A fall is any slip, trip or fall where you lose your balance and land on the ground, floor or lower level[i]. So it can include a fall downstairs, a fall going up the stairs, a fall to the floor from sitting or lying, sliding out of bed, falling off a kerb or over uneven surface.
Why do we care about Falls?
We all have falls, some of us more than others. My last fall was off my bike a few weeks ago outside Toughers in Naas when I somehow forgot to unclip out of my pedals, luckily only my pride was bruised. In the main there are two types of fallers – those who are relatively young and active who take risks and those who are more vulnerable due to being older or having a condition which makes them more likely to fall. This second group are more cautious, they may be frightened of falling and can even get into a vicious circle of reducing their activity to prevent a fall, which in turns reduces their movement, strength and balance making it more likely for them to have a fall. For example women who spend less than 4 hours a day on their feet (i.e. reduced activity) are twice as likely to fracture their hip compared to those who spend more[ii]. Falls can have significant consequences and for this reason we are concerned with doing all we can to prevent them.
How Common are Falls?
We have some information from health services about the incidence of falls, however these are just the falls that are actually reported, falls that don’t actually cause an injury at that time (between 75-80% of falls) are never reported so the full incidence of falls and their medical, physical and psychological effects will never be fully known.
From reported falls, what is known is that 1 in 3 women over 65 will fall each year. For men the no.s are 1 in 5. As we get older it gets worse with 1 in 2 men and women in the over 85’s falling each year[iii].
A study in 2000 (Bandolier) showed that in the UK there is a wrist fracture every 9 minutes and a hip fracture every 10 minutes. It is likely that this even higher now as there are higher no.s in older age brackets. In Ireland today around 11% of the population are aged 65 years or over and this is expected to increase to 18% by 2031[iv]. The prevalence of falls here has increased from 19.6% in 2011 to 22.2% in 2013[v]. The annual cost of falls in Ireland is estimated at €400 million[vi] The falls problem has been identified and many initiatives are in place around the world to tackle it and we can see that it is a growing problem in Ireland also.
We often think that we are safe in our homes and that we need only be concerned about falling outside. This is not the case; 40% of falls in over 65’s occur in the home, and in the over 85’s it goes up to 85% (DTI, 1997). In the 65 to 74 age bracket the kitchen is the most likely place for a fall in the home, whereas in the over 75’s the most common place for falls in the home is the bedroom. Men are more likely than women to have a fall outdoors, women are more likely to have a fear of falling which means they are probably less likely to venture into the ‘less safe’ areas outdoors[vii].
Wrist fracture is the most common fracture in falls in the younger old but later on as we maybe lose strength and speed of response we can’t get our hands out quickly enough and our hips take the brunt of the impact. Wrist fractures have better outcomes, unfortunately hip fractures result in only 20% regaining the mobility they had before the fall (Lord,1992), and 6 months after hip fracture surgery 50% of patients will have died, or entered a nursing home or are back in hospital.
We expect that falls will become more common as our population ages however we wouldn’t necessarily expect that fall related injuries would increase at an even greater rate but this seems to be the case[viii] . This suggests that although we may be living longer our skills in strength and balance are not lasting correspondingly longer so we may be living longer but if we are having injurious falls our quality of life is reduced.
[i] Lamb, S.E. et al., 2005. Development of a Common Outcome Data Set for Fall Injury Prevention Trials: The Prevention of Falls Network Europe Consensus. Journal of the American Geriatrics Society, 53(9), pp.1618–1622. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2005.53455.x/abstract [Accessed November 29, 2014].
[ii] Cummings, S.R. et al., 1995. Risk Factors for Hip Fracture in White Women. New England Journal of Medicine, 332(12), pp.767–774. Available at: http://dx.doi.org/10.1056/NEJM199503233321202 [Accessed April 28, 2015].
[iii] O’Loughlin, J. L., Robitaille, Y., Boivin, J. F. & Suissa, S. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am. J. Epidemiol. 137, 342–354 (1993).
[iv] Department of Health, (2013). Health in Ireland, Key Trends 2013. Available from http://health.gov.ie/wp-content/uploads/2014/03/key_trends_2013.pdf. [Accessed 29/11/14]
[v] The Irish Longitudinal Study on Ageing TILDA, Trinity College Dublin, University College Cork, (2014), http://tilda.tcd.ie/assets/pdf/Wave2-Key-Findings-Report.pdf
[vi]National Steering Group on the Prevention of Falls in Older People and the Prevention and Management of
Osteoporosis throughout Life, (2008), http://www.hse.ie/eng/services/publications/olderpeople/Strategy_to_Prevent_Falls_and_Fractures_in_Ireland%E2%80%99s_Ageing_Population_-_Full_report.pdf
[vii] Fleming, J. & Brayne, C. Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90. BMJ 337, (2008).
[viii] Kannus, P., Niemi, S., PArkkari, J., Palvanen,M., Vuori,i., Jarvinen,M., (1990), Hip Fractures in Finland, Lancet
[ix] alexander, B.H.F.P. Rivera, and M.E. Wolf, The cost and frequency of hospitalization for fall-related injuries in older adults. Am J Public Health, 1992. 82 (7): p. 1020-3.
[x] Bloch, F., Blandin, M., Ranerison, R., Claessens, Y.E., Rigaud, A.S., Kemoun, G., 2013. Anxiety after a fall in elderly subjects and subsequent risk of developing post traumatic stress disorder at two months. A pilot study. J. Nutr. Health Aging 18, 303–306. doi:10.1007/s12603-013-0415-y
[xi] Fleming, J. & Brayne, C. Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90. BMJ 337, (2008).