Falls Leading Cause Of Death For Those 65 And Older
April 21, 2019 at 10:58 p.m.
By Max [email protected]
Fracture of the hip is one of the most common and medically devastating conditions affecting older people, threatening survival as well as independence. More than 90% of hip fractures occur as a result of falls, with most of these fractures occurring in people 75 years or older.
According to the literature, one-third of the population greater than 65 of age living at home report falling one or more times a year, and 1 out of every 200 home falls produces a hip fracture. At ages 85 and above, one hip fracture occurs for every 10 falls. While the hip is the bone most frequently sited, fractures can also occur in the pelvis, vertebrae, humerus, hand, forearm, tibia and ankle.
Among people age 65 and older, falls are the leading cause of death from injury. The mortality rate for falls increases dramatically with age in both sexes and in all racial and ethnic groups, with falls accounting for 70% of accidental deaths in people 75 and older.
Every 19 minutes in this country, an older person dies from a fall. In the United States, 60% of fatal falls take place at home, 30% in public places and 10% in health care institutions. Home falls account for the greatest mortality because the elderly stay in this environment most of the time and because there is possibility of falling from greater heights, i.e., stairs. Falls are all too frequently the cause of not only death, but of long-term disability.
Causes
Multiple factors contribute to hip or other fractures. The relevant issues include:
• whether or not a fall occurs.
• the mechanism of the fall.
• how well bones and soft tissues can absorb the energy of an impact once a fall is initiated.
Direct causes can be intrinsic or extrinsic. Intrinsic causes relate to the patient’s susceptibility including age-related physiologic changes, diseases and medications. Extrinsic causes relate to environmental hazards. Age-related changes that impair postural stability and blood pressure homeostasis make older people more susceptible to falls and fainting.
In addition to age-related changes, disease-related factors such as rheumatoid arthritis, cancer, Alzheimer’s, Parkinson’s, and cardiovascular and neurologic disease further increase the risk of falls. Osteoporosis is often included as a risk factor, but its role as the cause of hip fractures remains unclear. Reduced sensory acuity in sight, hearing and smell play a role, as do altered balance and gait, delayed reaction time, and declining muscular endurance.
As a result of the development of disease, the elderly often adopt a sedentary life style, become out of shape, and have difficulty adapting to environmental stress.
The use of medications or improperly used assistive devices may further increase the risk of falling. Prescribed medications, so common to elderly patients, are frequently associated with an increased risk of falls and fall-related injuries. Medications that have been implicated include diuretics, cardiac drugs, corticosteroids, hypoglycermic agents, antihypertensives, psychotropics, antiparkinsonism drugs, narcotic analgesics, anticonvulsants and antihistamines. Psychotropic drugs include antidepressants, anxiolytics (especially long-acting benzodiazepines), sedative-hypnotics and antipsychotics. Their use can result in excessive sedation, psychomotor impairment, confusion, dizziness and ataxia – side effects that can result in falls. Topical eye medications used to treat glaucoma may also increase the risk of falling. Other factors to consider include taking four or more prescription medications or the initiation of a new drug treatment in the previous two weeks.
The extrinsic factors mentioned earlier include poor lighting, unsafe stairways, irregular floor surfaces, clutter and poorly designed furniture. Frail elderly people tend to fall and injure themselves in the home during the course of routine activities. Fracture injuries linked to walking leashed dogs have also increased significantly in the past several years.
Prevention
A number of critical steps can be taken to reduce the risk of falls in the elderly. Included are the need to eliminate environmental hazards, improve home supports, modify medications, provide balance training, supply opportunities for socialization and encouragement, and to involve the family to a greater extent in supportive measures.
The National Center for Injury Prevention and Control provides a website describing a number of factors related to falls and hip fractures among older adults. Included are a number of actions older adults can consider to reduce their risk of falling. They include:
• maintaining a regular exercise program.
• making living areas safer.
• asking doctors to review all medicines to reduce side effects and interactions.
• Having vision checks each year.
Tai chi is an excellent, low-impact way to improve balance. Also, practice standing on one foot when you brush your teeth or wash dishes.
Max Sherman is a medical writer and pharmacist retired from the medical device industry. He has taught college courses on regulatory and compliance issues at Ivy Tech, Grace College and Butler University. Sherman has an unquenchable thirst for knowledge on all levels. Eclectic Science, the title of his column, touches on famed doctors and scientists, human senses, aging, various diseases, and little-known facts about many species, including their contributions to scientific research. He can be reached by email at [email protected].
