FALLS IN THE ELDERLY

(SN): What do you know about falls in the elderly ?

(FC): Basically, as my family doctor has told me, falls occur when sudden and accidental loss of postural equilibrium happens while carrying out any daily activity, including walking, that is when the person falls down on any surface which is lower than their posture.

(SN): And when a person falls at least twice a year, we call this multiple fall. And falls not only can provoke fractures, but they can also be fatal.

(FC): This is what I wanted to ask you about. I mean the consequences.

(SN): They can be medical and psychosocial. The former are linked to fractures that can be induced by osteoporosis, mainly in women; also, generally, poor health conditions are associated to falls, among which are wounds, bed scars and hematomas. And the latter would trigger the feeling of vulnerability, retirement and anxiety that can lead to depression.

(FC): I heard that the fear of falling can lead to actual falling. Can you explain that to me please ?

(SN): It’s that the fear of falling leads the elderly to minimize movements, which make them lose muscular strength and autonomy that might lead to falls. And if the fall happens, it can be serious and lead to intracranial injuries, the impossibility to get up after the fall, and the post-fall syndrome with motor, psychological and cognitive disabilities.

(FC): Having said this, are there any specific risk factors ?

(SN): There are, and they are multiple and range from intrinsic factors to individual and precipitating, behavioral and environmental.

(FC): Can you give me a bit more details on that ?

(SN): Intrinsic factors are generally age-related conditions like diabetes, visual problems, incontinence, malnutrition, locomotor and muscular disabilities. Individual precipitating factors go from cardiovascular disease like hypotension, to neurological like stroke, metabolic like hyponatremia, confusional states, psychotropic intake, and dehydration. Behavioral factors are related to alcohol intake, sedentariness, and age- related pathologies like osteoporosis, arthrosis and sarcopenia. As for the environmental factors, they are linked to wearing inadequate shoes, ill-adapted ecological factors like weak lighting, loose rugs and different home obstacles like mal-positioned furniture, and maladjusted technical aid and physical constraints.

(FC): What measures can be taken to prevent fall ?

(SN): At home or in nursing homes, since people are over 80, we assess them first on the universal protocol or program against falls, that includes adapted clothing, shoes and footcare, vision checkup and the use of adapted glasses, nutritional assessment for weight, dehydration, well-balanced diets and vitamin D intake, the pertinence and compliance with prescriptions, mobility accompaniment and security, and also securing individual environment like using adapted lighting, bed, furniture, and eliminating obstacles that hinder movements and facilitate access to the bathroom.