Fall in old age- Risk factors

Dr M K Mam

Fall in old age is a common problem. It is also a serious problem facing the people in old age. People aged 65 and above have the highest risk of falling. The frequency of falls increases as the age increases. Fall is a leading cause of serious injuries in old age that require hospitalisation. It can result in a serious injury like head injury and broken bones--fractures that usually require hospitalisation.

The common sites of these fractures are the hip, spine and the wrist. Head-brain injury and the fractures especially the hip fractures, are associated with a lot of morbidity and mortality. These fractures put an enormous financial burden on the affected person and the family as the monetary costs involved in the management of these fractures in the elderly are tremendous.

These fractures also cause a lot of psychological and social problems thus affecting the quality of the life of the person and family. It can also result in immobilisation and loss of independence. Falls may also result in what is called "post fall syndrome" that includes dependence, loss of autonomy, confusion, immobilisation and depression, which further leads to restriction of activities. Overall the life of the person and family is badly affected. World Health Organization (WHO) reports that fall- related injuries in old age are a major cause of pain, disability, loss of independence and premature death.

Risk factors: There are various factors that increase the chances of fall in an elderly. Usually, it is the combination of factors that result in a fall. Chances of fall increase do with the increase in risk factors.A good thing is that many of these factors are preventable. The factors that increase the chances of fall in old age include:

i) Decrease in muscle strength: Loss of muscle strength is a major risk factor for the fall in an elderly. Strong muscles are important to keep joints mobile and functional. These also maintain the balance and keep the body moving. Muscles do get weaker with age and it is partly because of decreased activity. It is a fact that muscle mass decreases- muscles atrophy and get weaker if not put to regular use. Joints also get stiffer if not put in regular use. Weakness of muscles, stiffness of joints along with weakness of bones that usually develops when muscle joints are not put in regular use is what we call disuse atrophy. Poor muscle strength and stiff joints affect the overall function, especially the mobility and balance of the person.

ii) Disturbed balance and gait: It is well known that balance declines with age. Various reasons that disturb the balance in elderly include weak vestibular systems, i.e., the system in the inner ear that provides the sense of balance and position of body, overall poor muscle mass and strength, and poor coordination and reflexes. With the result an elderly experiences difficulty in standing and walking, and the possibility of fall increases.

iii) Poor vision: Visual problems are quite common in the elderly. Poor vision as such increases the chances of fall.

iv) Medication: The elderly, who are on tranquillisers, antidepressants, anticonvulsants etc., have significantly higher chances of falling as medication may change the behaviour,mood and level of consciousness of the person. Elderly people on multiple medications have higher chances of a fall. Studies show that risk increases significantly if more than four medications are taken, regardless of the type of drug taken.

v) Home hazards: Trouble spots at home like loose rugs on floor, uneven or broken steps, uneven and or slippery floor especially in washroom or steps, uneven walking area, poor lighting, improper shoe wear etc. increase the chances of a fall in the elderly. An unsafe environment, whether at home or outside, does increase the chances of fall.

vi) Previous fall: Research shows that falling once increases the chances of falling again. A history of previous fall in an elderly induces a fear factor in the elderly that makes the person averse to doing even routine activities like simple walking etc.

vii) Alcohol misuse: Alcohol somehow is not good for the overall health of a person. It is harmful for liver, bones, brain, nervous system, immune system etc. It also affects memory, can impair judgement, coordination and reaction time and the balance of the person, thereby increasing the risk of falls and fractures. Studies show that even a modest social consumption of alcohol may exaggerate or compound the existing risk factors and increase chances of fall.

viii) Medical and other problems: Elderly people with medical problems like diabetes, heart disease, hypertension, chronic lung problems, depression, neurological problems, stiff and painful joints arthritis, urinary incontinence, thyroid dysfunction etc. are more prone to falls.

ix) Age: As age advances chances of falls increase due to poor reaction - decreased ability to respond rapidly, poor coordination and reflexes etc. Studies indicate that 30% of people older than 65 years and 50 % of people older than 80 years fall at least once a year.

x) Cognitive disorders: Lack of understanding and loss of memory also increases the risk of falling.

xi) Foot problems: Any problem in foot like simple calluses on toes, nail problems, ulcers etc. causing foot pain on walking can increase the risk of fall. Again, an improper footwear can also increase the chances of fall.

XII) Inappropriate dress: A dress that is not appropriate or well fitting can also increase the chances of fall.

(To be continued with 'Prevention of fall in old age' in the next issue)

Dr M K Mam is former Vice-Principal, Professor. & Head of Orthopedics, Christian Medical College, Ludhiana, Punjab

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Courtesy:- Dr. M.K. Mam and December 2022 Koshur Samachar