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Why do Falls Happen? (13/5/15 – Drugs and Alcohol)
Falls happen for several reasons. Some of these are to do with our own body such as poor balance and some causes are outside ourselves such as slippery surfaces. Some of these causes are within our control and we can do something about them. These are the ones I’m going to concentrate on here.
It is useful to look at both causes for falls and risk factors. So what is the difference? Causes are factors mostly responsible for the fall, whereas risk factors don’t cause a fall but make one more likely to happen. Some of both causes and risk factors are controllable by us so I’ll discuss both – but first the CAUSES…..
Most causes can be categorised using the acronym DAME. D = Drugs and alcohol. A= age related physiological changes. M=Medical. E= Environment
Drugs and Alcohol: many prescribed drugs can contribute to poor postural stability and higher risk of falling especially sleeping tablets, antidepressants, antipsychotics, topical eye medications, diuretics (water tablets), vasodilators – for conditions like high blood pressure. If you are on 4 or more medications of any type you are at higher risk of a fall (NICE 2004). If you are on medications it’s a good idea to keep a list of them with details of what they are for, when prescribed etc. you can download a form here that you can use. Keep this list handy and bring it with you on any visit to any health practitioner. It’s also a good idea to have your medications reviewed regularly – so mention this to your GP. Let your exercise instructor know of any changes in your medications.
Heavy drinkers are more likely to fall for obvious reasons. In addition to the immediate effects of alcohol on balance there can be long term effects. The cerebellum of the brain can be damaged resulting in muscle coordination problems. http://m.livescience.com/16091-alcoholics-long-term-balance-problems.html
There are many different definitions of what constitutes “a heavy drinker” but all the definitions are scarily low levels of drinking by most people’s standards, e.g more than 4 drinks in one day, occurring more than 5 times in last month. So many of us might unknown to ourselves be “heavy” drinkers” and should really try to moderate for all kinds of reasons.
The recommended weekly alcohol limits for both men and women have been cut by Irish experts.
It is now recommended that men should not drink more than 17 alcohol units over a week. Previously, the limit had been set at 21 units.
Women should not consume more than 11 units of alcohol over a week. The limit was previously 14.
A unit of alcohol is a “rough measure of the drink amount that will provide about 10g of alcohol.
For instance, a half pint of beer, a pub measure of spirits and a small glass of wine,” according to guidelines contained in new document from the Food Safety Authority of Ireland (FSAI).
For those of us who like a glass of wine it’s worth noting that a bottle contains approx 10 units, so if you’re not getting 10 servings out of your bottle – your glass is too big and you’re consuming more units than you think. Use small wine glasses, and always check the alcohol % of your wine. I think 10-12% is high enough for white wine and no higher than 13% for red. The wine is a better wine if it’s not relying on high alcohol and sugars for taste. If you find any really good but low alcohol wines let me know.
Consequences of Falls
Falls do not just cause possible pain and injury which the faller has to suffer and recover from they also have social, psychological and financial effects for the faller, their family and carers and costs to the health service.
Falls can cause cuts, bruises, soft tissue injuries, sprains, dislocations, fractures, increase in pain in existing joint conditions and in the worst cases serious head injuries. 20% of injurious falls result in fractures[ix].
Falls and instability contribute to 40% of nursing homes admissions. Most people want to maintain their independence and continue living in their own home, a fall can have an impact on this as family and friends strive to ensure their loved ones safety and are afraid of the consequences of a fall. This is especially true for older adults living alone.
A fall can result in post fall syndrome or fear of falling where the person has a lot of anxiety associated with falling. They will limit their activities often to the point where their body becomes so deconditioned that they lose function and can no longer walk or carry out their daily activities of living. Reduction in activities can result in social isolation, they may no longer be going out to meet people, and this in turn is associated with decline in mental ability (cognitive impairment). Lack of activity and social contact will affect mood and can result in depression. It is thought that the fear of falling can even be post traumatic stress disorder[x] Fear of falling can be directly responsible for causing an actual fall as fear causes the person to change their behaviour and their gait. ‘Fear’ of falling may be too strong a word, even if the person is aware of THINKING about their moving and walking before they do it, it indicates some level of anxiety.
Even a fall that has caused no injury at all can have serious consequences. In fact a seemingly minor fall can be fatal if the person is unable to get up from the floor or summon help. This can result in what we call a ‘long lie’ – where the faller is on the floor for over 1 hour. We know that a lie of more than one hour is associated with an increased risk of dehydration, hypothermia, pneumonia, depression, kidney failure and pressure sores (Tinetti, 1993 and 1994).
Lying on the floor for a long time after falling is more common among the “oldest old”, one study[xi] shows that in the over 90’s 80% of fallers were unable to get up after a fall and had a ‘long lie’.
Who gets an injurious fall?
Risk Factors for Falls