|Wednesday, 20 February 2008 23:41 | Print page:|
The major cause of injuries resulting in hospital admissions for Victoria, 2001 was: falls (43%), followed by transport (14%), hit/ struck/crush (7%) and self-harm (6%).
*Based on studies conducted by the Victorian Injury Surveillance and Applied Research System (VISAR) at the Monash University Accident Research Centre. [Figures derived from: [3mb] Hazard - Edition 54 - Autumn 2003: Page 9].
Fall-related injuries are a major health threat for nursing home residents. Older people who live in nursing homes tend to fall more frequently than older adults who live within the community. When older people fall, they can experience decreased physical functioning, a reduction in the quality of life, decreased confidence, and an increased fear of falling, which can lead to further functional decline, depression, social isolation, and feelings of helplessness.
When a resident enters a nursing home, a plan of care must be developed. Within this plan of care, the resident’s risk of falling must be assessed to determine what assistance the person may need to get around.
There are a variety of reasons why the elderly might experience a fall, including weakness and gait problems associated with old age, in some cases due to negligence. Examples include falls caused by:
Falling, Prevention and Practical Advice
"The amount of human suffering associated with falling accidents is staggering," says Dr. Thurman Lockhart, an assistant professor of industrial systems engineering at Virginia Polytech Institute and State University. "And by 2020, medical costs from hip fractures alone—resulting from falling accidents—are expected to cost the healthcare system between 20 and 50 billion dollars."
In a study sponsored by the Centers for Disease Control and the National Institutes of Health, Dr. Lockhart is researching the mechanics of falling in order to develop intervention strategies. Below, he talks about the mechanics of falling, and offers some practical prevention advice.
Why do people fall more as they age?
There are intrinsic changes associated with the ageing process. The changes that increase the risk of falling are a degrading musculoskeletal system, sensory function, and gait changes associated with ageing.
How do changes in sensory function affect balance?
The maintenance of balance is organised, or controlled by three senses: sight, inner-ear function, and sense of touch, or tactile sensation. We maintain balance with these senses.
So these three factors contribute to falling as we age?
Yes. For example, you can divide slip-and-fall accidents into three different stages: Initiation, or the beginning of a slip, detection, or when we realise we're slipping, and recovery. So imagine when you are slipping and falling. There is the initiation process, where you slip a little bit, and in order to make a recovery, you have to detect that you're falling, which is assessed by your vision, inner-ear, and sense of touch. After that detection period, you have to make some recovery.
So the initiation, detection and recovery phases are all altered for the older individuals, because we have a gait change and the sensory change, as well as musculoskeletal degradation.
Are there other reasons why the elderly are at risk?
There are actually many factors that contribute to slip-and-fall accidents in the elderly. Medication side-effects can cause balance problems or dizziness, which can lead to falling. Elderly people have more chronic illnesses. Arthritis, for instance, is one of the major factors in falling. Pain associated with joints can cause falling. Fatigue, osteoporosis, dementia, and all sorts of things that more commonly strike the elderly, can lead to falls.
At what age does falling become a real risk?
Well, it's different for everybody. But after about fifty-five, our muscle mass begins to decrease and all of the factors associated with musculoskeletal degradation begin to develop. Including bone loss.
Also around age fifty-five, there is a drastic decrease in strength of the lower extremities. And this reduction in strength affects our gait style, or the way we walk. This change is one of the factors associated with how we recover from slip-and-fall accidents.
But it all depends upon a person's lifestyle. We have tested some eighty-five year old individuals who are very, very healthy and active. Their strength is maintained, and they didn't slip and fall in our tests. So age in years is not as important as actual physiological age.
Are the rates of falls different among women and men?
Elderly men fall more often than elderly women, but elderly women are more at risk of hip fractures.
We know that bones are affected by falling. Hip fractures are associated closely with the osteoporosis, or a fragility of bones and their liability to fracture. And osteoporosis is much more common in women than men. But the risk of hip fracture is also related to muscle mass. You have very thin muscle lining around your hips, and as it gets thinner, it becomes very bony. When you hit that area, the fracture rate increases as well.
Any advice to prevent falls?
One important piece of advice is: stay healthy. Walk around and keep the lower parts of your body strong. An active lifestyle is very important. And be aware of your surroundings. That's tougher for older individuals, because their senses and awareness of their surroundings is not as keen as younger individuals.
But it's also very important that people not be overly afraid of falling. Fear should not prevent you from going outside and exercising and doing your activities. Just take some considerations of your surroundings and eliminate all of the hazards associated with fall accidents.
Below is a list of tips from Dr. Lockhart for preventing falls around the house:
Kitchen and Bathroom