/p>>an article of Carlos Martin, Geriatrician
Medical Director Social Health Center
The Falls represent one of the most important problems in geriatric pathology, constituting one of the so-called “great geriatric syndromes”. To the statement that the elderly fall, it should be added that those adults who fall are essentially elderly.
Thus, the falls, in light of the information available to us, constitute one of the most serious epidemiological problems that affect the elderly, generating a cascade of consequences of all kinds, physical, mental, functional and socio-economic, which threaten their independence and require, for their prevention and treatment, the approach by health professionals , social and family, in an example of what should constitute the multi and interdisciplinary work typical of comprehensive care for the elderlyr.
The data speak for themselves: 25% of those over 65 who live in the community remember a fall in the last year, a figure that rises to 50% in those over 80; 50% of the elderly admitted to assisted living facilities will suffer one or more falls per year, and more than 60% of the elderly living in a residence have a history of falls in the previous year; 80% of falls occur at home; and 30% will be considered by the patient or the observer as inexplicable.
The most falls result in some type of injury, especially of soft tissues, such as cuts, abrasions and bruises; however, between 3-10% will produce fractures. In addition, half of the falls that require hospitalization produce a deterioration in the performance of the basic activities of daily living, which can lead to admission to an institution. And half of the elderly who fall can’t get up on their own, putting them at greater risk of falling. functional decline and death.
The causes of falls in older people are usually multifactorial and they are associated with intrinsic and extrinsic factors, which generally exert a summative effect, affecting balance and gait. Between the intrinsic factors associated with aging are reduced visual acuity, loss of sensitivity in the lower extremities, problems regulating blood pressure, intellectual deterioration, chronic neurological, bone and joint diseases and increased sensitivity to drugs that act on the nervous system .
By valuing the extrinsic factors that influence falls, the typology of the elderly must be taken into account; the vigorous elderly man falls performing more dangerous activities with a greater influence of environmental factors, while in the frail elderly the falls depend on his altered balance and gait and take place during the development of his self-care activities, the same thing that occurs in institutionalized elderly people .
The consequences of falls can be physical, which include the immediate ones (example: the wrist fracture when putting the hand) and the late ones due to staying on the ground for a long time. It is psychologically important fear that occurs after a fall, which can generate voluntary restriction of mobility, increased dependency, anxiety and depression. Accidents are an important cause of mortality in the elderly group, increasing with age and with complications secondary to the hip fracture.
The socioeconomic consequences are important, since to the direct costs (physical injuries, drugs, hospitalization, surgery, orthopedic material, rehabilitation) we must add the indirect costs (refurbishment of the home, payment to caregivers, admission to residences, etc.).
The main efforts to address this problem should be made from prevention, especially in the community and in care centers for the elderly. In this sense, the main recommendations for healthy older people are the practice of physical exercise age appropriate; The importance of physical activity is such that we can affirm that in this group the deterioration of the locomotor system is not secondary to aging, but to the lack of physical activity.
In very elderly or dependent people, give advice to the elderly and their main caregiver to reduce the risk of falls, such as the practice of moderate exercise, the reduction of environmental hazards and the periodic control of medication. In high-risk elderly or those who have already suffered one or several falls, a individualized intervention of an interdisciplinary team that includes advice on physical exercise, assessment of the risk factors and circumstances of each fall, periodic control of the state of health and medication, and review of the usual environment, as well as possible orthopedic aids and measures of rehabilitation.
The prevention and the awareness of professionals and society about the importance of this problem will surely improve the situation of the elderly today and in future times.