Each year, millions of older people—those 65 and older—fall.
Death rates from falls perImpact of falls in the elderly by age, sex, and year: National Center for Health Statistics annual mortality data tapes reporting external underlying cause of death.
Fall-related Injuries In general, fractures are the most common serious injury resulting from falls in older persons. Specifically, fractures of the hip, wrist, humerus, and pelvis in this age group result from the combined effects of falls, osteoporosis, and other factors that increase susceptibility to injury.
Although precise estimates are not available, there are several times as many fractures of other bones in persons aged 65 and older as there are hip and wrist fractures.
The epidemiology of fracture is reviewed in greater detail in Chapter 6. Other serious injuries resulting from falls include hematoma, joint dislocation, severe laceration, sprain, and other disabling soft tissue injury. There are few data on fall-related injuries other than fracture in the U.
In a regional study in northeastern Ohio, the rate of emergency room treatment of fall-related injuries in persons aged 75 and older approached 80 per 1, per year in women and 60 per 1, per year in men. These rates were higher in women than men at all ages.
About 40 percent of treated fall injuries were fractures. Most falls, however, do not cause sufficient injury to receive medical attention. Only 3 to 5 percent of falls in elderly persons who reside in the community and in nursing homes result in fractures, with fewer than 1 percent of falls causing hip fractures.
This focus probably results in significant underreporting and misclassification. About half of those elderly persons of all ages who report falling in the previous year fall two or more times, a finding consistent with recent prospective studies. Disability Estimates from the National Health Interview Survey indicate that, among persons aged 65 and older inthere were 5.
About one-quarter of falls in the community result in an activity limitation owing to injury or fear of falling. One study found that about half of those persons aged 65 and older living at home who are hospitalized for a fall injury are not discharged to their home; 95 this group also includes one-third of those with injuries other than a hip fracture.
The psychological and functional consequences of falls can be severe whether or not an injury occurs, but such consequences have received insufficient attention and study.
Postural instability or a fall can lead to fear of falling and anxiety about normal activities on the part of the older person at risk, as well as among family members and care givers. The result may be a reduction in activity, decreased mobility, and increased dependence, often self-imposed but sometimes originating from others e.
Many falls in the elderly are probably multifactorial, resulting from the convergence of several intrinsic, pharmacologic, environmental, behavioral, and activity-related factors. However, knowledge regarding the etiologic mechanisms of these risk factors and how they combine to produce falls remains limited.
Perhaps even more limited is an understanding of situational and environmental factors that precipitate a fall in persons with predisposing characteristics.
Situational and environmental factors may be among the most important determinants of risk in healthy older persons. Finally, a better understanding is needed of factors that affect the risk of injury and other adverse outcomes of a fall.
Intrinsic Risk Factors Falls are a recognized marker of frailty and mobility impairment in the elderly. The presence and severity of functional disability is a useful indicator of the risk of falling in individuals and populations Table Normal gait and postural stability depend on the proper functioning of sensory, neuromuscular, and musculoskeletal systems.
Several studies have found that impaired vision, lower extremity sensory impairment, reduced lower extremity strength, and reduced grip strength are associated with the risk of falls see Table Arthritis in lower extremity joints and foot disorders contribute to gait and balance problems and are also associated with falls in several studies Table Other sensory problems that may contribute to falls, including cervical mechanoreceptor and vestibular disorders, 72 and the role of impaired central processing in postural instability and falls, 53 need more investigation.
A few studies have assessed the association of falls with slowed reaction time, impaired reflexes, and other neurologic signs, with inconclusive results Table Performance-based measures of gait, balance, and neuromuscular function are strong predictors of falls Tableprobably because they reflect the combined effect of sensory, neurological, and musculoskeletal impairments on postural stability during the activities in which falls commonly occur.
Whether the association of cognitive impairment and falls reflects neurological and psychomotor causes of falls, or behavioral factors related to mental and psychological states, is uncertain. The role of diuretic and antihypertensive medications in increasing the risk of postural hypotension and falls needs further investigation.
Research is needed to determine possible synergistic effects among drugs that might increase postural instability. Although most studies have not found an association of falls with chronic cardiovascular conditions, including postural hypotension, their role as risk factors remains uncertain.
Falls may also be a nonspecific manifestation of a variety of chronic and acute conditions. This risk appears to increase with the number of risk factors a person has, 76so that those persons most likely to fall can be identified. Additional research is needed, however, including controlled trials, to determine which treatable risk factors are causal.The internal rate of return is the discount rate at which the present value of all future cash flows (in this case, social return) is equal to the initial investment (in this .
Falls are events that depend on multiple factors and can be related to the presence of pathologies. The pathologies inherent to the process of ageing, which may lead to fall in the elderly population, are numerous and diverse.
Highlights The built environment can contribute to reducing errors, falls, and infections. The built environment can enhance the privacy, comfort, and control. Examples of design features are: single-bed rooms and identical rooms. Most of the evidence is found in the topic of view and acoustic comfort.
Most staff outcomes are empirical based and not scientifically proven. Geoff Hoddinott December 30, at am. Adele, nice piece.
So many situations are so different. We moved my father and mother in with us 17 years ago when they were to be separated – Dad to a nursing home (only a about 6 – 12 months to live) and Mum to a retirement home. CDC’s Injury Center created this initiative, expressly for you—healthcare providers who treat older adults who are at risk of falling, or who may have fallen in the past.
As a healthcare provider, you are already aware that falls are a serious threat to the health and well-being of your older. Extension publications including fact sheets, GardenNotes, and publications for sale.
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