Falls

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1.  Background

Falls are a major cause of suffering for elderly people and an important public health problem. They can cause lacerations, bruised tissues, fractures,  and head injuries.  These injuries can lead to hospitalization, nursing home placement and death. Falling and balance problems can cause ‘fear of falling”. People may be afraid to walk in their homes or outdoors, leading to further weakness and more frequent falls.  Falls are not accidents and may be preventable.

2. How Common is Falling?

  • 33% of people older than 65 will fall during the year
  • 50% of people older than 80 will fall during the year

 

3. How does Age Affect Balance?

As people age their balance may deteriorate .  Balance is  a complex task and dependent on many organs in our body working in synchrony. The following  are some of the age related changes that may impair balance:

  • Loss of brain cells  affecting cognition, coordination and movement. Most people lose dopamine producing cells as they age
  • Vision- people may  have difficulty discerning contrasts, problems with depth and light perception
  • Vestibular – part of our balance depends on ‘spatial sensors” in our inner ear. These may degenerate with age
  • Muscles-  may get smaller, stiffer and weaker and not be able to support us or respond to changes in position
  • Joints – in our legs may get stiffer and less flexible. People with arthritis may feel pain with walking
  • Sensation- people may lose fine sensation in their feet and legs. This can affect balance
  • Foot Problems – such as painful calluses or deformities
  • Cardiovascular-  we lose some of our reflexes that ensure that the heart is able to pump blood to the brain and all of our tissues.   We may not be able to increase our heart rate sufficiently and this can lead to a drop in blood pressure, particularly when we stand up, eat a large meal or strain on the toilet. This can lead to light-headedness, fainting and falls . People may also have problems with heart rhythm, blockage in the valves and other causes for low blood pressure

4. What Causes People to Fall?

Falls are often caused by multiple factors interacting in the same person. This may include medications  and alcohol,  acute and chronic diseases and environmental hazards

  •  Medications and Alcohol
    • Any drug that affects the brain.  Sleeping pills are a very common risk factor for falling. Other drugs include antidepressants, antipsychotics, anticonvulsants and narcotics
    • Cardiovascular Drugs- any medication that lower our blood pressure or affect heart rate. The most common drugs are diuretics, vasodilators and other anti hypertensive medications
    • Alcohol can affect our balance acutely and chronically. Even small amounts which  do not make us drunk can affect our reflexes and balance
    • Multiple medications taken at the same time may interact and affect balance
  • Health Conditions & Poor physical condition due to inactivity
    • Neurological disorders –  such as dementia, stroke,Parkinson’s Disease, or peripheral neuropathy and many more
    • Vestibular problems – such as Meniere’s Disease and other causes of vertigo
    • Visual problems such as macular degeneration and cataracts. Removing a cataract may lower the risk of falls and hip fractures. Refrain from using multifocal lenses outdoors
    • Cardiovascular  conditions – such as orthostatic hypotension, bradycardia , sick sinus syndrome and aortic stenosis
    • Arthritis and deformities of joints may affect our gait and balance. These  include  foot deformities
    • Any condition that leads to weakness or pain like chronic lung disease, anemia, problems with electrolytes
    • Any acute medical illness such as a bladder or lung infection may lead to delirium, weakness and falls
  • Environmental hazards
    • Throw rugs, electrical cords, stools, and any tripping hazard
    • Slippery floors and bathtubs
    • Damaged stairs and rails
    • Glass doors
    • Low seats, chairs and beds
    • Poor foot wear

5. What should I do if I Fall or Have Balance Problems?

  • See your doctor if: 
    • You feel sick or acutely ill
    • You have new falls,  worsening falls  or balance problems
    • Falls occur after a change in your medications
    • Your chronic balance problems are getting worse
  • See a physiotherapist or kinesiologist for an exercise program
  • See an Occupational Therapist particularly if you have visual impairment, are falling indoors or have difficulties with personal care and bathing. You may need special equipment such as grab bars or a bath seat, as well as special seating to prevent falling when you stand up
  • Consider a Geriatric Assessment if you have multiple falls, increasing frailty  and health problems
  • Exercise has been shown to reduce falling and injuries. Remove tripping hazards from your home and make sure there is good lighting
    • Walking for 30-45 minutes per day
    • Tai Chi
    • Resistance training to improve muscle strength
    • Aerobic training.
  • Use shoes that have low heels and non slip soles
  • Consider using a walking aid such as a cane or walker  if this helps your balance
  • Consider getting a medical alert system,  especially if you live alone or have problems getting up from a fall
  • Use 1000 units of Vitamin D per day. This may improve muscle strength and reduce the risk of fracture
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