A fall is an event which results in a person coming to rest inadvertently on the ground or other lower level, not as a consequence of intrinsic event (such as stroke, sustaining a violent blow, loss of consciousness, sudden onset of paralysis, or an epileptic seizure) or overwhelming hazard.
Falls are one of the most frequent and serious problems facing the elderly, it is an important cause of morbidity and mortality in the elderly.
Causes of falls
Most often the cause of fall is multifactorial, it can be intrinsic (internal) or extrinsic (external). Common causes are:
- History of falls: This is associated with an increased risk in recurrent falls.
- Age: Falls increase with age because of a reduced ability to respond rapidly and effectively compared to younger adults.
- Gender: The rate of falls is similar for both men and women in the younger elderly, while among the most elderly, the women fall more often than men and are more likely to suffer from fractures when they fall.
- Solitary lifestyle: The fact that someone living alone seems to be a risk factor in falls, although part of this effect appears to depend on the type of house in which they reside. It also indicates greater functional capability, but injuries and their consequences could be even worse, especially if the person cannot get up from the floor.
- Race: Evidence from the United Kingdom and the United States suggests that Caucasian subjects fall more often than African tribes of the Caribbean, Hispanics, or South Asians, but there are no studies to report national differences in continental Europe.
- Drugs: the use of benzodiazepines in older people is associated with a 44% increase in risk of hip fracture and night falls. There is a significantly increased risk of falling when using drugs such as psychotropic, antiarrhythmic drugs, digoxin, diuretics, and sedatives. Most studies have reported that, the risk increases significantly if more than four medications are taken, regardless of the type of drug.
- Medical conditions: Such as, vascular diseases, chronic obstructive pulmonary disease, depression, and arthritis are each associated with a 32% increased risk. The frequency of falling increases with increasing deterioration due to chronic disease. The incidence of falls relevant to cardiovascular causes is unknown in the general population, but vertigo is common in people with falls. Depression and incontinence also occur frequently in populations with falls.
- Impaired mobility and gait: According to WHO (2016), the reduction of strength and endurance after the age of 30 (10% loss per decade) as well as muscle power (30% loss per decade) lead to a decrease in physical function below the limit. As a result, daily living activities become difficult and then impossible – this is the case in early aging in generally sedentary subjects. When strength, endurance, power, and especially functionality are reduced considerably, it is not impossible for a false trip or a slip to turn into fall. Muscle weakness is a significant risk factor in falls, as well as difficulty in gait, imbalance, and the use of walking aids. Any disability of lower limbs (lack of power, orthopedic disorders, or poor sensation) is associated with increased risk. Having difficulty in getting up from a chair is also associated with increased risk.
- Deconditioning/immobility: Those who fall tend to be less active and may tend to cause further irreversible atrophy of the muscle around an unstable joint. Non active persons fall down more often than those who are moderately or very active.
- Psychological condition/fear of falling: According to Yannis Dionyssiotis (2012), up to 70% of people who have recently fallen down and up to 40% of those who have not reported a recent fall confess fears of falling. Reduced physical and functional activity is associated with stress and fear of falling. Up to 50% of those who fear falling limit or exclude social or physical activities because of this fear. Strong links were found between fear and poor posture, low-speed walking and muscle weakness, and poor health self-esteem and reduced quality of life. Women with a history of stroke are at greater risk of falling and experiencing fear of falling. Having four or more medications is also implicated in a fall-related phobia. However, many older people do not appreciate sufficiently the level of danger.
- Nutritional deficiencies: Low body mass index (which indicates poor nutrition) is associated with increased risk of falling amongst the elderly. Vitamin D deficiency is reported to be common in elderly people living in institutions and may lead to wrong gait patterns, muscle weakness, osteomalacia, and osteoporosis.
- Cognitive disorders: Lack of understanding has been associated with increased risk, even at relatively modest levels. For example, a result of less than 26 or less than 24 on the Mini Mental State Examination is related to increased risk. Poor memory has been proven to be an independent risk factor for falls in people over 75 years, according to LASA (Longitudinal Aging Study Amsterdam). Residents of institutions with dementia fall more than twice as often as people with normal cognition, but there is no difference in the severity of injury between the two groups (Yannis Dionyssiotis, 2012).
- Attenuated vision: visual acuity, contrast sensitivity, field of vision, cataracts, glaucoma, and glaucoma plus bifocals or multifocal lenses lead to risk of falls. Multifocal lenses reduce the depth of perception and impair edge-contrast sensitivity when detecting obstacles in the environment. The elderly can benefit from wearing nonmultifocal glasses when using stairs and in unfamiliar surroundings outside their home.
- Foot problems: calluses on the big toe, long toe defects, ulcers, deformed nails, and general pain when walking increase the difficulty of balance and the risk of falls. Correctly fitting shoes are also important.
Extrinsic risk factors
The magnitude of the influence of environmental factors on the risk of falls in the elderly is uncertain. Some studies have indicated that in the elderly living in the community, 30%–50% of falls are due to environmental causes (such as, poor lighting, slippery floors, and uneven surfaces) and approximately 20% of falls are due to significant external factors (such as, those that would lead to a fall in any healthy elderly person). A frequent problem that older people encounter is to slip, trip, or misstep.
- Gait training and advice on appropriate use of assistive devices
- Review and modification of medications, particularly psychotropics (review without modification shows no benefit)
- Exercise programmes, with balance training
- Treatment of postural hypotension
- Appropriate treatment of medical conditions including visual problems, cardiovascular disorders and cardiac arrhythmias
- Reduction or withdrawal of psychotropic medication
- Modification of environmental hazards.
Compiled by: Victoria Haruna, BSc. (Biochem), MPH (Health Promotion and education)
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