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Falls are the leading cause of injury-related hospital presentations and admissions in older people. Yet most are preventable.
A fall can lead to serious injuries such as fractures and head trauma. It can also reduce mobility and increase the risk of institutionalization. Fear of falling can lead to less physical activity, which in turn increases the risk of a fall.
Physical
Most falls happen while people are moving—getting in or out of bed, a chair or the toilet, walking, and going up or down stairs. These movements can be hazardous if someone is moving too fast or their attention is divided. They also become more dangerous if someone has a medical condition that makes them lose balance, such as dementia, low blood pressure, or an overactive thyroid (hyperthyroidism).
personal medical alarms About half of all falls result in injuries. Most injuries are minor, such as bruises and sprained ligaments, but some are serious, including broken bones, head trauma, and internal organ damage. Older people have the highest risk of severe injury from a fall. This is partly due to age-related physical changes that weaken muscle strength and vision, increase the chance of falling, and reduce the ability to recover from a fall.
Doctors assess the cause of a fall by conducting a thorough physical examination and completing tests of balance, coordination, and strength. They may listen to the heart with a stethoscope and record its rhythm and function, or give a person a series of simple tasks that are intended to test their reaction time and balance. They can be done in the doctor’s office or at home with portable equipment.
Mental
The experience of falling can have a profoundly negative impact on elderly people. It can lead to the loss of independence, and it can have a negative effect on their quality of life. Fallers often fear being injured again, and this can lead to activity restriction – which ultimately leads to weakened muscles and poor posture – thus feeding the fall cycle.
The risk of falls increases with age due to physical, sensory and cognitive changes, as well as living in environments that are not adapted to older persons. Certain medical diseases, such as Parkinson’s disease, diabetes and strokes, can also increase the risk of falling, as can cognitive disorders (e.g. dementia).
A sedentary lifestyle is associated with an increased risk of falls, and so are a fear of falling and a lack of confidence in walking. People who live alone also appear to be at an increased risk of falls, perhaps because they are more likely to be injured if they fall and cannot get up themselves. These factors can all be addressed with help from a GP, who can carry out tests to assess balance and review medication that may contribute to the risk of falls. It is also worth contacting your local social care and support service to understand the options available to you.
Social
Falling is a socially disabling event. It can lead to a loss of confidence in mobility and cause people to limit their activities. This can lead to social isolation, which is a significant problem in older people.
Falls can also be a major social and emotional burden for family and friends, especially when they are fatal. In addition, the person may suffer from low self-esteem and social anxiety, which can lead to depression.
Most falls happen when a person is moving-getting in or out of bed or chair, going to the bathroom, climbing stairs, or walking. These movements can be especially hazardous when a person is rushing, distracted, or tripping. Injuries such as fractures or lacerations can make it difficult to get up after a fall. Many older people remain on the floor for hours after a fall, increasing risk of dehydration, pressure ulcers, rhabdomyolysis, hypothermia, and pneumonia.
Most medical conditions that increase the risk of falling are not obvious to the person who falls. A careful history and physical examination should be done to evaluate whether an underlying condition contributes to the fall. Physicians should be trained in the use of standardized assessment tools for common medical conditions that are associated with falls, including symptom-based questionnaires (eg, U.S. Preventive Services Task Force [USPSTF]), physical therapy, and medications.
