Falls in the elderly: simple steps can shape effective strategies for reducing risk

Posted: 09/04/2019

Around one in three people over the age of 65 will have a fall once per year, and half of those will have more than one fall. Why do we worry about falls in the elderly? Of course, anyone can fall and hurt themselves, but in older people there are increased risks of a fall in the first place, and potentially increased harm. Injuries can have devastating long-term consequences as well as short-term. Fortunately, many falls (probably 50%) are potentially avoidable and this is why there are significant efforts in hospitals and care homes to put in place safeguards to prevent falls.

Elderly people are more likely to be at risk of falling and among contributing factors may be poor eyesight, weaker muscles, poor balance, dementia, or arthritis. They may be taking multiple medications, some of which (or the combination of which) may impact on their balance, blood pressure or cognitive function. Each of these can affect a person’s ability to walk, balance, correct a minor trip, or to appreciate the risk of mobilising without support. We know that if a person has sustained one fall, this dramatically increases their chances of sustaining another.

If they do fall, older people are then at greater risk of sustaining serious harm. Osteoporosis in older people, particularly women, means that the bones are weaker and more prone to fracture. There are other serious potential complications if a person is on anticoagulant medication, which means that they can develop serious bleeding from a relatively minor fall. Following the injury itself, many will require surgery under general anaesthetic, and this itself can have a detrimental effect. Post operative delirium is a very common feature, with estimates of around 20% of patients suffering from a degree of delirium. This may mean a prolonged hospital stay, and a lack of cooperation with rehabilitation, which can therefore result in a poorer long-term outcome. In cases where the underlying causes of delirium do not resolve, there may be no resolution to the delirium, and this will often interact with underlying cognitive impairment from dementia or other degenerative diseases. The result of that in some cases may be a patient who requires a long-term supported environment rather than returning home.

Some relatively straightforward steps can reduce the likelihood of falls occurring. Simply removing trip hazards in the home will reduce risk. Ensuring that a person who has fallen once is reviewed at their GP will allow them to be referred to a falls clinic to have their longer-term risk assessed and safeguards put in place. On admission to a hospital or care environment, patients should routinely undergo a multifactorial risk assessment to gauge their overall risk of falling. Then, depending on the level of risk, measures may be put in place, such as non slip footwear, bed rails, call bells, falls mats, bed/chair alarms, and in many cases simply having adequate staff to tend to patients. In general, it is a straightforward task to assess a patient’s risk, and for the reasons above there is little excuse for not carrying out this assessment within the first 24 hours.

Lucie Prothero, senior associate in Penningtons Manches’ clinical negligence team, said: “We know that elderly people are at particular risk of falling, and of sustaining serious harm. Entering into an unfamiliar environment further increases that risk. Sadly, we still see hospital trusts and care homes failing to assess patients and to implement really basic safeguards which can prevent falls or mitigate the harm caused. There is rarely any excuse for allowing an older person to fall and sustain serious harm in a care environment and yet we still see large numbers of cases each year. These falls really can have a substantial impact on individuals and their families.”

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