Fall Related Injuries
Falls are common causes of accidental injuries in the elderly. Most fall injuries are minor, involving cuts and bruises of soft tissues only. However, studies show that about 10% of all falls in seniors resulted in serious injuries, including brain damage and hip fractures. In addition, falls were the leading cause of brain injury-related deaths in adults aged 65 or older.
Common fall injuries are:
- Cuts and contusion of soft tissues which usually do not require hospitalization
- Fractures or dislocation of shoulders, forearms and wrists
- Fractures of hips, femur, pelvis
- Sprained or fractures of ankles
- Spinal injuries
- Head injuries including skull fractures and traumatic brain injuries (TBI)
Elderly people are prone to fall because of their frailty. As a result of falls, they may lose consciousness temporary or for a long time. Even if they remain conscious, because of the shock from falling and their frail physical state, many of them cannot get up again without help. Remaining on the floor for long period increases risk of complications such as dehydration and hypothermia, or excessive bloods loss if there was a cut.
The type of injury and fracture sustained is usually related to the force and direction of the fall. For example, falling sideways is more likely to lead to hip fracture, whereas wrist fractures are more strongly associated with forward or backwards falls with an outstretched arm. Of course, a person may sustain multiple fractures too.
Most elderly would have some degrees of osteoporosis which weakens bones and increases the risk of fractures. Women after menopause are prone to rapid loss of bone mass. This might explain why older women are susceptible to fractures, and most inpatients with hip fractures are women.
Subject to regional variation, it is estimated that about 2% of falls resulted in hip fractures which required hospitalization and treatment. Of those admissions, only about 25% will make a full recovery.
Although they were ambulatory and active before fracturing a hip, most elderly do not regain the same level of mobility and independence, and 40% of them have to be taken care of in nursing homes after hospital discharge.
About 5% of elderly people with hip fracture die during their stay in hospitals. Overall mortality in the 12 months after the injuries ranges from 18 to 33%.
Head injuries resulting from falls are very common causes of hospitalization and death among older people. Trauma to the head can cause several types of injuries, including traumatic brain injury (TBI) which accounts for about 70% of fatality for those above 65 years.
- Skull fracture – a crack in one or more places of the skull. It usually causes bruising or contusion of the brain under the fracture. A depressed skull fracture is more severe when shattered bone fragments press inward onto the surface of the brain.
- Epidural hematoma – a collection of blood in the space between the skull and the dura (the outer most membrane that covers the brain) due to a torn blood vessel in the skull. Since the skull is a closed space, an expanding hematoma pressing on the brain can cause serious brain damage or death.
- Subdural hematoma – a collection of blood between the dura and the surface of the brain when a blood vessel is torn following a serious head injury. Acute subdural hematoma develops rapidly, especially among elderly who are on blood-thinning medicines such as aspirin. The patient is usually unconsciousness, and fatality is about 50%.
Chronic subdural hematoma is found in some cases when blood accumulates gradually from several episodes of small bleeds over times. This typically follows a fairly minor head injury in an elderly person who is taking anticoagulants or whose brain has shrunk as a result of alcoholism or dementia. Over a period of one to six weeks, the patient might develop symptoms such as drowsiness, inattentiveness, confusion, headaches, personality change, seizures and mild paralysis.
- Intraparenchymal haemorrhage and contusion – Intraparenchymal haemorrhage is pooling of blood within the brain tissue. A contusion is a bruise or swelling of an area of the brain but there is no collection of blood. For both types of injury, there is potential danger associated with increasing pressure inside the skull.
- Concussion – It is a temporary injury to the brain caused by a bump, blow or jolt to the head. There may not be visible injuries but patients may have symptoms such as impaired memory, temporary loss of consciousness, nausea, dizziness, coordination problems, headache, confusion, ringing in the ears, sleepiness or seizures.
Signs of concussion usually appear within a few minutes or hours of trauma. However, occasionally they may not be obvious for a few days. Therefore, it is prudent to look out for the typical signs in the days following a head injury and consult a doctor where necessary. The problems may last for a few days or weeks.
Seniors who have survived moderate or severe head injuries often become disabled or require extended hospital care. They are likely to suffer recurrent falls and further TBI. Other complications include long term cognitive changes and loss of independent living skills.
The outcome of fall
Falls do cause death or disability directly. But most falls are minor and do not end in serious injury or mortality.
However, the long term psychological impact could be problematic because many elderly subsequently develop a fear of falling. The lack of confidence leads to reduced mobility, and some people may even avoid everyday activities such as cooking, cleaning, shopping or any outdoor activities.
This inactivity causes deterioration of physical and mental health, and actually increases the risk of further falls, hospitalization, and death.