Falls in the Elderly

Old age is one segment of human life when concerns for health and well being is re-thought of and revisited periodically. The basic principles of health as followed during adulthood do not apply during this time. A new set of conditions, management plans and prevention strategies are needed in their stead. Few conditions tend to be rare at this age and few become more common when compared to the other stages of life. Amongst such conditions, falls in the elderly are a priority concern.

Falls are common accidents among the geriatric population. These are attributed to frailty, reduced physical strength, poor performance, morbid conditions, lack of essential support etc. Falls are one of the serious incidents which can be life threatening or result in increased morbidity. Identifying the reasons for falls and preventing them should be considered a priority in elderly care.

Why Are Falls Common in the Elderly?

When you ask a doctor the above question, they can come up with many common and uncommon reasons for the same. The ones which we would be able to prevent if intervened actively can be studied and understood well.

Common causes for falls in the elderly include:

·       Poor balance in the body: is due to problems in the balancing apparatus of the body

·       Poor eye sight: is due to cataract, age related corneal changes, or refractive errors which are very common among the elderly

·       Poor physical strength: is a part of the natural ageing process involving poor muscle built and weakness

·       Joint diseases like arthritis: are a problem, especially with issues in the joints of the lower limbs

·       Syncope: is secondary to heart or brain related conditions. Usually due to blockage in the vessels supplying blood to either the heart or the brain. Even degenerative brain changes commonly seen in the elderly can led to syncope and falls.

·       Environmental factors: can be problems like risky housing environment, poor physical strength and not being able to cope with the harsh ecosystem.

·       Other factors: can be elderly abuse etc.

Balancing the body is one of the most important functions. It is primarily to maintain necessary posture for walking and other daily activities. It is also a defence mechanism against environmental factors which when weak could lead to a fall. This balancing function is performed by an apparatus called vestibular apparatus that is present near the inner ear in the head. This works in co-ordination with the muscles of the body in maintaining the posture and balance of the body. Any defect to this apparatus can lead to imbalance and falls.

Conditions that affect the vestibular apparatus function, leading to falls are:

1. Presbyastasis: disequilibrium commonly associated with ageing with no clear explanation; it is related to poor performance of the vestibular apparatus

2. Vertebrobasilar insufficiency: poor blood supply to the vestibular apparatus

3. Cervical vertigo: abnormal neck posture or cervical spine injury leading to dizziness and neck pain

4. Acute neuro labyrinthitis: infection or inflammation of the inner ear

5. Transient ischemic attacks: lack of blood supply to the brain for a short period of time

The above conditions should be looked at by a doctor and managed at the earliest to prevent falls. The other conditions mentioned as causes for fall too should be addressed during routine elderly check up which should be held at least once in 6 months.

Changes within a household that makes an elderly friendly environment are:

1. Less number of stairs with short stance

2. Railings at the staircase and side walls of big rooms

3. Non slippery floor tiles, especially in the bathroom

4. Wall handles in toilets          

5. Western system of commode in toilets

6. Avoid stoppers         

7. Resting stations in each room of the house

Any such changes which help and enable the elderly to transit safely in the house environment are to be employed to prevent falls. Regular health check-ups are essential to treat balance disorders, to prevent or manage conditions which can cause falls. Always consider them as first priority in elderly care.