Spice Route India Newsletter
Aging is an irreversible normal physiological phenomenon that takes place at a molecular level, reflecting not only physically but functionally and psychosocially as well. Falls are one of the major problems in the elderly and are considered one of the “Geriatric Giants”. Recurrent falls are an important cause of morbidity and mortality in the elderly and are a marker of poor physical and cognitive status. Evaluation of the morbidity profile among elderly people, and the impact of chronic conditions on functional disability and psychological well-being are an essential part of comprehensive assessment of the elderly. It has implications for providing health care for the elderly population and its costs. Hence this article aims to describe the burden of falls among the elderly, the risk factors associated with it as well as certain measures the health care professionals can take to prevent it in elderly communities by reviewing the existing literature.
India is the second most populated country in the world, with over 1.21 billion people, and according to the population census in India 2011, the percentage of older adults above the age of 60 is 8.6% of the total population and this population is likely to increase to 198 million in 2030(1).Falls are common in the geriatric population, and they have devastating consequences. They are one of the leading causes of injury and death by injury in adults over the age of 65 years. Fall rates are higher among women. According to the World Health Organization (WHO) global report on falls prevention, among people aged 65 years and above, about 28%–35% fall each year and this proportion increases as age and frailty level increase.(2) The prevalence of falls in India among the elderly above the age of 60 years was reported to be 42.2%, in a community based cross sectional study conducted in urban area of Kolar Taluk, Karnataka, published in 2016(3).
Aging results in joint stiffness, decreased muscle strength, and impaired neurologic feedback. Majority of the people fall in the morning, and most occur indoors especially in bathrooms as reported by a study. The presence of slippery flooring inappropriate tiling, inadequate lighting, absence of grab bar were found to be the possible risk factors in the bathroom. (4,5) The common risk factors associated with falls were found to be aging (more than 80yrs), gender (female), visual impairment, previous history of fall, musculoskeletal problems, neurological illness, syncope, vestibular causes, hypertension, postural hypotension, depression, gait problems, and dementia(6,7).The sedentary group fell more frequently than the exercising group due to lack of stability(8). Impaired strength is a strong predictor of falls in most studies. A growing body of evidence indicates that the elderly respond to exercise training and that this response continues at very old ages and extremes of fragility(8). So people who exercise will have a lower incidence of falls. Drug induced falls were commonly associated with sedatives and hypnotics. The study conducted by Sirohi et al., reported that among 456 elderly, the prevalence of falls in a rural area of Haryana was 36.6% (32.1–40 at 95% CI)(9) where as a community prevalence study conducted by Yeong et al. in Malaysia showed the prevalence of fall among the elderly was 4.07%, this study found out that elderly who lived alone had more than two-fold increase in the risk for falls (OR = 2.60,P = 0.042) (10)
A systematic assessment of individual risk is desirable and a pro-active, multi-factorial approach to injury prevention is essential. In community-dwelling adults, use of multifactorial assessments and interventions has led to a decrease in fall rates by 25% to 40%.(12)
Depending on the results of this risk assessment, appropriate multifactorial interventions for preventing ambulatory falls may include any or all of the following :
1. Exercise/physical therapy programs aimed at improving balance, gait, and strength
2. Withdrawing or minimizing psycho-active medications
3. Management of orthostatic hypotension
4. Management of foot problems
5. Changes in footwear
6. Modification of home environment
7. Patient and caregiver education
8. Vitamin D supplementation in patients with vitamin D deficiency or high risk of fall
9. Expedited cataract surgery (selected patients
10. Dual chamber cardiac pacing (selected patients).
Actions to be taken for patients at high risk for falls:
1. Ask about history of falls and patient’s assessment of their functional ability.
2. Review medications and medical history.
3. Perform gait assessment; Physical examination (especially neurologic, cardiac); Assessment of orthostatic vital signs; Visual acuity examination; Cognitive evaluation; Examination of feet and footwear; Home safety evaluation.
4. To reduce the risk of fall-related fractures, patients should be screened for osteoporosis at the appropriate age and the relevant medications should be prescribed if necessary.
1. Ministry of Social Justice and Empowerment, Government of India. National Policy for Senior Citizens; March 2011. Available from: http://www.socialjustice.nic.in/writereaddata/UploadFile/dnpsc.pdf. [Last accessed on 2016 Jul 05].
2. World Health Oraganization.WHO Global Report on Falls Prevention in Old age . Available from: http://www.who.int/ageing/publications/Falls_prevention7March.pdf. [Last accessed on 2016 Jun 15]
3. Mahesh Venkatesha, Latha K et al Prevalence And Risk For Fall Among Elderly In Urban Area Of Southern Karnataka, National Journal of Community Medicine.
4. Dsouza SA, Rajashekar B,Dsouza HS, Kumar KB. Falls in Indian older adults: A barrier to active ageing. Asian J Gerontol Geriatr 2014; 9:33-40.
5. Pitchai P, Dedhia HB, Bhandari N, Krishnan D, D'Souza NR, Bellara JM. Prevalence, risk factors, circumstances for falls and level of functional independence among geriatric population - A descriptive study. Indian J Public Health [serial online] 2019 [cited 2021 Aug 31];63:21-6. Available from: https://www.ijph.in/text.asp?2019/63/1/21/253889.
6. Joseph A, Kumar D, Bagavandas M. A review of epidemiology of fall among elderly in India. Indian J Community Med [serial online] 2019 [cited 2021 Aug 31];44:166-8. Available from: https://www.ijcm.org.in/text.asp?2019/44/2/166/261507.
7. de Rezende LF, Rey-López JP, Matsudo VK, do Carmo Luiz O. Sedentary behavior and health outcomes among older adults: a systematic review. BMC Public Health. 2014 Apr 9;14:333. doi: 10.1186/1471-2458-14-333. PMID: 24712381; PMCID: PMC4021060.
8. European Review of Aging and Physical Activity: https://eurapa.biomedcentral.com/
9. Sirohi A, Kaur R, Goswami AK, Mani K, Nongkynrih B, Gupta SK. A study of falls among elderly persons in a rural area of Haryana. Indian J Public Health. 2017;61:99–104. [PubMed]
10.Yeong UY, Tan SY, Yap JF, Choo WY. Prevalence of falls among community-dwelling elderly and its associated factors: A cross-sectional study in Perak, Malaysia. Malays Fam Physician. 2016;11:7–14. [PMC free article]]
11. Tinetti ME, Kumar C. The patient who falls: “It’s always a trade-off. JAMA. 2010 Jan 20;303(3):258-666. DOI: http://dx.doi.org/10.1001/jama.2009.2024. [PMC free article] [PubMed]
12. The Permanente Journal 2013 Fall; 17(4): 37–39. doi: 10.7812/TPP/12-119 PMCID: PMC3854807,PMID: 2436101912.
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