Fall is common among the elderly, hence many people feel that unsteadiness on the feet and frequent falls are the norm.
It is true that with age, the likelihood of falls increases, but we should not regard fall as a normal phenomenon of ageing.
Thirty percent of those over 65 and 40% over 80 years old fall once a year.
Two-thirds of those who fall will fall again within a year.
Fifty percent of those who fall will be injured, while 10% will be seriously injured.
Many older people are admitted to the emergency department for fall related injury, while 1% of falls lead to hip fractures.
Fall is the second leading cause of death from accidents or injuries worldwide.
There are many factors that cause fall, often there is more than one factor.
In order to prevent from falling again, we should find out the cause of the fall and take appropriate actions against it.
Cause for falls
The most common reason for falls is because of the environment.
Wet floors such as in the bathroom, a dimly-lit room, carpets that are not properly secured, or messy staircases can lead to falls.
As we get older, the muscles become weaker. This affects our strength and balance, leading to falls.
The reasons for muscle weakness are lack of physical exercise, arthritis, polymyalgia rheumatic (inflammatory disorder that causes muscle pain and stiffness) and other diseases.
Poor balance is caused by muscle weakness, stroke and Parkinson’s disease, or by side effects of certain medications.
Dizziness or fainting can also cause falls.
The most common cause of dizziness is postural hypotension (a drop in blood pressure from lying down to sitting up, or from sitting to standing), caused by dehydration, ageing circulatory systems, Parkinson’s disease or medications to treat high blood pressure.
Inner ear problems, such as labyrinthitis (inflammation of part of the inner ear) and benign paroxysmal positional vertigo (a sudden sensation of spinning due to specific changes in the head’s position); fast, slow or irregular heartbeat; dehydration; and anaemia; can cause dizziness.
Other causes of falls include standing for too long (especially in hot or crowded places); low blood pressure; low blood sugar; foot problems such as corns, calluses, long or thick nails and ulcers; or shoes that do not fit well and/or are inappropriate.
Diabetes, vitamin deficiency, or numbness in the feet prevent elderly people from feeling their feet on the floor and subsequently fall.
Dementia, memory loss, and confusion can affect an elderly person’s ability to judge risk of falls, prevent and identify harm while walking around.
Eye problems (such as stroke-related visual problems, cataracts, or glaucoma) can cause difficulty in predicting and spotting obstacles and hence cause slipping or tripping.
If elderly people wear double-focus lenses in their glasses, which contain short and long sightedness lenses, they may face difficulties walking up or down the stairs.
Some medications can cause side effects such as dizziness, instability, drowsiness, blurred vision, difficulty in thinking clearly and confusion.
Drugs commonly causing these symptoms include medications for low mood or anxiety, blood pressure medications, sleeping pills, epilepsy medications, and opioid painkillers.
The more medications an elderly person takes, the more likely he is to fall.
Excessive alcohol drinking, especially when taken with some medications, can cause unsteadiness in elderly and slow down their reactions.
If they have problems with bladder or bowels causing them to rush to the bathroom, or they frequently go to the toilet during the day or night, their risk of fall may increase.
In addition, falls may be the first sign of a new disease or that their health condition has began to worsen.
Many new and temporary health conditions that cause falls include acute confusion, urinary tract infections, pneumonia, dehydration, anaemia, heart problems, stroke, constipation and so on.
Not just a fall
Don’t underestimate a fall, as it may cause a series of serious injuries in the elderly.
Half of those who fall will have injuries such as joint dislocation, sprains, skin tearing, bruises, fracture, bleeding in the brain, disability, pain and inability to walk.
A fall can lead to an independent elderly becoming bedridden, or even towards death!
Long-term bed rest after a fall can cause dehydration, pressure ulcers, clots in the lower extremities or chest, and pneumonia.
About 50% of those who fall will lose confidence or “afraid of falling”, while 25% would avoid activities such as walking, shopping, or socialising.
As a result, a series of events will happen: the fear of falling can result in falls, which cause a loss of confidence and fear of activity that results in weakness and muscle atrophy, which makes the person more prone to falls, and even cause them to become bedridden.
This is a vicious cycle that is difficult to break.
After a year, 50% of the fallers will be less able to mobilise.
Thirty-five percent of people will fall and lose the ability to self-care, leading to a decline in independence or quality of life.
They may not be able to stay in their own homes.
Preventing falls
So how can elderly prevent from falling?
We can use non-slip mats in the bathroom, clean spillage immediately to prevent slippery floors, ensure that all rooms, corridors and stairs are well lit, do not use wires across paths, and avoid messy home corridors.
We can also secure the edges of carpets to the floor with tape and place handrails on both sides of bathtubs, bathrooms, washrooms and stairs.
Elderly people should use handrails whenever possible when going up and down stairs and while using the toilet.
We should organise the houses of the elderly and keep what they need in lower cabinets so that they can minimise climbing, stretching and bending their bodies.
Elders should not climb stools and ladders.
If something requires climbing, they should seek assistance from others.
Do not walk on slippery floors with socks and do not wear loose clothing in order to avoid tripping.
Older people should also wear shoes that are comfortable and fit well and have non-slip soles, as well as regularly trim their toenails and take care of their feet.
Older people should consult a physiotherapist for appropriate mobility aids.
In addition, physiotherapists are able to provide advice and exercise to improve their gait.
Replace the rubber sole of a walking stick that is worn out.
The elderly should turn their body and head slowly, avoid running up and down the stairs, maintain a stable walking gait at all time, avoid carrying heavy items, and avoid going to crowded or slippery places.
The elderly should wait for vehicles to stop before getting in and out of them.
They should slow down the speed of getting out of bed and avoid drinking too much water before bed so that they do not need to get up many times at night.
If an elderly person takes more than three medications a day or falls again, they need to consult a doctor who may reduce the dose of the medications or remove unnecessary medications.
If the elderly have vision or hearing problems, they can have vision or hearing tests, and wear glasses and hearing aids when needed.
Older people should do more exercise to keep their bones strong and improve their muscles strength and balance.
Elderly people who fall frequently should have bone density scans to detect and treat osteoporosis.
In order to maintain strong bones, elderly people should drink less alcohol; avoid smoking; do regular muscle strength and balance exercises such as yoga, walking, tai chi and qigong; and have food high in calcium and vitamin D, such as milk, broccoli, tofu and so on.
If there is osteoporosis (bone density and mass decrease making bones porous and fragile), older people should regularly take anti-osteoporosis drugs.
The risk of such fractures is greatly reduced with these measures.
Fall is not a “disease”, but a symptom, hence it is often ignored.
Therefore, after a fall, many do not seek medical attention, resulting in recurrent falls.
Only when they develop serious complications from a fall such as fracture, will they see a doctor.
There are usually many factors that cause a fall, and we need to find out the reasons to prevent further falls.
Dr Tay Hui Sian is a consultant internal medicine physician and geriatrician. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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