Why do we fall?
Every year more than two million Americans fall and sustain serious injury, costing in
excess of $3 billion dollars. Hidden costs include pain, disability, lawsuits, deterioration
in general well-being, and the impact on other family members. Falls and the resulting
injuries have become one of the elderly’s most serious health issues. As our senior
population continues to grow, falls and their consequences will increase in the future.
Causes
The accumulation of injuries throughout life change or damage the central nervous
system (CNS) and the body as a whole, and our bodies deteriorate through inactivity.
Vision diminishes with advancing age, and this directly affects the sensory systems
involved with movement. The sensory cells in the ears’ balance system change, gradually
decrease and cannot be replaced. The nerves which carry sensory information to the brain
also deteriorate with age, and complex brain interconnections lose connecting fiber and
nerve cells. The ability of nerve endings to generate the chemicals responsible for the
transmission of information also seems to be affected by aging. This process accelerates
after the age of 50.
Many diseases affect the CNS and sense organs. Hardening of the arteries
(atherosclerosis) is probably the worst; it is accelerated by hypertension, smoking, and
diabetes. Although it gradually increases during middle age, there is a point at which a
slight additional decrease in blood flow causes serious vascular impairment such as
stroke.
Head injuries, sometimes caused by falls, can damage the sense organs in the inner ears,
or the brain itself. The worst disability occurs when both sense organs and CNS
structures are damaged simultaneously. Physical activity is very important for recovery
from injury to the sensory systems. The general debility of aging can negatively affect
recovery if it results in a decreased level of activity. Central nervous system disorders,
such as Alzheimer’s Disease, can severely affect higher nervous system function.
Diseases of the eyes, such as glaucoma and cataracts, decrease visual sensory function
and are a common problem in old age. Injuries to the knees, hips, and back often do not
completely heal, leaving some limitation of motion. Arthritis can cause permanent,
crippling, nonreversible effects. Osteoporosis leads to bone weakness and increases the
probability of serious injury from a fall, or might cause a spontaneous fracture and lead to
a fall. Muscle strength gradually decreases with age. Joint tendons and ligaments lose
their flexibility and limit motion. The combined ravages of bone and joint injury,
arthritis, and inactivity can result in a body which cannot carry out motion commands
initiated by the brain.
Prevention
As many of the problems responsible for falling develop during early and middle age,
initial efforts to prevent injuries must be aimed at younger age groups. Many of the
changes in muscle, bone, and the central nervous system are not inevitable results of
aging, but are brought on by inactive lifestyles and self-inflicted damage from smoking,
poor diet, and lack of exercise. Although hardening of the arteries is occasionally
hereditary, in most cases it can be reduced by diets low in cholesterol and saturated fatty
acids, as well as regular physical exercise. This stimulates the muscles as well as the
cardiovascular system and could greatly reduce this problem. If there is a family history
of hardening of the arteries, medications to lower cholesterol are available. Early
diagnosis and treatment of diabetes mellitus and hypertension can make a difference in
the progression of arthrosclerosis. Smoking cessation might also help reduce this
disorder.
Many of the medications used to treat hypertension, heart disease, allergy, insomnia,
stomach acidity, and depression have side effects which influence brain function and can
increase the likelihood of falling. In this time of specialization, it is possible for one
patient to receive prescriptions from several physicians that might have additive side
effects on brain and sensory function. Patients should keep a complete list of all their
medications from several physicians that might have additive side effects on brain and
sensory function. Patients should keep a complete list of all their medications and
dosages, and make this list available to each physician they consult. Coordination of all
medications through a single primary care physician would help avoid adverse drug
reactions. This requires that the patient purchase all medications from the same
pharmacy, or list all medications with each pharmacy. Unfortunately, some over-thecounter
medications such as antihistamines, sleeping medications, analgesics, and cough
suppressants can add to the side effects of prescription medications. Alcohol also affects
movement and judgment and adversely interacts with many medications.
Prevention tips:
Health
- Have your vision and hearing checked regularly. If your vision and hearing are
impaired, you may lose important cues that help you maintain your balance
- Get up slowly. A momentary drop in blood pressure, due to drugs or aging, can
cause dizziness if you stand up too quickly
- Maintain balance and footing. If you sometimes feel dizzy, use a cane or walker
to help you to keep your balance on uneven ground or slippery surfaces. Wear
sturdy, low-heeled shoes with wide, nonslip soles
- Exercise regularly. Regular exercise improves your strength, muscle tone, and
coordination. This cannot only help prevent falls, it can reduce the severity of
injury if you do fall. Walking is a good form of exercise.
Home
- Remove raised doorway thresholds in all rooms. Rearrange furniture, if
necessary, to keep electrical cords and furniture out of walking paths. Fasten
area carpets to the floor with tape or tacks, and don’t use throw rugs
- Don’t use difficulty to reach shelves. Never stand on a chair. Use nonskid
floor wax and wipe up spills immediately
- Be sure stairways are well lighted and have sturdy hand rails. If you have a
vision problem, apply brightly colored tape to the first and last steps
- Install grab handles and nonskid mats inside and just outside your shower and
tub, and near the toilet. Shower chairs and bath benches minimize the risk of
falling
- Put a light switch by the bedroom door and by your bed so you don’t have to
walk across the room to turn on a light. Night lights in your bedrooms, halls,
and bathroom are a good idea.
Rehabilitation
What about patients who have already fallen? Although rehabilitation is not
perfected, much can be done.
- The first tank is a thorough and complete evaluation of the patient’s
sensory, CNS, and muscle/joint function
- A careful evaluation of the balance function should be performed. This
includes a search for causes of dizziness, such as inner ear diseases that
cause imbalance; an evaluation of the inner ear balance system which
might be adversely affected by certain drugs (such as a class of antibiotics
known as aminoglycocides;) trauma; and the aging process.
- Tests of higher mental function are important since falling may be a sign
of serious mental deterioration
- A careful review of all medications (both prescription and over-thecounter)
used by the patient is very important. If the patient needs
medication for anxiety or depression, switching from a long-acting drug to
the one which is more quickly passed from the body seems to decrease the
risk of falling
All correctable problems should be treated. Visual correction with proper
eyeglasses, improvement of hearing by hearing aids, adjustment or
elimination of medications, and correction of hypertension or any other
disease which could impair balance must be accomplished.
Rehabilitation includes increasing the range of motion as well as physical
strength. A very important part of rehabilitation is helping patients overcome
their fear of falling and thus avoid further injury. Walkers and canes can aid
stability, and adaptations in the home are important. Simple changes, such as
installing hand holds in bathrooms or along walls, could decrease the
likelihood of falling and increase patient confidence. Removing the patient
from a familiar environment, or drastically changing it, often hampers
recovery.
As soon as possible, rehabilitation should be moved to an outpatient setting
with participation of family members and home support groups. Rapid return
to physical activity and social interaction with family and community can
often stop the vicious spiral into inactivity, reclusiveness, and progressive
deterioration.
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