9.3. Falls and Fractures

 
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In the elderly, falls and bone fractures are a serious problem. Falls occur most often when performing basic everyday activities, e.g. getting up, sitting down, bending down or walking. In the case of an elderly person, even a minor fall can have a lot of negative consequences including fractures, the treatment of which in the elderly is often long and limited by many factors.

 
The causes of falls in this age group can be divided into two main groups – internal falls and external falls.
 

Internal falls

Internal falls are associated with the so-called involutive (senile) changes, that is, atrophic processes, caused by aging of all systems of the body. These include slowing down the reaction of the nervous system to the effects of stimuli, weakening of muscle strength, balance disorders, circulatory disorders, deterioration of vision and hearing or coordination of the movements. In addition, the functioning of the aging organism is affected by accompanying diseases, i.e. cardiovascular, neurological (Parkinson’s, post-stroke), metabolic (diabetes, osteoporosis) or the diseases of limbs (degenerative changes, deformations after previous injuries).

The elderly also often face mental illnesses such as dementia, depression and anxiety. Taking medications has an effect as well – among the side effects there are often dizziness, concentration issues or decreased blood pressure, which in many cases has a bad influence on the overall well-being. All these factors can greatly impair the way the senior moves, increasing the risk of them falling down.
 

External falls

The causes of external falls include all types of the environmental factors that make it difficult for the elderly to move, e.g. slippery ground, moving rugs, stairs, too high thresholds, lack of handles in the house or in the means of transportation, inadequate lighting or bad weather conditions (snow, ice on the pavements).
 

Consequences of falls

Among the most common effects of falls in the elderly are hematomas, bruises, muscle stretches, bone fractures and skull injuries (concussions, intracranial haemorrhages), which may manifest the consequences only a certain amount of time after the accident itself.

It is also worth mentioning the so-called post-fall syndrome, resulting from the fear of another fall, and the limitation of daily motor activity, in order to minimize the likelihood of it happening again. It significantly impairs the functioning of the respiratory, circulatory, organ and mental state of the elderly, which are already limited by senile changes, and directly leads to the deterioration of the quality of life.

The most common types of fractures resulting from falling down are those in the thighbone, humerus and further parts of the forearm, just above the wrist. Fractures within the vertebrae and ribs tend to happen less often.

The most dangerous for the elderly are those within the lower extremities (even the least complicated ones), as they can cause many complications. This is mainly due to the necessary immobilization, which can lead to very serious side effects, e.g. pneumonia, peripheral circulatory disorders, deep vein thrombosis, pressure disorders, urinary tract infections, intestinal disorders (constipation), worsening of osteoporosis, muscular atrophy, etc.

The duration of the immobilization depends primarily on the treatment used. The longer it lasts, the more side effects it can cause. The condition of an elderly person does not always allow performing a surgery, which significantly increases the time the person is required to remain in the lying position and, in the worst case, can lead to death.
 

How to protect an elderly person from fractures?
Prevention

Preventing the elderly person from falling – for this purpose, it is worth looking at the immediate surroundings where the person is staying, for example, their apartment. The installation of handrails or bathroom handles, supports or anti-slip mats will definitely facilitate the functioning of the elderly person.
 

Suitable footwear

The footwear which the elderly person uses to walk should be light, equipped with anti-slip soles and adapted to possible deformations in the foot. It must also ensure proper stabilization of the ankle.
 

Equipment

In certain cases, it is necessary to choose suitable supporting equipment that will make it easier for the elderly person to move around: a cane, crutches, and a walking frame.
 

Preventative treatment

If the person has noticed deterioration in the overall health, it is worth consulting a doctor who will prepare a suitable treatment or modify the doses of the medication already taken.
 

Physioprophylaxis

A systematic work on the physical fitness of the elderly person helps in everyday, independent functioning and minimizes the risk of falling. A set of appropriate exercises should be developed by a physiotherapist. The exercise programme should include exercises aimed at adequate joint mobility and the flexibility of the surrounding tissues, muscle strength, balance, coordination and the overall performance.
 



How to proceed in the case of a fracture of a lower or an upper limb in an elderly person?

   Do not adjust or move the limb abruptly so as not to aggravate the injury
 
   Immobilize the limb in the two joints around the fracture – e.g. if the tibia is suspected to be broken, the leg needs to be immobilized from the ankle to the knee
 
   Do not give the person anything to eat or drink
 
   Cover the person with a blanket or a jacket
 
   Call an ambulance immediately


 
 
 
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