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Without gravity there would be no falls. Falls are a major cause of accidental trauma throughout one’s life. Often falls are multifactorial. Prevention of falls can pay significant dividends by reducing healthcare costs, disability and mortality.  Fall prevention in the elderly population is especially important since they are the most susceptible.

At Home and in the Community

Many falls occur in the home or community. Some are related to environmental factors such as ice or a slick surface in a store. Some are related to substance abuse. Others are associated with old age or frailty. Many occur in the home and can be traced to:

  • stairs
  • working around the house
  • bathrooms
  • poor visibility

For a person receiving home care, a regular falls assessment can be an important step in falls prevention. Medical calculators and analytics which can aid in assessment and risk evaluation are suggested throughout this discussion. 

Comorbid Conditions and Medications

Many comorbid conditions can increase the risk for falls. These may include:

  • seizures
  • movement or mobility disorders
  • ataxia
  • stroke
  • syncope
  • joint instability
  • old age

People who have comorbid conditions are often on multiple drugs, some of which can increase the risk of falls by:

  • causing sedation or impaired cognition
  • dizziness or orthostatic hypotension
  • blurred vision.

The interaction between comorbid condition, medication and environment can make prevention of falls difficult.

Healthcare Facilities – Fall Risks

Because the sick and elderly are at risk for falls it should not be a surprise that healthcare facilities are a major site for serious falls. Many patients are receiving medications that may contribute to falls. The hospital can also be a strange environment where obstacles are unexpected. Staffing may be a contributory factor, since some patients will try to go to the bathroom on their own if assistance is not readily available.

Workplace Fall Risks

Falls are a major cause of occupational injury and death. It may be a hazard for

  • roofers
  • construction workers
  • firefighters

The risk is particularly high during disaster recovery when buildings may be damaged. Construction falls can be reduced by a number of interventions such as personal fall arrest systems. Unfortunately for many people working in other industries falls may be harder to prevent.

Activity-Related Fall Risks

People who are active are at risk for falls. Some examples include:

  • climbing
  • parachuting
  • winter sports
  • using a tree stand
  • outdoor play

The circumstances around a fall may not be clear cut. Sometimes child abuse is masked as a fall. It can also be challenging to differentiate an accidental fall from a height from a suicide attempt.

Complications from Falls

Sometimes a fall may cause only a bruise or minor injury. But at other times a major injury can occur, even when the person falls while standing. For an older adult a fractured hip or femur may be the kiss of death. Fractures are a concern in patients with osteoporosis. A blow to the head in a patient on warfarin can lead to intracranial bleeding. Falling onto a protruding object can result in impalement. A break in the skin occurring in a contaminated environment can easily become infected.

Because falls may occur without warning and can have life-threatening consequences, it should not be a surprise that the elderly and other vulnerable populations may become afraid. This may restrict what a person does.

Guidelines – Fall Prevention in the Elderly

Because falls are an important cause of geriatric morbidity and mortality, guidelines for fall prevention in the elderly have been developed for older adults in the community and in healthcare facilities. Interventions to improve physical activity, balance and vision can significantly reduce fall-related injuries.

Conclusions

Falls are an important source of injury, especially in the old and sick. Reducing falls can significantly improve a patient’s quality of life. Medical algorithms can help to identify a patient at risk and to manage the fall victim.

 


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