April 24, 2021

Falls in the Elderly: Danger Signs and What to Do

Written by: Iris Tabangcora, M.D.
Reviewed by: Mubashar Rehman, PHD

Trauma caused by falls is one of the most common reasons of emergency room (ER) visits in the United States. For the past decade, incidences of falls and injuries are steadily increasing with more than one out of four old people (aged 65 and above) falling down every year. Centers for Disease Prevention and Control (CDC) states that if this rate continues to rise, we can anticipate seven fall deaths every hour by the year 2030.

Falls are serious and costly. It is the most common cause of traumatic brain injury and hip fractures. With three million ER visits per year of old people falling down, medical costs in the year 2015 due to falls totaled more than $50 billion.

Since fall is so common, primary caregivers and family members should know what to do when an elderly falls and hits their head. Moreover, knowing what symptoms to look for after a fall is essential, as it can save a life and prevent substantial morbidity. Up to 50% of elderly falling backward are not able to rise after a fall, so it will take some time before they are found and or managed to ask for help.

Who is More at Risk for Falling Among the Elderly? 

Descriptive studies profiling the demographics of elderly falling down described that incidence of fall is more common among women. However, this is because of early mortality among men. Low body mass index and greater height are also associated with increased incidence of falls. Those with other diseases like stroke (problems with muscle strength and balance), uncontrolled diabetes (fluctuating sugar levels may affect level of consciousness), cognitive deficits like dementia (gait problems), and alcohol abuse have higher risks for falls. Hip fracture is common among women while traumatic brain injury is more common among men.  

 

What are the Signs and Symptoms to look for After a Fall?

 Whether witnessed or not, regardless of the body parts involved, there are danger signs and symptoms to look for after a fall.

 

Altered Level of Consciousness

 This is the most critical clinical index of the function of the nervous system. Alteration in the level of consciousness signifies deterioration in an elderly’s condition. The Glasgow Coma Scale (GCS) is one of the most popular scale used to rate the extent of traumatic brain injuries among patients, ranging from mild to severe. This uses three responses, namely: eye-opening, verbal, and motor response.

One can note if they’re able to open their eyes, speak, and move spontaneously. If not, are they able to when using stimuli like voice and pain? Are their responses inappropriate? Do they mumble incomprehensible sounds? Notice also if there is any abnormal posturing like generalized spasticity and rigidity.

Concerning the level of consciousness, it also helps to test their orientation to time, place, and person. Asking questions like their name, the place where they are at right now, and what they think the time of the day provides significant insight

 

Chest Pain and Difficulty of Breathing 

Trauma to the chest may present with chest pain and difficulty in breathing. Real emergencies like punctured lungs from broken ribs and/or tension pneumothorax (air entrapped in the pleural space) require immediate care. 

A quick look if breathing is paradoxical also helps. Careful palpation of the chest and clavicles for obvious deformities provide insight for possible dislocations and fractures in old people falling.


Abdominal Pain          

Trauma to the abdomen may cause rupture of the organs and can manifest as severe abdominal pain. The presence of bruises and/or any underlying skin color changes may also be noticed. Another sign to look out for after a fall is an abdominal rigidity, which indicates a probably ruptured viscus. A rigid abdomen associated with unstable vital signs requires an emergency exploration in the operating room for the bleeders. 


Wounds and Obvious Deformities 

Documenting the type of wounds and their location is helpful in determining the body parts directly injured, especially in old people falling unwitnessed. An open wound, no matter how small, found near a body part with obvious deformity, signals a possible open fracture. Swelling and limitation in the range of motion of certain body parts can also signify fracture. 


Others

Some falls in the elderly may be precipitated by medical conditions. It is important to rule out stroke, hypoglycemic episodes or hyperglycemic crisis, substance overdose, and alcohol dependency among these patients. A baseline 12-lead electrocardiogram, random blood sugar, and appropriate blood tests should be done. 

In trauma, it is also important to note the nature, time, place, and date of incidence. This is vital in medico-legal cases and prognostication of certain conditions. 

 

What Can You do to Prevent Falls?

Falls can be prevented. Some simple things can be done to keep old people from falling. 

Physician consultation should be done to evaluate the risk for falling. During visit, a review of medications should be done to determine any dizziness and/or drowsiness. An eye check-up should also be done to determine the need for corrective lenses because problems with visual acuity affect balance and coordination. 

Strength and balance exercises geared towards making the limbs stronger also helps to prevent elderly people from falling backward. 

Lastly, making house arrangements to be safer for elderly members should be done. Ensuring adequate lighting on hallways and stairs prevent elderly members from falling backward. In addition to this, installing handle bar in the toilet can also provide additional support for them, especially on some occasions, the toilet floors may be wet. Rugs and slippers should be replaced with anti-slip ones. 

 

Conclusion

Falls, while common, is still preventable. It is important to act on it fast as this brings more serious morbidities especially in the elderly age group. Knowing to recognize these danger signs facilitates prompt initiation of care for these age group.

 

References:

  1. https://pubmed.ncbi.nlm.nih.gov/15106368/
  2. https://www.cdc.gov/falls/index.html
  3. https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

 

Article written by Iris Tabangcora, M.D.
Iris is a Philippine-based physician currently training in Emergency Medicine. She has been writing for various health websites for the last 10 years. Also a Nursing degree holder, she has spent her energy in educating nursing students on Research and Pharmacology. Her interests lie in medical education, research, and public health.

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