FALLS IN THE ELDERLY
(By: Dr. Rensa, Sp.PD-KGer, FINASIM)
Walking balance disorders and falls are conditions that often occur in elderly people. This is a consequence of various changes in organ function related to the aging process, disease and also environmental factors. Falls are reported to occur in around 30% of people aged over 65 years per year, and this percentage increases with age.
The consequences of falls, such as injuries to the head/other body parts, up to broken bones (fractures) can reduce the ability of elderly people to carry out daily activities more significantly, compared to the young adult age group. Not infrequently complications from immobilization (long bed rest or >3 days), namely infection, joint stiffness (contractures), muscle wasting (muscle atrophy), pressure sores (pressure ulcers), nutritional disorders (malnutrition), blocked blood vessels. (deep vein thrombosis), up to self-isolation/depression can occur. This will ultimately affect the quality of life of elderly people who experience falls.
Risk factors for falls can be divided into 2 (two), namely intrinsic (conditions that exist in/come from the elderly's body) and extrinsic (acquired from outside/the elderly's environment). Several intrinsic factors that can cause falls are:
- Gait disturbance.
In walking, the term gait is known, namely the method or style of walking which generally includes moving speed (meters per second) and the number of steps per unit of time (steps per minute). The distance between steps that is too short or the feet are not lifted high enough when walking are examples of gait disorders in the elderly which can cause falls.
- Decreased postural control.
Postural control includes control of body position for stability so that body balance can be maintained and for orientation of various body parts to environmental conditions. In the elderly, there is often a slowing of reflexes in the limbs when falling, a decrease in "shallow-deep" perception and a decrease in muscle strength in both legs, which can increase the risk of falling.
- Dizziness ("Vertigo").
This condition is often experienced by elderly patients who experience falls, similar to syncope (sudden fainting). If you complain of recurring dizziness, you must immediately consult a doctor.
- Vision and/or hearing problems (examples: nearsightedness, cataracts, glaucoma, earwax buildup (cerumen impaction), etc.)
- Muscle and/or joint disorders (example: joint calcification/ osteoarthritis, reduction in muscle size due to stroke, etc.)
- Diseases (example: Stroke, Parkinson's, heart failure, chronic lung disease, etc.)
Apart from that, extrinsic fall factors that need to be considered are:
- Insufficient room lighting
- Slippery bathroom floor
- Lots of carpets or household furniture in the room
- Children's toys scattered on the floor
- Winding, steep and slippery stairs
- The influence of drugs that are used without supervision from a doctor (for example: antihypertensive drugs (lowering blood pressure), sleeping pills, etc.)
What are some tips for preventing falls in the elderly?
1. Exercise regularly, 3–4 times per week, 30–60 minutes per time. The type of exercise chosen focuses on muscle strength in both legs and also balance training, for example: morning walking/jogging, elderly exercise, yoga, Tai-Chi, swimming, etc.
2. Carry out routine medical check-ups, especially laboratory (blood) tests to find out whether there is anemia or other chronic diseases, as well as regular eye and ear checks (at least once every 3-6 months). If necessary, elderly people are advised to always use appropriate seeing and hearing aids when walking.
3. Use safe and comfortable footwear/shoes. It is not recommended for seniors to wear flip-flops (especially in the bathroom), and footwear should always have appropriate cushioning.
4. Use appropriate walking aids (e.g. cane, walker, etc.).
5. Use sufficient light in every room (especially in the bedroom, toilet/bathroom, terrace, kitchen and stairs/steps area).
6. Use of "bed-rails for seniors" (protecting the edge of the sleeping mattress). This tool can prevent falls when being/waking up from a sleeping position.
7. Handrails in areas frequently passed/used by elderly people who are at risk of falling (for example: stairs, toilets, etc.).
8. Make sure the stairs are not steep, not slippery and have a strong handrail.
9. Consult a doctor about all medications you regularly take. This is to evaluate the effects of certain drugs which can directly/indirectly increase the risk of falls in the elderly.
What should be done if an elderly person falls?
- Reflexes protect the elderly's head area when they fall on their back/stomach. If an elderly person falls in a sitting position, try not to support the body with the palms of both hands, to prevent wrist fractures (Colles Fracture).
- Immediately ask for help. Elderly people who have just fallen should not be forced to stand up immediately. If you feel capable, maintain a sitting position first.
- Feel the part that hurts first to determine whether there is/isn't an injury and convey it to the person helping.
- Immediately check with the nearest doctor/health service (example: hospital emergency room).
Efforts to prevent and handle falls appropriately in the elderly are very important, in fact falls can be considered as a predictor of decreased quality of life and death in the elderly.
