Falls are one of the major causes of morbidity, mortality and loss of quality of life of the elderly patients. It is always difficult to consider all the consequences of falls, but ordinarily they include both physical as well as psychological traumas. falls occupy the first position of the fatality accidents of the elderly and are estimated to be responsible for 40% of deaths from injuries in people over 65 years old. Fractures of the hip, wrist, femur as well as severe muscle injuries are common implications after a fall. But this is only a part of the problem. The majority of falls do not cause injury, but statistics are hard to describe the fear, humiliation and disability, mental and physical, which result for the elderly patients.
When the frequency of falls increases, the eve of the elderly person at home is unsafe and forces him to move into a nursing home. A fall or the fear of a new fall devastates the morale of the elderly person who often feel like losing the joy of life, when subjected to immobilization due to a fall which in many cases causes also depression problems. big issue is the fact that falls often are not communicated to therapists due to many reasons: some patients do not ever report their fall incident, the doctors do not include fall incidents in their history taking when there is no injury from the fall incident, and finally because many patients and even doctors consider the falls as a normal part of the ageing.
Falls of the elderly are the result of underlying risk factors and diseases and the detailed study of the medical history of the patients and of the information taken from the people who provide care to them can elucidate their causes and help prevent them.
Epidemiological Data
The incidents of falls increase with age. It is estimated that every year 30-40% of people over 65 years in Europe experience a fall, while the figure rises to 50% for people over 80 years. 10% -15% of falls cause serious injuries and around 50% of them cause minor injuries. Severe injuries like subdural hematoma or vertebral fracture are rare, but fractures of the femur, pelvis, extremities or dislocations are common. After falling 10% of sufferers have difficulty moving from the position where they felt on the ground and remain there for a considerable amount of time something crucial for the final outcome of their fall implications.
In a recent study 50% of 70-85 years old people who felt, said they fear a subsequent fall and 60% of them were moderately restricted their mobility to avoid future falls. fears of a new fall, which is called after the fall anxiety disorder in Traumatic Stress Disorder is a new recognizable clinical syndrome of the third age. The combination of psychological and somatic implications caused by falls have the effect of limiting the autonomy of the elderly, causing the need for permanent assistance with housekeeping, or the necessity for moving into nursing homes, and a major increase in the use of health services and a concomitant increase in the cost care.
Risk Factors
Falls of the elderly are rarely due to a single cause, but usually happen because of a combination of deregulation (ageing) of the normal homeostatic mechanism maintaining upright accidents (sliding, bumping into objects, loss of balance), or because of underlying diseases (infections, arrhythmias and others). For example, an elderly person with multiple risk factors (previous falls, dementia) and febrile infection is falling after bumping at the edge of a carpet (extrinsic factor) due to his inability to maintain his balance. The risk factors of falls are divided into intrinsic and extrinsic but often falls occur due to a combination of both. endogenous risk factors are associated with the maintenance of the upright position, history of previous falls, postural hypotension, chronic disease and senile dementia. The maintenance of the upright position depends on sufficient information of the brain via the sensory systems and the activation of the muscular system. In the elderly people, a decrease of visual acuity, depth perception and adaptation to darkness is a crucial factor for numerous fall incidents. diseases mostly related to fall incidents are the disease of Parkinson, multiple sclerosis, osteoarthritis, and diabetes. The light and medium senile dementia is associated with an increased risk of falls and hip fracture.
Frequent exogenous risk factors are the side effects of drugs and environmental factors such as poor lighting, inappropriate shoes, objects in which the patients stumble, carpets inadequately restrained. Drugs are a common cause of falls and it is clear that increasing the number of medications a patient receives proportionally increases the risk of a fall. The most frequent implication caused by medication is connected with the activity in the central nervous system mainly benzodiazepines, neuroleptics, tricyclic antidepressants.
Alcohol excessive consumption of course doubles the chance of falling. from accident caused by environmental factors or poor assessment represent 35 to 50% of all falls. The most common impediments causing falls are raised sections of flooring, carpet edges that make turning, scattered objects or animals. Due to impaired vision or bad lighting the 1/3 of falls from accident occurr on the stairs – elderly patients lose the last steps mistakenly believing that they have reached the last step. Examination of footwear for the elderly also can show us the causes of falls.
Falls are more frequent when on high heels, slippery shoes or when the elderly person is moving barefooted. from falling should be treated immediately and frequently the patient requires hospitalization. After a fall a thorough intervention is required from the family, friends and social workers to remove barriers to the patient’s home and provide a safe environment. Sedatives, narcotic drugs are advisable to be interrupted, vasodilators associated with orthostatic hypotension are better to be changed. the patient leaves the hospital therapists must be sure that the elderly person is able to safely fulfill his daily routines. simple test to check the ability of elderly’s gait is “get up and go”, during which the patient has to get up from a chair without arms, stand up, walk 3 meters, turn and return to his place to sit.
Source:
http://www.sosiatroi.gr/en/briefing-of-doctors/journals/236-2010-07-08-12-42-22.html