Joseph R. Anticaglia MD
Medical Advisory Board
Recently, Shirley, a 75 year old neighbor rang my doorbell at approximately 9:30 p. m. and said, “I fell.” She was holding a handkerchief against the right side of her forehead and blood was streaming down the right side of her face.
I asked her to come into my apartment, sat her down and applied pressure with sterile gauzes to the right side of her forehead to control the bleeding. This was the second time she had fallen and hurt herself within the past month. The first time resulted in minor scrapes and bruises. However, this time she required a trip to the E. R. She suffered a 2 inch ragged gash on the forehead that required suturing to close the wound.
When we arrived at the emergency room, Shirley told the doctor, “I don’t remember exactly how it happened. I lost my balance and think I tripped on the carpet and hit my head against the furniture.”
After suturing the wound, the doctor said, “I recommend a CT of the brain, a type of X-ray, particularly to rule out bleeding within the brain.” The CT was negative for any evidence of bleeding or other brain injuries.
Afterword, Shirley did fine. She kept the appointment with her family doctor to better understand the reasons she’s falling. Furthermore, she started a physical therapy program to prevent future episodes of falling.
The fear of falling affects both men and women of all ages but elderly women are particularly prone to falling and injuring themselves. Perhaps you or one of your parents or grandparents is worried about falling? Rightfully so, because according to the CDC-Center for Disease Control and Prevention
- Approximately every twenty minutes an elderly adult, 65 years of age or older, dies from a fall in the US. Approximately 30,000 older adults died as a result of a fall in 2016. Many more are injured.
- Falls are the most common cause of traumatic brain injury (TBI)
- More than 95% of hip fractures are caused by falling. It causes more than 300,000 thousand older people to be hospitalized because of such fractures
- Each year, 3 million older people are treated in emergency departments for injuries due to falls, such as broken bones or a head injury
- In 2015 it cost more than fifty billion dollars a year in the U. S. to treat injuries secondary to falls.
Risk Factors
A combination of risk factors cause falls such as your age and home environment. We’re more likely to fall as we age, especially people older than 75 years. Both genders are at risk of incurring injuries because of falls but it’s more frequent in women in the U. S. Also, children at various developmental stages are also prone to injuries due to falls.
Those who work under hazardous conditions such as at elevated heights, have a higher incidence of deadly falls. Side effects of medications or medical conditions can cause loss of balance or dizziness predispose to falls.
Alcohol and substance abuse can lead to falls. An unsafe environment at home, poor vision, inactivity and poor mobility are risk factors that make it more likely for you to fall.
Prevention
A combination of approaches is best utilized to reduce injuries from falling. Successful prevention programs reduce the number of people who fall and the severity of injury. For those people with a history of falls, it decreases significantly the likelihood of future falls. Below are suggestions to prevent falls.
Consult Your Doctor
- Review the side effects of medications that might cause you to become off balanced, dizzy or sleepy
- Check your blood pressure. Low blood pressure can make you feel light headed when going from a sitting or lying position to a standing position.
- Have your vitamin D and calcium levels checked which are important for good bone health
- Check your vision at least once a year. Trouble with depth perception can lead to falls.
- Take care of any foot problems you may have — wear proper footwear
- Talk to your doctor about successful programs to reduce falls
- Work with a physical therapist or trainer with experience helping people with dizzy and balance problems. Ask about strength and balance exercises. Tai Chi is an example of this kind of exercise
Your Home
- Remove throw rugs or tape them down; remove clutter you can trip over
- Install and use grab bars in your bathroom (showering, next to the toilet)
- Use non-slip bath mats in the bathtub and bathroom
- Place a handrail or a banister on both sides of the stairs
- Use night lights to make it easier to find your way to the bathroom at night
- Consider getting a medical alert system if you live alone
Falls are common, costly and often preventable. They’re a major health problem robbing individuals of independent living. A previous fall puts you at risk for another one; but there are steps you can take to prevent future visits to the emergency room
References
- Yara K. Haddad PharmD, MPH et al; Willingness to Change Medications Linked to Increased Fall Risk; J Am Geriatrics Society, Dec 13, 2018
- World Health Organization Falls, Jan 2018
- Yvonne A Johnston, DrPH, MPH, MS et al; Implementation of the Stopping Elderly Accidents, Deaths, and Injuries Initiative in Primary Care: An Outcome Evaluation The Gerontologist, September 20, 2018
- Center for Disease Control and Prevention,-CDC; Important Facts about Falls; February 10, 2017
- CDC; Morbidity and Mortality Weekly Report (MMWR); Deaths from Falls Greater than 65 Years—United States May 11. 2016
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.