Aging Begins at 30

Falls

Mobility is precious. A third of adults will reach 80 and a third who do will have a damaging fall. Consider an old woman with a cane, bent back, head, and arms,walking slowly with feet apart and turned out. She is likely to break her hip. Faster walkers fall forward, breaking a wrist. Slow walkers fall sideways and break a hip. Seven percent of falls cause a hip fracture, but 95% of hip fractures are caused by falls. Falls contribute to 40% of nursing home admissions.

Asking an older adult if they have fallen is as important as asking a young patient if they smoke.

Each year, about 28% of elderly fall. Women twice as often as men. Frailty triples falls. A quarter of falls are preventable, half are possibly preventable, and a quarter are inevitable. Fear of falling can cause social isolation. But who knows, the better exercised "new" elderly may do better.

Sway is common in infants and returns in the elderly encouraging falls. The ill elderly on multiple medicines have more falls. If an elderly faller looks fit, think of abnormal heart rhythms or a heart attack.

If you fall the doctor will ask, "What happened." "What were you doing?" "What next?" He or she may do a "get up and go" mobility test. From a chair, get up and go to a wall, turn without touching it, and sit down. Falling may be a marker of disease, so you need a blood chemical review. Check feet, ankles, footwear, and gait. Check vision especially, also hearing, and mental function. Do you sway with your eyes closed? What is the strength of your leg muscles? If the strength of healthy elderly quad muscles is considered 100%, it is 62% in nursing home patients, and 37% in nursing home fallers. Even in old age, muscles can be strengthened.

A checklist of home hazards should be completed. Discard all but essential medicines. Wear proper footwear, avoid scatter rugs and extension cords, and light stairs adequately. The work-up for falls is complex, but it may prevent a fatality.

Learn how to get up from the floor. Roll to the right, get up on the right knee, and stand with the help of a chair. Physical therapists are helpful teachers. Have a phone handy, not hanging high on a wall. Frail elderly living alone should carry an alarm to a central telephone monitor. Muscle deconditioning causes loss of self-confidence, great anxiety remains, and a need of human or furniture support.

Most falls are neither random, unpredictable, nor age inevitable. Distance yourself from falls by exercising.

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See related Patient Topics Falls, Safety or Seniors' Health.

See related Provider Topics Safety or Seniors' Health.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

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