Jayalakshmi is 86, but leads a reasonably active life. She lives alone in her apartment. One morning, as she went about her chores, she slipped and fell. She was carrying a plastic container that had rice in it and wasn't in a hurry. She doesn't remember slipping on water, tripping on any object, or losing her balance but the next thing she knew was she had fallen. Once investigations were completed, she was told she had fractured her hip and needed surgery.
Falls in the elderly, a common occurrence, can have painful consequences if not treated immediately and properly. Sajan K. Hegde, Consultant Spine Surgeon and Head of the Department of Orthopaedics, Apollo Hospitals, Chennai, attributes falling among the elderly “to slowing reflexes, failing eyesight, restricted mobility.”
Adds P.V. Jayasankar, Head and Senior Consultant, Department of Orthopaedic Surgery, Sundaram Medical Foundation, Dr. Rangarajan Memorial Hospital, “Accidental falls are the major cause of injury among those aged above 65, and are responsible for 30 per cent of mortalities. The most common way of falling is slipping in the bathroom or bedroom at night. Some of the other causes are inflammatory joint diseases (such as severe arthritis), impaired hearing, neuromuscular disorders causing tremors (Parkinsonism), dementia, equilibrium /balance disorders (vertigo), foot problems (diabetic peripheral neuropathy, corns and calluses). Chronic illnesses such as uncontrolled diabetes, hypertension, hypotension, cardiac arrhythmia, loss of cognitive senses, intake of prescription drugs or taking more than four drugs, changes in prescription, alcoholism or environmental factors such as cramped homes with too many stairs to climb could lead to accidental falls.”
How is an elderly patient having a fall more at risk than a younger person?
Points out Dr. Hegde, “An elderly person is more likely to sustain injury. A younger person is usually more agile and able to take steps to prevent a fall.”
Dr. Jayasankar elaborates, “The elderly take longer to adapt to the darkness (proprioception) when they wake up from sleep and try to get out of bed at night. Bone mass also decreases with age and bones become brittle and sometimes powdery. In addition, the soft tissue covering the joints and bones which act as shock absorbers (muscles, ligaments and subcutaneous fat) gets worn out and the entire impact of a fall is felt by the bones and joints. This results in fractures.”
Which joints are most likely to be affected?
In Dr. Hegde's opinion, “The most common fractures are around the hip, wrist, shoulder and spine (vertebral compression fractures).” Dr. Jayasankar adds “stress fractures of the toes and fingers, ankle sprains and meniscal tear on the knees” to the list.
Is falling more risky for women than men?
Dr. Hegde says, “Elderly women patients are more likely to sustain fractures compared to men, as the former are prone to osteoporosis.”
Adds Dr. Jayasankar, “The poor nutritional status of women and their smaller physique compound the problem.”
However, what is critical after a fall is getting a medical opinion immediately rather than self-medication, or neglecting the injury.
Cautions Dr. Jayasankar, “Even a minor fall can lead to a major fracture, so it's best not to ignore it or brush it aside as a sprain. Seek medical attention at the earliest as major fractures can prove fatal if not attended to at the right time. Conservative management is acceptable for upper limb fractures. But in case of lower limb (particularly hip fractures) and spinal fractures, non-operative treatment will confine the patient to bed and lead to other complications such as bedsores, lung infections due to pneumonia, electrolyte imbalance, poor cardiac and lung function, multi-organ failure, septic shock due to infection, urinary infection caused by catheters, deep vein thrombosis leading to fatal pulmonary embolism, endangering life and sometimes leading to death.”
In conclusion, Dr. Prashant Kekre, Consultant Spine Surgeon, Apollo First Med Hospitals and Sundaram Medical Foundation, says, “Proper nutrition, medication and early treatment of osteoporosis, not to forget family support, can go a long way in sparing our elders the pain of a fall.”
It's also important not to forget measures to make our living spaces safer for them.
Fix grab rails in toilets.
Use anti-skid flooring.
Ensure toilets are dry.
Make sure homes are well-lit.
Use night lamps, or keep a torch at the bedside.
If you get up at night remain seated for 5 minutes in bed so that disoriented walking and possible falls in the toilet could be avoided.
Keep a calling bell by your bedside and in the toilets (preferably wireless) so as to call someone when in need.
Do not climb a stool or stepladder.
Wear shoes with rugged soles for better grip while walking.
Don’t shy away from using a walker or walking stick for support when necessary.
Have your eyes, ears, hypertension and diabetes checked at least twice a year along with a baseline bone mineral density (BMD) test.
Talk to your doctor about drugs that make you drowsy.
Keep active by doing exercises and walking. This will improve proprioception and reduce the incidence of falls.
Limit or avoid smoking and drinking.
Walking in early morning sunlight and taking calcium and Vitamin D supplements (especially for post menopausal women) can make bones stronger.
Prevention and treatment of osteoporosis helps reduce the incidence and severity of fractures following falls.
Lobby for smooth, well-lit and even pedestrian zones without open manholes.