Sruthy Mathew from Kottayam, Kerala, is always on her toes to ensure that her 90-year-old grandma doesn’t slip on the floor. The family makes sures that the washroom is dry all the time and she is holding a walking stick every time she is not in her bed. There are grab bars in the washroom to ensure she has support when she is on her own. “So far, she hasn’t had a fall, thankfully. But we are always on watch,” Mathew says.
Dr Anoop Amarnath, chairman, geriatric medicine, Manipal Hospitals, Bengaluru, says falls are a major geriatric issue but they can be prevented if cautions are in place.
A fall in the elderly can result in significant injury, fracture in the rib, hip and vertebral facture, says Dr Sachin Bhonsle, senior consultant, orthopedic surgery, Fortis Hospital, Mulund, Mumbai. He says that in some cases it can also lead to head injury, depending on the fall and the object the person hits during the fall. “After a fall, the elderly don’t get back to normalcy. If the fall leads to hip fracture, in 30 per cent of the cases they do not survive beyond a year,” says Dr Bhonsle. Preventing fracture following a fall is most important, he says.
Dr Amarnath says falls are a consequence of an underlying cause. “The elderly person may have come to the hospital with a head injury, fracture, limb injury and soft-tissue injury which need to be treated,” says Dr Amarnath. “At the same time, we also have to look for the underlying cause, which may have led to the fall, and treat the same. We do the fall-risk assessment, which includes the causative factor of the fall.”
Falls are the second leading cause of unintentional injury deaths worldwide, according to the World Health Organization’s 2021 factsheet. Each year about 684,000 individuals — over 80 per cent in low- and middle-income countries — die from falls globally. The WHO figures say 37.3 million falls are severe enough to require medical attention each year.
What leads to falls
According to Dr Amarnath, falls are caused by external and internal causes:
- Slipping at home or outside, tripping on a foot mat, uneven surfaces. Poor lighting too could lead to a slip and a fall
- Outside the house, falls could be due to uneven footpaths or walkways or roads
- Can be due to lack of proprioception (the body’s ability to sense movement, action and location), which is present in every muscle movement. The vision, hearing and balance mechanism also have a bearing on falls
- Those with gait and balance disturbance are at a higher risk of fall
- Those with stroke, severe neuropathy can also suffer a fall
- Metabolic complications such as hyponatremia (low sodium level), hypoglycaemic (low sugar level) or thyroid abnormality can also lead to falls
- Those with cognitive dysfunction (for example, people with dementia) are also at a higher risk
- Polypharmacy (the use of multiple medicines) can also cause falls. Multiple medications such as anti-depressants, anti-psychotic, anti-allergy, pain killer, sedatives and sleep pills can increase the risk of fall among the elderl
In addition to all these causes, Dr Amarnath says, “Sarcopenia (the loss of skeletal muscle mass and strength due to ageing) is an independent risk factor. With aging, the reaction time goes down and that’s another high-risk factor,” he told Happiest Health.
Treatments old and new
Talking about treatment, Dr Amarnath says a risk assessment of all the drugs that the person is taking is done and it is checked if any of the drugs being used is “having more benefits or risk to the person”.
Some technical advancements also help. Wearable devices can raise an alarm in case of a fall and some devices also assess possibilities of a fall based on gait, posture and balance of the user.
Doctors also employ a specific screening modality called the Timed Up and Go Test (TUGT), a performance measure of functional mobility. In TUGT, a person is made to get up from an armchair and walk for ten feet, turn around, come back and sit. “The entire exercise should be over in 12 seconds. If someone is taking more than 12 seconds, more investigation needs to be done and it shows the risk of fall. We would have to check if more time is taken in turning or while sitting and walking and whether it is a muscle issue or a sensory issue,” says Dr Amarnath. “TUGT is a very good non-invasive screening tool that can access the fall-risk assessment and check functional abilities. This can be followed by a blood test to check sugar, sodium, thyroid and infections if any. Neurological assessment also is done.”
Fall prevention among older people
Bengaluru-based V Ravichandar recalls how his aunt (who was in her 80s and lived next door) was using an AI-based neck wearable. “The device would not assess and prevent a fall but was meant for immediately raising an alarm through emergency calls to five contacts in case if she had a fall,” said Ravichandar. His aunt, who did not have a fall, died in 2021 due to old age-related issues. Still, the family had ensured that she would immediately get help in case of a fall.
There are also smart wearable devices fitted with a gyroscope sensor, says Dr Amarnath. These measure and maintain the orientation and angular velocity of an object and person. “The gyroscope sensor immediately assesses if the user is falling and gives alarm to ensure help immediately,” he said.
Some measures that can be taken up at the household level can also effectively prevent falls, according to Dr Bhonsle. He says there must not be any stumbling blocks at home, no slippery tiles, no water lying around. “There must be adequate lighting and anti-slip paints can be used. The movement of the elderly persons must be designed in such a way that they must not end up going around much. Their requirements — such as study and living room, and washroom — must all be close by,” says Dr Bhonsle. He says that having a small lamp in the bathroom and access areas at night also help.
Dr Amarnath says gait and balance therapy can help a person in improve walking, balance and posture. “Using a tripod walking stick is better than using a single leg-regular walking stick. Depending on the risk assessment we also suggest some to use Zimmer frame, a metallic walking frame. A metallic walking frame fitted with wheels in the front called rollator can also be used. For those who have difficulty in movement, we suggest using a wheelchair. These tools, however, require an ecosystem to use them effectively,” says Dr Amarnath.
Intake of good nutritious food, ensuring no deficiency in vitamins and calcium, can help in fall prevention. Maintaining optimal medical condition, improving reflexes and coordination among the elderly also helps, says Dr Bhonsle.