Anyone with elderly relatives or friends knows that one of the many problems associated with old age is an increasing likelihood of falling. Falls, especially frequent falls, have many adverse consequences for the individual, the family and the health and social services. Are you wondering why senior falls occur and what to do about it? This article will discuss these consequences, the potential causes of falls, and some preventative measures.

One of the main reasons why senior falls occur is simply because of fear. This fear not only helps cause falls, it also can lead to social isolation as the elderly person may be unwilling to walk outdoors, negotiate steps, or use public transport, especially when it is dark or the pavements are slippery. A direct consequence of this isolation is reduced physical activity. This reduced physical activity can lead to reduced mobility thereby further increasing the likelihood of falling, and a vicious downward cycle can begin. Once begun, it can be very difficult to break this cycle.

An obvious consequence of a fall is injury. Of the many injuries associated with a fall, one of the most serious is a bone fracture, especially of the hip. Following a hip fracture, up to 40% of older people will not regain full independence and up to 20% die within one year of the fracture. Even without a serious injury, many elderly people are unable (or too frightened) to get up from a fall. If the fall happens within the home (which is very common) the faller may lie a long time on the floor undetected. This may lead to hypothermia and death, as temperature regulation in elderly people is compromised and the home may be poorly heated. One measure, which can prevent this is a fall alarm, worn around the neck. These alarms are connected via the telephone to a central agency that will contact neighbors who have access to the house if necessary.

Treatment of injuries, rehabilitation, and care of the elderly in the community incurs huge costs for the health and social services. For family and friends, there is continual worry along with the extra burden of care.

What are some additional reasons why senior falls occur? There is no simple answer to this question and, in many instances; there are a number of causes. Eyesight deteriorates with age and many elderly people have an inappropriate prescription for glasses. Therefore obstacles in the home, such as cables, steps, rugs and pets can cause trips and falls as they are either not seen or distances are misjudged. Medication, particularly multiple medications, can lead to unsteadiness and periods of low blood pressure. Even if the prescribing doctor is aware of the potential danger of drug interactions, older people can often confuse tablets and take them inappropriately. The problems of poor eyesight, home obstacles and inappropriate drug use, are relatively simple and cheap to counteract. For example, homes can be inspected and advice given on adaptations to help reduce the risk of falls. Tablets can be placed in weekly dispensing trays in which each day has 3-4 separate sections. Opticians can be encouraged to alert elderly patients that they require an eye test.

A particularly insidious type of fall is when the older person has no memory of falling and only becomes aware of it when they find themselves on the floor or in the ambulance. This type of “silent fall” is often attributed to a small ischemic cerebral event (or mini-stroke).

Another reason why senior falls occur is reduced muscle strength, particularly of the leg muscles. Not only do people get weaker as they age, their muscles also contract and relax more slowly. In this event, a trip that would be easily corrected by a younger person could lead to a fall for an older person. In addition to reduced muscle performance, there may be concurrent joint stiffness and pain that further retards speed of movement. There is also some (controversial) evidence that older muscles are more “wobbly”, i.e. the muscle contractions and associated movements are less steady. This could be an important factor in falls associated with negotiating steps.

As previously mentioned, hip fractures are a major consequence of falls. There is (again controversial) evidence that some people suffer a hip fracture and THEN fall.  The propensity for bone fractures in older people is due to reduced bone strength (osteoporosis), which, together with reduced muscle strength, increases the likelihood of a fall and fracture.

As our scientific knowledge about aging improves, the medical community has become more aware of these problems and how to go about rectifying them. A major target for intervention is to improve muscle performance, balance, and therefore mobility. In the US, there are now many health professionals and exercise instructors specifically trained to advise on exercises targeted for reducing falls. One important component of this intervention is to train the older person on how to get up safely after a fall and this alone can reduce the fear of falling. With increasing numbers of people, in the developed and the developing world, living well beyond their 7^th decade, it is critical that fall-prevention becomes a major public health target in order to enable the older person to enjoy an active and independent lifestyle without the fear of falling and subsequent injury.

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