Geriatric Fall Patterns

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November 13, 2012
Edward Smith

Falls cause the most injuries and visits to the emergency room with trauma than any other type of injury. It is the leading cause of accidental death in patients over the age of sixty five years. Mortality increases with age. Falls account for 70 percent of all accidental deaths in those patients 75 years or older. Falls are usually associated with a great deal of morbidity in the elderly. Ninety percent of hip fractures occur secondary to falls; most patients are over 70 years.

Experts believe that elderly people who fall need a thorough evaluation. There can be hidden fractures and underlying organic disease such as dementia that are the ultimate cause of the disease.

About 147 million injuries were seen in the ER from 1992-1995 in the US. Falls were the most common injury noted, which accounted for 24 percent of injuries. This was especially true in children and adults greater than 65 years of age. Elderly fall patients were 10 times more likely to end up hospitalized than children and 8 times more likely to die from their fall. Trauma is the fifth leading cause of death among people greater than 65 years of age. The elderly account for 75 percent of deaths due to falls. About 1,800 falls cause death in the US each year. And about 9,500 deaths in the elderly are associated with falls within a year of the fall each ear.

Those elderly people who actually survive their fall have a great deal of morbidity. Hospital stays are twice as long as hospital stays in the elderly with different reasons. There is a greater functional decline after a fall when compared to having other illnesses. They are at a much greater risk of being in a nursing home indefinitely.

Falls can be markers of poor health and declining cognitive and physical functioning. A fall can indicate that the person has pneumonia, a bladder infection or a heart attack. It could mean the person has Alzheimer’s dementia. The fall itself can cause fractures of the wrist, head trauma, soft tissue injuries and hip fractures. In fact 5-15 percent of falls cause fractures of some kind. One to two percent result in hip fractures.

One fourth of the elderly who sustain a hip fracture are dead within 6 months of their fall. A total of 50 percent of people who survive their hip fracture end up in a nursing home. Half of those patients are still in the nursing home after one year. If they survive their hip fracture, the elderly are 10-15 times more likely to die early than their counterparts who didn’t have a fall.

In one study, the researchers decided to look at the mechanism of injury and the injury types seen in geriatric falls in order to identify risk factors associated with death from the falls. The trauma centers that were level one were asked to give information of all trauma patients over the age of 65 years of age who had an injury score of greater than 15 from 2004-2006. About 276 patients were looked at. The average age was 81.5 years. Over half had high blood pressure and falls caused their injuries 72 percent of the time. Those geriatric patients suffered from head trauma, C spine injury, received blood transfusions, needed intubation or had chest trauma were more likely to die from their trauma. They decided that more research was recommended to further flush out risk factors to falling.