Risk factors associated with falls
- Mental health
- Weakness and frailty
- Vision defects
- Musculo-skeletal factors
- Neurological factors
- Heart / circulatory problems
- Environmental factors
- Other factors
Mental health
Mental and intellectual processes are altered by ageing and may be manifested in various ways but there is considerable individual variation.
Short- term memory may be affected with difficulty in remembering new information or recalling recent events, though long-term memory will be unaffected. There may be less problem-solving ability, slower reaction times and speech may be slower. There may be more caution and rigidity in personality and attitudes.
Elderly people may be “confused”. This may be as a result of dementia, cerebro-vascular disease affecting the brain [“hardening of the arteries”], mental illness such as depression or chronic diseases such as COPD with chronic oxygen lack. This may be demonstrated on the “Mini Mental Score Examination (MMSE).
More severe mental illness such as psychosis may be present where reality and fiction are blurred, there is no real concept of time and day may be confused with night.
An elderly person who is not normally confused may suffer “acute confusion” in response to a specific event such as hospital admission, operation or an infection such as a urinary tract infection or pneumonia.
The effects of medication can also put elderly people at risk. Sedative drugs such as sleeping pills are particularly important. Anti-depressants and sedatives may slow the reaction - time and thus may prevent the older person from responding quickly or appropriately. Drugs, which lower the blood pressure either intentionally e.g. medication for high blood pressure or as a side effect e.g. water tablets (diuretics), may cause a fall in blood pressure on standing, making the elderly person feel dizzy and falls may result.
Weakness and frailty
Frail people are at risk of unpredictable falls because of a generally more vulnerable state and a combination of factors, which lead to a predisposition to falling, being less able to avoid a fall and problems getting up unaided after a fall, which could lead to dangerous consequences, such as dehydration, hypothermia, pneumonia, fractures or sub-dural haematoma (bleeding on the brain).
Vision defects
Vision is often impaired in older people, (see “Effects of Normal Ageing”). It is not only the visual acuity and ability to focus but also contrast sensitivity (the ability to adapt to light changes) and peripheral vision, which may be affected. This reduces the ability to see hazards and avoid a fall.
Musculo-skeletal factors
In older people, changes in gait and balance can occur. With stiffness and pain in weight-bearing joints and weak musculature, (as a result of osteo-arthritis or from normal ageing) there is less ability to lift feet up properly (steps become short and shuffling) and a greater tendency to trip and stumble. A lower limb may be weak or paralysed (as the result of a stroke) and thinner bones (a result of osteoporosis) are more likely to break. The feet themselves may have reduced sensation and/ or ulcers for example, as a result of diabetic neuropathy, alcoholism or medication.
Neurological factors
Neurological factors, which may lead to a danger of falling are:
- Cerebro-vascular disease and stroke with resultant impaired gait and balance,
- Reduced position sense,
- Reduced vibration sense,
- Peripheral neuropathy, with loss of feeling in the feet,
- Slower reflexes,
- Slower reaction time,
- Abnormalities of gait, as in Parkinson’s Disease,
- Dizziness,
- Epilepsy,
- Effects of medications. Falls are associated with the use of 4 or more medications at the same time, sedative- hypnotic drugs, especially long- acting benzodiazepines, some antidepressants and some major tranquillizers.
Heart / circulatory problems
Some heart / circulatory problems which can lead to falls are:
- Arrhythmias, such as atrial fibrillation,
- Heart block,
- Heart failure,
- Aortic stenosis,
- Syncope (faints) and low blood pressure on standing (postural hypotension). (All of these may cause a sudden loss of consciousness because of reduced blood circulating in the brain),
- Medications such as digoxin, diuretics, some anti-arrhythmics and some medications that reduce blood pressure for example, ACE inhibitors.
Environmental factors
Many of these factors are hazardous, and can be changed to minimize risk to the person:
- Steep stairs,
- Slippery surfaces such as polished and wet floors,
- Loose rugs,
- Trailing cords and flexes,
- Poorly - lit areas,
- Incorrect height of furniture,
- Unfamiliar environments.
Measures such as the use of grab rails, raised toilet seats, installation of proper lighting and stair lifts (if necessary), the use of brightly - coloured strips around light switches and on the edges of steps and the installation of personal and home alarms all help to minimize environmental risk and restore some confidence.
Other factors
Other factors to be considered are:
- Previous falls (an elderly person who falls more than twice in a six- month period should be evaluated for treatable causes).
- The use of mobility aids (stick or walking - frame), which may indicate some difficulty with mobility (but also the aid may be unsuitable or not safe).
