By Dr.Achala Balasuriya MD
Consultant Physician(Special Interest- Elderly Care medicine)
Falls among elders is a common cause of morbidity , hospitalization , disability and death. Nearly a third of the elderly have falls that trigger a chain of events that usually have them succumb to the situation or leave them bed-ridden till the end comes. With age, the ability of the body to heal itself reduces considerably and the immunity drops. The muscles and ligaments tend to get more lax with bones becoming more brittle and porous.Under these circumstances, even a trivial looking fall may prove fatal.
Common causes of fallsReduced muscle strength, coordination and reflexes Poor sensation in the lower extremities due to diabetes or degenerative conditionsPoor balance due to neurological diseases, hypothyroidism or ear problems Poor visionPostural drop in blood pressure Seizure disorders Strokes, transient ischemic attacksAbnormalities of cardiac rhythmMultiple medication useEnvironmental hazards eg poor lightning ,carpets, rugs, clutter etc. *Osteoporosis*
Osteoporosis is a one major risk factor for falls. What is debatable is whether brittle bones break after a fall, or break when stressedand in turn cause a fall. In either event, a decrease in bone densitycontributes to falls and resultant injuriesOsteoporosis is a condition wherein bones become more porous, less resistant to stress, and more prone to fractures. Caused by hormonal changes, calcium and vitamin D deficiency, and a decrease in physicalactivity, osteoporosis is a chief cause of fractures in older adults, especially among women.
Prevention Tips
"Eat or drink sufficient calcium. Postmenopausal women need 1,500 mg of calcium daily. Calcium-rich foods include milk, yoghurt, cheese, fish andshellfish, selected vegetables such as broccoli, soybeans, tofu and almonds."Get sufficient Vitamin D in order to enhance the absorption of calcium into the bloodstream. Vitamin D is formed naturally in the body after exposure to sunlight, but some older adults may need a supplement."Regularly do weight-bearing exercise.
Lack of Physical Activity
Failure to exercise regularly results in poor muscle tone, decreased strength, and loss of bone mass and flexibility. All contribute to falls and the severity of injury due to falls.
Prevention Tips"Engage regularly (e.g., every other day for about 15 minutes daily) in exercise designed to increase muscle and bone strength, and to improve balance and flexibility."Undertake daily activities in a safe manner, such as reaching and bending properly, taking time to recover balance when rising from a chair or bed, learning the proper way to fall, and learning how to recover after a fall."Wear proper fitting, supportive shoes with low heels or rubber soles. Impaired Vision
Age-related vision diseases can increase the risk of falling.Cataracts and glaucoma alter older people's depth perception, visual acuity, peripheral vision and susceptibility to glare. Theselimitations hinder their ability to safely negotiate their environment, whether it be in their own home or in a shopping mall.Young people use visual cues to perceive an imminent fall and takecorrective action. Older adults with visual impairments do not have this advantage to the same extent. Prevention Tips"Have regular checkups by an ophthalmologist to discern the extent of age-related eye diseases such as cataracts and glaucoma, mascular degeneration etc."Use colour and contrast to define balance-aiding objects in the home(e.g., grab bars and handrails).Add contrasting colour strips to first and last steps to identify change of level."Clean eye glasses often to improve visibility.
*Medications*People taking multiple medications are at greater risk of falling Sedatives, anti-depressants, and anti-psychotic drugs can contribute to falls by reducing mental alertness, worsening balance and gait, and causing drops in systolic blood pressure while standing.
Prevention Tips"Know the common side effects of all medications taken."Talk with your physician or pharmacist about ways to reduce your chances of falling by using the lowest effective dosage, regularly assessing the need for continued medication, and the need for walking aids while taking medications that affect balance."Remove all out-of-date medications and those no longer in use.Limit intake of alcohol as it may interact with medication Environmental Hazards. IndoorsAt least one-third of all falls in the elderly involve environmental hazards in the home. The most common hazard for falls is tripping over objects on the floor. Other factors include poor lighting, loose rugs, lack of grab bars or poorly located/mounted grab bars, and unsturdy furniture.
Prevention Tips
It is useful to conduct a walk-through of your home to identifypossible problems that may lead to falling.
*Outdoors*
Repair cracks and abrupt edges of sidewalks and driveways.Install handrails on stairs and steps.Keep floor dry, devoid of wet areas and greasy surfaces.Keep walk areas clear of clutter, rocks and mud.Install adequate lighting by doorways and along walkways leading to doors,gates.
*Indoors* Ensure adequate lightning inside the house.Remove unnecessary furniture and over crowding.Keep floor dry and clean and devoid of wires, toys etcIndicate steps, stairs by painting in contrasting colours.If person has had a fall, he should get him self properly checked out by a physician to assess the risks of falling again and to ensure safety at home. When you go to see the doctor after a fall please remember to tell the doctor about all your current medications and medical conditions.
