IDIOPATHIC INTRACRANIAL HYPERTENSION | 10.01.2023

FALLING AMONG ELDERLY

Everyone stumbles, loses their balance, and sometimes falls over from time to time. However, recurrent falls without any other factor may indicate a neurological disease.

As we all know, children grow up falling and standing back up, and this is perfectly normal if there is no obvious childhood disease. However, falls and injuries in the elderly can affect quality of life due to inactivity, fear of falling and increased dependency.

The risk of falling increases with age. A third of those over the age of 65 fall at least once a year, and half fall even more frequently.

falling among elderly

Photo: Dilek Necioğlu Örken

What Are the Risk Factors for Falling Among the Elderly?

Falling is common among the elderly. Drug use is one of the well-known risk factors. In particular, the use of multiple drugs and psychotropic drugs significantly increases this risk. Cognitive effects, pre-existing balance problems, age-related loss of muscle mass or sarcopenia, drowsiness, decreased hearing and vision are among the most significant falling risks. Also, middle-aged women can fall for no reason.

What is Drop Attack?

Drop is a sudden fall without any warning signs preceding the attack. There may or may not be loss of consciousness. The first thing to distinguish in an elderly person who falls is whether the fall was accidental or due to a drop attack.

What are the Causes of Drop Attacks?

When the drop attack is accompanied by loss of consciousness, it may be a syncope (cardiac origin) or an epileptic event. Meniere's disease, cataplexy attack of narcolepsy, midline tumours in the posterior fossa, and some transient ischemic attacks may cause falls without unconsciousness. Again, some neurological diseases such as neuropathies, stroke, multiple sclerosis, parkinsonism and dementia may cause weakness, muscle stiffness, loss of sensation or balance in the legs and thus predispose to falls.

How We Fall?

With aging, there are significant changes in gait characteristics even in healthy people. Normal aging alters many physiological functions that enable standing upright. Such altered functions are as follows;

  • Decreased sense of perception (proprioception)
  • Reduction in muscle mass (sarcopenia)
  • Orthopaedic disorders (degenerative osteoarthritis)
  • Cardiovascular disorders
  • Obesity
  • Impairment of vision and hearing
  • Cognitive impact
  • Decreased postural reflexes
  • Current and newly started drugs

Why is Falling Dangerous for the Elderly?

While gait impairment is at the rate of one in ten over the age of 65, the number of those over the age of 85 with normal gait is one in ten. One-third of those over the age of 65 fall once a year. As the frequency of falls increases with age, fall-related injuries and fractures, especially hip fractures, also increase accordingly. The reasons for this are that the severity of falls cannot be reduced with the arms, the soft tissue on the joints is reduced and the bone resorption we call osteoporosis developed. Falls are often repetitive, and women are more at risk than men. Women have more fractures and fear of falling after falling. Men have more head trauma and death as a result. There is also a difference between men and women in the way of falling. Women fall more often while walking, while men fall when getting up from their seat. Since the use of blood thinners is higher among elderly people, there is a risk of cerebral haemorrhage due to falling and hitting the head. 50% of elderly people who fall cannot get up from where they fell. A person lying on the ground may develop water loss, pressure sores, muscle breakdown (rhabdomyolysis), temperature drop, and pneumonia, each of which can be fatal individually.

What Should I Do Not to Fall?

First of all, you have to make your home safe. You need to organize items that could cause you to trip or slip (ex: furniture, electrical cords, carpets or rugs, messy items, wet surfaces). You should light your home well. You should avoid putting your belongings in places where you can't reach them and where you'll have to get on top of something.

You should wear shoes that are sturdy, non-slip and fitting your feet. High heels, slippery soles and loose shoes can cause you to fall. Walking around barefoot or in socks also increases the risk of falling.

Taking vitamin D reduces the risk of falls among the elderly. You should consult your doctor about when and how much vitamin D you should take.

You should be physically active. Regular exercise also reduces the risk of falling and injuring yourself if you fall. Both strength and balance exercises are helpful. There are many safe exercises for the elderly, such as walking, swimming, and Tai-Chi.

If necessary, you should use a cane. When your doctor recommends using a cane or walker, make sure they are the right size for you and that you use them correctly.

What Should I Do When I Fall?

Even if you are not injured in any obvious way, you should definitely consult a doctor.

SOURCES:
D.P Kiel. Falls in older persons: Risk factors and patient evaluation. Up to Date Feb. 2021
J.W Lance, S.E Waller. Drop attacks of the elderly. J Neurol Neurosurg Psichiatry 2019
B.F Remler, H Attar. Falls and Drop Attacks. Bradley and Daroff’s Neurology in Clinical Practice 2

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