Preventing Falls In The Elderly

The Indian Orthopaedic Association (IOA) is celebrating the IOA Bone & Joint Week from 3^rd-10^th August and the theme for this year is 360⁰ Care for the Elderly- Ensuring mobility, Dignity and Longevity. To ensure these objectives and letting elderly lead a dignified and active life, it is essential to prevent falls.

Falls are a common problem in elderly and constitute the leading cause of injury related visit to emergency department. One-third of persons above 65 years sustain a fall each year. The probability of a fall resulting in hospitalization is 10 times more in elderly than children with 3-5% of the falls resulting in a fracture. Falls are responsible for 70% of accidental deaths in persons above 75 years.

With the increasing life expectancy in our region, the falls in elderly is bound to be a significant problem in future. At present, about 150 million are aged above 60 years and this number is expected to more than double, reaching 347 million by 2050. This is bound to create challenges in difficult fields, especially heathcare. Our limited resources and meagre spending on health is going to compound the problem.

Do elderly fall more often

The incidence of fall in elderly is more than younger ones because of some certain intrinsic and extrinsic risk factors. The former includes disorders of gait like wide base gait, increased body sway and joint instabilities which make them prone to fall. Knee and hip arthritis with the associated pain and deformity, sensory impairment, decreased vision and hearing, dementia, cerebrovascular accidents, orthostatic hypotension, dizziness and incontinence increase the risk of fall greatly. Extrinsic factors like inappropriate footwear, ill-fitting clothes, and environmental risk factors all add up to more chances of fall. Most of the elderly are on medications, some of which have side effects in the form of dizziness or confusion, resulting in falls.

Consequences of fall

Falls may lead to fractures, head injury, chest and abdominal trauma. This results in increased morbidity and a huge economic impact, especially with hip trauma. 90% of all hip fractures in elderly result from a fall. After one year of sustaining a hip fracture in elderly 20% die, 30% have permanent disability and 40% are unable to walk independently. Further, the management of fractures is more difficult in the elderly as they have more peri-operative mortality and morbidity. In addition, the associated osteoporosis and delayed mobility result in less union rates and higher rates of implant failure.

How to prevent falls

Prevention of falls involves a multidimensional approach with management of the health problems and taking care of extrinsic risk factors.

Managing health problems:  Regular consultation with the physician for managing conditions like Parkinson’s, stroke, arthritis and orthostatic hypotension and regular blood sugar levels in diabetics may prevent falls. Tricyclic antidepressants, anxiolytics, anticholinergic drugs and hypoglycaemic drugs all increase the chances of fall and should be given only when required and under supervision. Regular check-up of the visual acuity and corrective measures for same decrease the risk of falls. Avoiding sudden changes in light, like when going from dark to light or vice versa, some time must be given to eyes to adjust.

Fall-proofing the surroundings: Majority of falls occur in or around homes. Certain measures taken in the homes can greatly reduce falls in elderly.

Lighting: Good lighting in the frequently used areas and keeping lights on in the passageways at night is of help. Similarly, making obstacles or hazards stand out, like using furniture a contrasting colour to wall and floor or highlighting the edges of steps with bright paint or tape, lessen the chances of fall.

Preventing tripping: Keeping walkways clear of clutter or fallen leaves, and checking outdoor paths for cracks and uneven areas is an efficient way of preventing fall. Avoid keeping mats or rugs that curl up or fold over.

Preventing slip: Most of our elderly who land up in orthopaedic wards fall in the washroom. Measures to prevent slip in the washroom include using non-slip matting or replacing floor with non-slip material. Using safe shoes, having a hand-rail or chair in the bathroom and avoiding slippery floor make the home safe for the elderly. Safe shoes are comfortable, firm-fitting, flat shoes with a low broad heel and soles that grip.

Regular exercises and activities strengthen muscles and improve body balance, thereby reducing falls. A good diet with sufficient intake of calcium and vitamin D make the bones strong and resistant to fractures. Use of cane and devices like hip protectors may lessen the damage in the eventuality of a fall.

Healthy ageing involves physical activity, healthy eating and a little sunshine. Keeping oneself actively involved with family and community and knowing one’s limitations is a safe and prudent of preventing damage. Keeping the home and surroundings safe will lessen the burden on the individual and the community.

Dr Asif Nazir Baba is an Associate Prof GMC Srinagar & Consultant Bone & Joint Hospital, Barzulla

The post Preventing falls in the elderly appeared first on Greater Kashmir.