Falls: cause of death in 3,605 people in Spain in 2020
“Falls are the second leading cause of death from unintentional injuries worldwide”, behind traffic accidents, according to the WHO. And “ every 20 minutes an elderly person in the US dies from falls” , according to the United States Centers for Disease Control and Prevention (CDC).
The risk groups are children and the elderly . Specifically, the latter are the ones who are most at risk of dying and suffering injuries. In Spain, according to data from the National Institute of Statistics, in 2020, 3,605 people died from accidental falls , a figure that has been rising steadily since 2006 (the year in which only 1,647 were recorded). People between 80 and 94 years old are the age range with the highest number of deaths .
Rodríguez-Molinero et al. performed the characteristic profile of most falls in the elderly in their study. The result was that most falls in the elderly occur in women, at home, with a forward fall direction, while walking alone, due to a trip (dizziness is the second cause); and the most frequent injury is contusions, followed by fractures.
What are the causes of falls in the elderly?
The risk of falls increases with age and is higher in people who have fallen before. These falls are falls at the same level , we are not talking about spectacular falls from practicing extreme activities. But, as has been explained, these sudden falls in the elderly can be fatal .
The causes of falls in the elderly are multifactorial . There are diseases that cause falls, such as musculoskeletal, cardiovascular and neurological diseases (Alzheimer’s), and diabetes. Cognitive impairment and depression are also diseases associated with an increased risk of falls.
On the other hand, there are alterations typical of age, since there is a deterioration of the organism at multiple levels . For example, feet, eyes, and hearing deteriorate over the years. And this deterioration also causes falls. Loss of agility, muscle weakness and/or poor balance also contribute to accidents.
On the other hand, it is estimated that taking more than 5 medications increases the risk of falls. “51.5% of the treatments taken by the elderly are associated with a high risk of falls” , according to a recent study by Luque et al, published at the 67th Congress of the Spanish Society of Hospital Pharmacy. And we know that one of the characteristics of the elderly is that they are polymedicated . The medications most associated with falls are those used to treat hypertension, allergies, sleep disorders, anxiety or depression. Opioids, antipsychotics, antiepileptics, and benzodiazepines are also dangerous. And, of course, the interactions that occur between them.
There are also extrinsic factors such as alcohol consumption, the use of shoes that do not fit well, with heels or slippery soles and a messy, unknown or poorly lit environment.
Finally, it is important to mention that falls themselves, or the mere fact of being afraid of falling, are a risk factor. According to Lederle, “Falls can lead to fear of falling, which can limit usual activities and lead to a loss of independence.”
What happens if an older adult falls?
Although most falls result in minor injuries, 5% of older adults who fall will require hospitalization . Lederle et al state that “a quarter of falls result in serious injuries, including broken bones, head injuries, and even death.”
Atrial fibrillation is a type of arrhythmia that appears in a high percentage of older people. The main treatment is blood thinners, which prevent clots from forming because your heart beats irregularly. Therefore, when an older adult falls and hits his head , especially if he takes this anticoagulant medication, it is necessary to go to the emergency room for evaluation. Because one of the consequences of falls in elderly people who have hit their heads is that a cerebral hemorrhage has occurred.
Head trauma can occur, but most of the time what appears are contusions , without reaching fractures. When fractures occur, the ones that appear the most are fractures of the hip, wrist and vertebrae .
What can I do to prevent falls?
The prevention of falls in the elderly is a great challenge. We have already seen that aging is a great risk factor that we cannot modify and, in itself, explains why the elderly fall frequently. But there are physical aspects that can be delayed or improved. And there are external elements that can be controlled.
The CDC states that “most falls are caused by a combination of risk factors.” The more risk factors a person has, the greater their chances of falling. Therefore, to prevent falls and reduce the greatest number of risk factors, these tips can be followed:
- Exercise regularly, focusing on building strength and balance . A physical therapist can teach you what these exercises are and how to perform them. Other activities such as tai chi and dance are especially helpful in preventing falls.
- It is important to tell your doctor or nurse when you fall , even if you were not injured. Your doctor may consider reviewing or re-evaluating your prescribed treatment, or may decide to make an assessment of your health status .
- Get your vision tested at least once a year. If you wear glasses, the prescription may need to be changed. If you have bifocals or progressive lenses, your ophthalmologist may recommend long-distance lenses for walking and outdoor activities. This is because these types of bifocal lenses can make things appear closer or further away than they really are while we walk, causing imbalances.
- It may also be advisable to have a hearing test and check the condition of your feet at the podiatry office.
- In the evaluation of the professionals mentioned above, they may recommend a cane or walker . If you already use one, make sure it’s the right size and that you know how to use it properly.
What safety measures can be taken to prevent falls?
In addition to health advice, some safety measures can be taken, especially at home:
- Make your home safer: remove rugs , especially loose rugs, cords, and maintain a tidy environment .
- Make sure your home has adequate lighting , paying special attention to stairs. It may be necessary to add more or brighter light bulbs.
- Use non- slip elements in the bathtub and on the floors of the shower.
- Install grab bars in bathrooms and sturdy railings on stairs. Fix loose or uneven steps.
- Choose suitable footwear with a non-slip sole and the correct size.
- Keep frequently used items in cabinets and areas that you can easily reach without using a stool.
Forgive the audacity to end the article with a personal experience. In almost four years working as a nurse in a mobile ICU, I think I have saved more lives at home by giving this advice and reviewing the correct taking of medication, than by treating heart attacks and cardiorespiratory arrest. Take care of your elders by checking that these security measures are met.
References:
Bustelo, M.F. (2022). Drug-related falls, a problem that could be avoided. Retrieved on July 16, 2022, from the Illustrious Official College of Pharmacists of Granada. https://www.cofgranada.com/paginas/noticia.asp?idNoticia=15958
Facts about falls. (2021). Retrieved on July 16, 2022, from the Centers of Disease Control and Prevention. https://www.cdc.gov/falls/facts.html
Lederle LI, Widera E. I Am Worried About Falling: What Do I Need to Know? JAMA Intern Med. 2021;181(12):1684. DOI:10.1001/jamainternmed.2021.6175
World Health Organization. (2021) Falls [Internet]. Who.int. https://www.who.int/en/news-room/fact-sheets/detail/falls
Rodriguez-Molinero, A. (2015). Falls in the Spanish elderly population: incidence, consequences and risk factors. Spanish Journal of Geriatrics and Gerontology, 50(6), 274–280. DOI: 10.1016/j.regg.2015.05.005
