Causes for falls in the elderly.

• Falls in the elderly are usually mutlifactorial- there are several underlying causes.

• Older people who fall are generally different from those elderly non-fallers in that they have-

  • impaired balance,

  • they are generally frailer,

  • they sway more when standing,

  • they take more steps to turn around,

  • they have impaired sensation in the lower limbs,

  • they have weak quadriceps or thigh muscles and difficulty getting out of a chair.

  • they are generally slowed up in all of their movements.

• Falls are not caused by “old age”.

• Not all older people fall!

• There are always underlying causes for falls in the elderly that can be treated!

• Older people with recurrent falls are commonly on multiple medications including sedative medications such as sleeping pills, narcotic analgesia, anti-psychotics which impair balance.

• Medications that cause dizziness in elderly include blood pressure pills and heart pills which can lower the standing BP-this is postural or orthostatic hypotension.

• Postural hypotension is a major cause of dizziness, feinting (syncope), falls, fractures and head injury in the elderly.

• What causes dizziness and loss of balance and lightheadedness in the elderly- NOT “old age” ! but rather drug side effects or neurodegenerative brain disease.

• RISK FACTORS FOR FALLS IN THE ELDERLY INCLUDE:

  ·       Severe arthritis of the hips and knees.

  ·       Acute illness such as infections.

  ·       Cognitive impairment and dementia.

  ·       Parkinson’s Disease.

  ·       Previous strokes.

  ·       Low standing Blood Pressure.

  ·       Poor vision and hearing.

  ·       Taking more than 3 medications.

  ·       Narcotic analgesia.

  ·       Anti-psychotic medications

  ·       Long term steroids which cause proximal muscle weakness.

  ·       Sleeping pills

  ·       Cardiac medications causing a drop in blood pressure and dizziness when they stand

  ·       other causes for low standing BP

  ·       A previous history of falls indicates a high risk for further falls. 

  ·       Lower limb muscle weakness.

  ·       Peripheral neuropathy or numb feet.

  ·       Slowing up with a gait and balance disorder.

  ·       Use of a walking aid.

  ·       Sitting around all day.

  ·       Difficulty getting out of a chair.

  ·       Malnutrition with muscle weakness and wasting.

  ·       Environmental factors such as poor lighting, loose carpets, mats and lack of bathroom safety equipment.

• People with Alzheimer's dementia have a much higher falls risk due to confusion, poor co-ordination and planning.

• Poor hearing and deafness increases the risk of falls, confusion, and depression.

• It is usually not recognised that malnutrition is also a potent cause of falls in the elderly due to muscle weakness and wasting of the lower limbs from poor calorie and protein intake. 

• The biggest risks for falls in the elderly are acute hospital admissions and long hospital stays. Prolonged bed rest is a major contributor to falls, deconditioning, muscle wasting, pressure sores and falling blood pressure causing dizziness when the older person tries to stand up (postural hypotension). 

• Public Hospital Emergency Departments tend not to sort out and diagnose the underlying causes of falls in elderly patients. They simply address whether there has been a major injury and if not, then send them home again to fall!

• No elderly patient who has had a major fall should be sent home from the Emergency Department until the causes of the fall are diagnosed and treated.

• One fall usually means they are at risk of further falls until sorted out!

• There are usually multiple causes for falls in the elderly which require comprehensive medical assessment, admission into hospital and multidisciplinary rehabilitation to prevent further falls.

For more information read Dr Peter Lipski’s book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.