Preventing falls and related fractures
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Falls are serious at any age, and breaking a bone after a fall becomes more likely as a person ages. Many of us know someone who has fallen and broken or fractured a bone. While healing, the fracture limits the person�s activities and sometimes requires surgery. Often, the person wears a heavy cast to support the broken bone and needs physical therapy to resume normal activities. People are often unaware that there is frequently a link between a broken bone and osteoporosis. A silent disease involving gradual loss of bone tissue or bone density and resulting in bones so fragile they break under the slightest strain, osteoporosis progresses without symptoms. Consequently, falls are especially dangerous for people who are unaware that their bone density is low. If the patient and the doctor fail to connect the broken bone to osteoporosis, the chance to make a diagnosis with a bone density test and begin a prevention or treatment program is lost. Bone loss continues, and other bones may break.Even though bones do not break after every fall, the person who has fallen and broken a bone almost always becomes fearful of falling again. As a result, she or he may limit activities for the sake of �safety.� Among Americans age 65 and older, fall-related injuries are the leading cause of accidental death.
The Fall Itself
There are several factors that can lead to a fall. Loss of footing or traction is a common cause of falls. Loss of footing occurs when there is less than total contact between the person's foot and the ground or floor. Loss of traction occurs when the ground upon which the person is stepping is wet or slippery, and the person's feet fly out from under her or him. Other examples of loss of traction include tripping, especially over uneven surfaces such as sidewalks, curbs, or floor elevations that result from carpeting, risers, or scatter rugs. Loss of footing also happens from using household items that were intended for other purposes � for example, climbing on kitchen chairs or balancing on boxes or books to increase height.A fall may occur because a person's reflexes have changed. As people age, reflexes slow down. Reflexes are automatic responses to stimuli in the environment. Examples of reflexes include quickly slamming on the car brakes when a child runs into the street or quickly moving out of the way when something accidentally falls. Aging slows a person's reaction time and makes it harder to regain one's balance following a sudden movement or shift of body weight.
Changes in muscle mass and body fat also can play a role in falls. As people get older, they lose muscle mass because they have become less active over time. Loss of muscle mass, especially in the legs, reduces a person's strength to the point where she or he is often unable to get up from a chair without assistance. In addition, as people age, they lose body fat that has cushioned and protected bony areas, such as the hips. This loss of cushioning also affects the soles of the feet, which upsets the person's ability to balance. The gradual loss of muscle strength, which is common in older people but not inevitable, also plays a role in falling. Muscle strengthening exercises, however, can help people regain their balance, level of activity, and alertness no matter what their age.
Changes in vision also increase the risk of falling. Diminished vision can be corrected with glasses. However, often these glasses are bifocal or trifocal so that when the person looks down through the lower half of her/his glasses, depth perception is altered. This makes it easy to lose one�s balance and fall. To prevent this from happening, people who wear bifocals or trifocals must practice looking straight ahead and lowering their head. For many other older people, vision changes cannot be corrected completely, making even the home environment hazardous.
As people get older, they also are more likely to suffer from a variety of chronic medical conditions that often require taking several medications. People with chronic illnesses that affect their circulation, sensation, mobility, or mental alertness and those taking some types of medications (see chart) are more likely to fall as a result of drug-related side effects such as dizziness, confusion, disorientation, or slowed reflexes. Drinking alcoholic beverages also increases the risk of falling. Alcohol slows reflexes and response time; causes dizziness, sleepiness, or lightheadedness; alters balance; and encourages risky behaviors that can lead to falls.
The Force and Direction of a Fall
The force of a fall (how hard a person lands) plays a major role in determining whether a person will fracture or not. For example, the greater the distance of the hip bone to the floor, the greater the risk of fracturing a hip, so tall people appear to have an increased risk of fractures when they fall. The angle at which a person falls also is important. For example, falling sideways or straight down is more risky than falling backward.Protective responses, such as reflexes and changes in posture that break the fall, can reduce the risk of fracturing a bone. Individuals who land on their hands or grab an object on their descent are less likely to fracture their hip, but they may fracture their wrist or arm. While these fractures are painful and interfere with daily activities, they do not carry the high risks that a hip fracture does. The type of surface on which one lands can also affect whether or not a bone breaks. Landing on a soft surface is less likely to cause a broken bone than landing on a hard surface.
Preliminary research has suggested that by wearing trochanteric (hip) padding, people can decrease the chances of fracturing a hip after a fall. The energy created by the fall is distributed throughout the pad, lessening the impact to the hip. Further research is needed to fully evaluate the role of these devices in decreasing the risk of a hip fracture following a fall.