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Fracture of the hip is one of the most common and medically devastating conditions affecting older people, threatening survival as well as independence. More than 90% of hip fractures occur as a result of falls, with most of these fractures occurring in people 75 years or older.
According to the literature, one-third of the population greater than 65 of age living at home report falling one or more times a year, and 1 out of every 200 home falls produces a hip fracture. At ages 85 and above, one hip fracture occurs for every 10 falls. While the hip is the bone most frequently sited, fractures can also occur in the pelvis, vertebrae, humerus, hand, forearm, tibia and ankle.
Among people age 65 and older, falls are the leading cause of death from injury. The mortality rate for falls increases dramatically with age in both sexes and in all racial and ethnic groups, with falls accounting for 70% of accidental deaths in people 75 and older.
Every 19 minutes in this country, an older person dies from a fall. In the United States, 60% of fatal falls take place at home, 30% in public places and 10% in health care institutions. Home falls account for the greatest mortality because the elderly stay in this environment most of the time and because there is possibility of falling from greater heights, i.e., stairs. Falls are all too frequently the cause of not only death, but of long-term disability.
Causes
Multiple factors contribute to hip or other fractures. The relevant issues include:
• whether or not a fall occurs.
• the mechanism of the fall.
• how well bones and soft tissues can absorb the energy of an impact once a fall is initiated.
Direct causes can be intrinsic or extrinsic. Intrinsic causes relate to the patient’s susceptibility including age-related physiologic changes, diseases and medications. Extrinsic causes relate to environmental hazards. Age-related changes that impair postural stability and blood pressure homeostasis make older people more susceptible to falls and fainting.
In addition to age-related changes, disease-related factors such as rheumatoid arthritis, cancer, Alzheimer’s, Parkinson’s, and cardiovascular and neurologic disease further increase the risk of falls. Osteoporosis is often included as a risk factor, but its role as the cause of hip fractures remains unclear. Reduced sensory acuity in sight, hearing and smell play a role, as do altered balance and gait, delayed reaction time, and declining muscular endurance.
As a result of the development of disease, the elderly often adopt a sedentary life style, become out of shape, and have difficulty adapting to environmental stress.
The use of medications or improperly used assistive devices may further increase the risk of falling. Prescribed medications, so common to elderly patients, are frequently associated with an increased risk of falls and fall-related injuries. Medications that have been implicated include diuretics, cardiac drugs, corticosteroids, hypoglycermic agents, antihypertensives, psychotropics, antiparkinsonism drugs, narcotic analgesics, anticonvulsants and antihistamines. Psychotropic drugs include antidepressants, anxiolytics (especially long-acting benzodiazepines), sedative-hypnotics and antipsychotics. Their use can result in excessive sedation, psychomotor impairment, confusion, dizziness and ataxia – side effects that can result in falls. Topical eye medications used to treat glaucoma may also increase the risk of falling. Other factors to consider include taking four or more prescription medications or the initiation of a new drug treatment in the previous two weeks.
The extrinsic factors mentioned earlier include poor lighting, unsafe stairways, irregular floor surfaces, clutter and poorly designed furniture. Frail elderly people tend to fall and injure themselves in the home during the course of routine activities. Fracture injuries linked to walking leashed dogs have also increased significantly in the past several years.
Prevention
A number of critical steps can be taken to reduce the risk of falls in the elderly. Included are the need to eliminate environmental hazards, improve home supports, modify medications, provide balance training, supply opportunities for socialization and encouragement, and to involve the family to a greater extent in supportive measures.
The National Center for Injury Prevention and Control provides a website describing a number of factors related to falls and hip fractures among older adults. Included are a number of actions older adults can consider to reduce their risk of falling. They include:
• maintaining a regular exercise program.
• making living areas safer.
• asking doctors to review all medicines to reduce side effects and interactions.
• Having vision checks each year.
Tai chi is an excellent, low-impact way to improve balance. Also, practice standing on one foot when you brush your teeth or wash dishes.
Max Sherman is a medical writer and pharmacist retired from the medical device industry. He has taught college courses on regulatory and compliance issues at Ivy Tech, Grace College and Butler University. Sherman has an unquenchable thirst for knowledge on all levels. Eclectic Science, the title of his column, touches on famed doctors and scientists, human senses, aging, various diseases, and little-known facts about many species, including their contributions to scientific research. He can be reached by email at [email protected].
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