As the years go by, physical, sensory and cognitive disorders appear and with them, the risk of falls. The WHO predicts that by 2030, one in six people in the world will be aged 60 or older. By 2050, the world’s population in this age group will have doubled to 2.1 billion. Given these numbers, it is imperative to know why falls occur in older adults, how they can be prevented, and what the consequences are. With this objective in mind, Fundación MAPFRE has updated its research study FALL-ER: a multi-center registry of people over 65 years of age treated for a fall by the Spanish emergency services.
TEXT: SARA GARBAJOSA BARROSO
Carmen, 84, stumbled and fell on her way to the kitchen. Fortunately, her granddaughter, who was with her, was able to help her up and call the emergency services. X-ray tests showed that Carmen had broken her hip and needed emergency surgery. The same thing happened to 87-year-old Antonio. He also had to undergo surgery for a hip fracture after stepping badly down the stairs at his home in Madrid. The after-effects mean that he can no longer live alone. He has lost his independence and has now been placed in a nursing home where he receives all the help he needs on a day-to-day basis. Worldwide, there are 37.3 million falls each year that are serious enough to warrant medical attention. People over the age of 60 suffer the majority of these incidents, which are often fatal: according to the World Health Organization (WHO), more than 680,000 people die each year as the result of a fall.
The truth is that we currently see it as inevitable that older people will suffer falls. This totally erroneous conception should be eliminated, especially considering that, in many cases, falls are avoidable. Antonio insisted on using the stairs when there was an elevator. Likewise, Carmen tripped over an object on the floor that was not supposed to be there, a badly positioned wire.
It is important to bear in mind that people are living longer. Life expectancy is increasing year after year. According to the latest data provided by the Spanish National Institute of Statistics, life expectancy in Spain is currently 83.58 years, one of the highest in Europe. But this trend is not only true for Spain; the WHO predicts that by 2030 one in six people in the world will be 60 years of age or older. In other words, this population group will have increased from 1 billion in 2020 to 1.4 billion. By 2050, the world’s population in this age group will have doubled to 2.1 billion. The number of people aged 80 and over is expected to triple between 2020 and 2050, to 426 million. Faced with this situation, the United Nations General Assembly has declared the period 2021-2030 as the Decade for Healthy Aging with the aim of improving the lives of older people, their families and their communities. The challenge for countries is to put effective measures in place to help meet this challenge.
In the United States of America, between 20% and 30% of older adults who fall suffer moderate to severe injuries, such as contusions, hip fractures and head trauma. Given this information, it is imperative to know why these falls occur, how they can be avoided, and what the consequences are. With this objective in mind, Fundación MAPFRE has updated its research study FALL-ER: a multi-center registry of people over 65 years of age treated for a fall by the Spanish emergency services. The study involved an analysis of 1,610 patients aged 65 and over in five emergency departments in Spanish hospitals.
Sensitizing the environment so that this does not occur
Falls are involuntary events that cause a person to lose their balance. That is what happened to Carmen and Antonio. They can be caused by dizziness, stumbling, slips, distractions… causes, as we have indicated, which are often avoidable.
As the years go by, physical, sensory and cognitive disorders appear and it is our failure to adapt the environment to the needs of the aging population that is one of the main problems. To this we should add the side effects of certain medications, physical inactivity and a loss of balance. In fact, 58% of falls in the over-60s are due to extrinsic factors and are therefore preventable.
The goal is to minimize the risk of falling without compromising the mobility and functional independence of older adults and to avoid the severity of all the possible consequences, be they physical, functional, psychological or social.
Nine out of ten people over the age of 65 who have a fall suffer some type of injury and require medical attention
To achieve this, it is necessary to raise awareness among seniors and their families of the high risk of a fall and how this can drastically impact their current way of life, deteriorating their physical and emotional health. And one of the most important points: it could happen again. “I never thought it could happen to me, although admittedly I have taken special care to make sure it didn’t. Even so, it never occurred to me that I could trip over a wire. Fortunately my granddaughter was there to help. I have to acknowledge that one of my greatest fears is falling again”, admits Carmen. It was the first time she had fallen. However, the Fundación MAPFRE study reveals that one in four patients had already suffered a fall in the previous 12 months, or had an emergency hospital admission related to a fall. Half of the patients confirmed that they were afraid of having another such incident.
Food for thought
Falls in people aged 65 and over are a common reason for visits to the Spanish public emergency services (6 patients are treated for falls with injuries every day). Having suffered such an incident previously is a risk factor for new falls.
It is worth noting that 8 out of 10 falls occur during the day and are witnessed by another person. This is what happened to Carmen, and her granddaughter’s help was the key to calling the emergency services. In fact, in most cases (68%), the person who falls cannot get up alone: only 15.5% do so.
Although a fall can have multiple causes, it has been shown that extrinsic or external factors are the most frequent, these being the reason for 58% of cases. These factors include, inside the home, the state of the floors and the unsuitable use of carpets or bathtubs. Outside, tripping over curbs, wet floors, holes and potholes are the most frequent culprits. Cardiovascular and neurological disorders are among the most frequent intrinsic patientrelated factors.
It is remarkable that almost all falls produce some type of injury requiring urgent medical attention and that in 4 out of 10 cases there is a fracture and a serious intracranial injury (in 2.5 %). Indeed, 12% of patients require surgery.
Falls have physical and psychological repercussions, but also functional ones: 15% of the people who were completely independent become partially dependent and 2% become totally dependent. In addition, 19% require some kind of walking assistance.
The study also examines the consumption of extraand intra-hospital resources, as well as the quality of emergency care. It shows that one in three people need medical assistance at the site of the fall and 46% require an ambulance to get to hospital. Once there, the most frequently performed test is an x-ray, in 85.1% of cases. 23.5% of the patients treated in the emergency department require admission to the hospital.
Finally, it should be noted that, in this study, 11% died six months after the fall and another 11% re-injured themselves.
To prevent future falls, it is important to look deeper into the possible etiological medical causes, as well as to eliminate extrinsic risks both in the home and on public thoroughfares. Carmen tripped over a wire that was not supposed to be there; this caused a broken hip and the consequent operation. It was later discovered that Antonio was developing Alzheimer’s and this was probably one of the reasons he had lost the strength he needed to walk down the stairs properly.
The key is to raise awareness of the risks of falls and their consequences. We must be aware in order to prevent. We should adopt the necessary measures so that falls are no longer seen as frequently as they are in hospital emergency rooms.