinics improve the quality of life of the older population and reduce the burden to the healthcare system

How can we prevent falls?

As falls could be due to many reasons, the strategy for preventing falls should be comprehensive and multifaceted. Reducing the risk factors is the key to fall prevention. Treating fluctuating blood pressure, vitamin D and calcium supplementation, treating any visual problems, muscle strengthening and balance retraining exercises by trained health professionals. These are some of the measures that can help one to prevent falls and be saved from their sinister consequences. Creating a safer environment that can lower the severity of falls. Add grab bars inside the bathroom and next to the toilet. Put railings on both sides of the stairs. Make sure your home has lots of light because inadequate light also increases imbalance in the elderly.

Source : DNA India