A fall is an event which results in a person coming to rest inadvertently on the ground or other lower level. 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 in the Elderly

Most often the cause of fall is multifactorial, it can be intrinsic (internal) or extrinsic (external). Common causes are:

Intrinsic causes

  1. Age: Falls increase with age because of a reduced ability to respond rapidly and effectively compared to younger adults.
  2. Gender: The rate of falls is similar for both men and women in the younger elderl. While among the most elderly, the women fall more often than men and are more likely to suffer from fractures when they fall.
  3. Solitary lifestyle: Those living alone seems to be at a greater risk of falls. However, this effect appears to depend on the type of house in which they reside. It also indicates greater functional capability. Nonetheless, injuries and their consequences could be worse, especially if the person cannot get up from the floor.
  4. Race: Evidence from the United Kingdom and the United States suggests that Caucasian are subject to fall more often than African tribes of the Caribbean, Hispanics, or South Asians. However, there are no studies to report national differences in continental Europe.
  5. Drugs: the use of benzodiazepines in older people is associated with a 44% increase in risk of hip fracture and night falls. Consequently, there is a significantly increased risk of falling when using drugs such as psychotropic, antiarrhythmic drugs, digoxin, diuretics, and sedatives. Studies report that the risk increases significantly if more than four medications are taken, regardless of the type of drug.
  6. Psychological condition/fear of falling: 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. Also, women with a history of stroke are at greater risk of falling and experiencing fear of falling.

Other intrinsic causes of falls in elderly

  1. 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. However, vertigo is common in people with falls.
  2. Impaired mobility and gait: 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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 also, approximately 20% of falls are due to significant external factors. A frequent problem that older people encounter is to slip, trip, or misstep.

Preventive Measures of Falls in the Elderly

  1. Gait training and advice on appropriate use of assistive devices
  2. Review and modification of medications, particularly psychotropics (review without modification shows no benefit)
  3. Exercise programmes, with balance training
  4. Treatment of postural hypotension
  5. Appropriate treatment of medical conditions including visual problems, cardiovascular disorders and cardiac arrhythmias
  6. Reduction or withdrawal of psychotropic medication
  7. Modification of environmental hazards.

Compiled by: Victoria Haruna, BSc. (Biochem), MPH (Health Promotion and education)

References
  1. Tinetti ME, Speechley M, Ginter SF; Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988 Dec 29; 319(26):1701-7.
  2. Rubenstein LZ, Josephson KR; The epidemiology of falls and syncope. Clin Geriatr Med. 2002 May; 18(2):141-58.
  3. Maki BE, McIlroy WE. Control of compensatory stepping reactions: age-related impairment and the potential for remedial intervention.Physiother Theory Pract. 1999;15(2):69–90.
  4. Rogers MW, Kukulka CG, Brunt D, Cain TD, Hanke TA. The influence of stimulus cue on the initiation of stepping in young and older adults. Arch Phys Med Rehabil. 2001;82(5):619–624.
  5. Yannis Dionyssiotis; Analyzing the problem of falls amongst older people. Int J Gen Med. 2012; 5: 805–813. PMC3468115.
  6. WHO Fact sheet; Falls. Reviewed September 2016.

 

 

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