Falls among elderly people: detection, advice and prevention

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Falls are the first cause of accidental death for people over 65 years old. It often affects one’s physical and psychological condition.
People who fall can lose self-confidence. They can fear falling again and they can become isolated. Falling down can have many consequences: they are often serious since they are linked to the gravity of the wound and the state of health of the person.
In what circumstances do older people usually fall? What are the best means to detect and prevent falls? How can someone get up after falling and what can we do to prevent falls?
Find all the answers here.

Detecting falls

Every year, more than 2 millions of people over 65 years old fall. 1 out of 2 people aged over 80 fall down.

Image from the "Champagne" short film
Image from the “Champagne” short film

Risks of falling down are multiplied by 20 after a first fall. To detect falls, it is important to be able to identify them. There are several type of falls:

  • A heavy fall: quick loss of verticality due to a shock
  • A soft fall: when the person tries to hold on to a piece of furniture, for instance
  • A syncope fall: when losing consciousness.

It is however difficult to define all types of falls, especially since it is important to identify false alerts as well.

The more time is spent on the floor, the worse the consequences of the fall can be. It is therefore essential to be able to detect a fall in order to maintain the independence of older people.

Estimating the economic cost related to falls among the elderly is challenging, but we already know it is a quite high number. It includes many health care expenses such as hospital admission, physical and psychological monitoring, costs due to a rise of dependency, etc. Working on detecting and preventing falls among the elderly is therefore a major issue.

In that regard, several technologies to promote independent living were developed and new systems were conceived to detect falls and give alert in problems occur.

A lot of research is going on to create devices which would not need an active alert from the victim is case of a fall: they would give an alert even if the person is unconscious. There are several types of devices of this type:

  • The ones which detect the fall itself (a sudden and quick movement or a shockwave on the floor);
  • The ones which identify an extended horizontal position after the fall;
  • The ones which identify sudden and extended break of daily activities and movements;
  • The ones which follow the biological data of a person (such as heart rate and blood pressure);
  • The ones which combine all of the above.

The main causes of falls among the elderly

The different possible circumstances of a fall are many; some are due to the environment, others to the person’s health state.

Most of the time, these falls occur when the person walks, does some housework or some gardening, or even when they get up from a chair. The loss of reflexes, muscular power and sometimes balance can provoke these accidents.

Falls usually occur during daily activities, indoors or outdoors. 1 out of 2 falls happen at home: in most cases, they happen in the bathroom, especially in the shower and the bathtub. Many obstacles in the house can be the cause of falling down: stairs, carpets, threads on the floor of bad lighting.

Falls can also happen to a person suffering from problems of alertness, following an excessive consumption of alcohol or after taking medicine. Patients suffering from dementia also tend to fall more often. There are more obvious causes of falls among the elderly: balance problems, walking difficulties, eye trouble or inadequate shoes.

The most significant factors of risks of falling in the home are:

  • Three falls or more during the previous year;
  • A fall resulting in a wound during the previous year;
  • Having trouble getting up from a chair;
  • Balance problems, walking difficulties: osteoarthritis, strokes with altering deficits, Parkinson’s disease
  • orthostatic hypotension coupled with dizziness while switching positions
  • Muscular weakness
  • Foot problems: for example, having trouble putting on shoes
  • Cognitive disorders such as dementia
  • Consumption of psychotropic drugs

In November 2001, another cause was brought forward in an English study. Researchers think the seniors who are victims of recurring unexplained falls could in fact be the victims of an undiagnosed heart problem. This « carotid sinus syndrome » (CSS) can greatly weaken both heart rate and blood pressure. If a pressure is applied to the carotid artery, the heart can temporarily stop and result in a syncope. Therefore, people suffering from CSS are more likely to lose consciousness and fall. Since CSS also causes memory loss, the victim does not remember losing consciousness before falling down. For these people, applying a pacemaker can reduce this kind of cardiac arrhythmias.

The consequences of falls

According to the frailty of the older person and the circumstance of the fall, consequences can range from minor to severe with a hospital admission and the risk of complications linked to a forced immobilisation.

Immediate consequences can be fractures and hematomas. According to Inserm, more than 50 000 falls result in a fracture of the femoral neck In France. They often result in heavy consequences and decreasing independence.

Consequences also need to be known beforehand when a person spends an extended period of time on the floor and is unable to get up. Spending a long time on the floor can very quickly be the source of dehydration, hypothermia, circulation problems, pressure sores, etc…

For an older weakened person, the post-operatory consequences of a fracture can be severe, with risks of infection.

Other consequences have to be considered like behavioural problems or clinical signs linked to the sudden stop of medication, such as sleep pills.

The older person can become fearful, lose their independence and need domestic help. They may even need to enter a specialised institution. The aftermath of a feel may indeed result in an inability to stay at home by oneself and the destruction of social ties.

How to prevent falls

40% of confined persons after a fall can no longer live at home. However, this is not inevitable. It can be anticipated thanks to rules of life and vigilance in order to limit risks.

Start with a healthy and balanced eating in order to prevent undernourishment and muscle loss. Meals need to be rich in calcium, proteins, carbohydrate content and vitamins. Sufficient hydrating is also vital.

Maintain a physical activity. Working out can prevent the consequences of a fall as well as osteoporosis, heart diseases, obesity, diabetes, colon cancer and mortality. Any activity counts and anyone can start exercising whatever their age. It is recommended to work out with a moderate intensity at least 30 minutes a day: walking, swimming, hiking, biking, stretching, climbing stairs…

Set up the habitat to secure moving in the house:

  • Do not leave items on the ground, especially in passageways like corridors, room entrances or stairs.
  • Secure electric wires (from phones, lamps, television, computer…) in order not to trip on them.
  • Make sure the lighting is strong enough so that there are no shadow zones when walking.
  • Do not rush to answer the phone, the door or the intercom.
  • Stabilise supports: set up support bars, make the access to calling devices easy. Install handrails for stairs.
  • Beware of slippery floors, carpet edges, pets that can involuntarily make you fall by getting in your way.
  • Set up adapted and secure showers.
  • Wear shoes with non-slip soles.

Getting up after a fall

Learning to get up after a fall is vital, but it has to be thought of beforehand. Staying on the ground while waiting for help after a fall is not a pleasant experience. It does happen to many older people who do not know how to get up.

Do not hesitate to practice, preferably with another person. Follow those steps:

  1. Bend a leg to roll on the side;
  2. Roll over on your stomach;
  3. Get yourself into the “knight” position with one knee on the ground and a straight leg;
  4. Put yourself on all fours;
  5. Pull yourself up by holding a chair or a rail.

For people who are truly unable to get up by themselves, teleassistance technologies can warn caregivers.

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