Falls can cause major lacerations, fractures,
head trauma, and other injuries

About 35 percent of people over age 65 fall in their homes at least once each year.

That figure increases to 50 percent for those ages 75 and over. We have less information on falls among people over age 85, who are mostly women and now make up the fastest-growing segment of the elderly population.

But one study of women and men ages 91 to 105 found that about 60 percent had at least one fall in the course of a year.

Most of the resulting injuries are minor, but falls can also cause major lacerations, fractures, head trauma, and other injuries that may lead to hospitalization, disability, nursing home care, and premature death.

Falls also have psychological consequences.

Fear of falling and an associated general loss of confidence can result in depression, isolation, and a decline in physical function by lack of activity.

Not surprisingly, there has been considerable research on how to prevent falls in older people. Recommended preventive strategies include strength training and balance work, vision checks, medication review, and home modifications. But there's no way to prevent all falls, so it's important to limit their complications.

A major source of complications is lying on the floor for a long time afterward, a risk that increases with age and declining muscle function. For older people in particular, it can result in pneumonia, pressure sores, dehydration, hypothermia, and even death.

A new study shows that lying on the floor for a long time after falling is more common among the "oldest old" -- those ages 85 and over -- than previously thought, as well as strongly associated with serious injuries, hospitalization, and nursing home care. Results of the study were published in the British journal BMJ in November, 2008.

THE STUDY

Researchers at the University of Cambridge in England collected data for one year on falls among 90 women and 20 men participating in the Cambridge City over-75s Cohort Study, a long-term investigation of aging and health. Investigators noted whether participants were injured, how long they were on the floor, whether they had called for help, and whether they were able to get up on their own.

Hospitalizations and moves to extended care facilities were also recorded, along with information on cognitive and physical function from earlier surveys and health assessments.

During the year of the study, 60 percent of participants reported falling (most fell at least twice); of those who fell, 88 percent said they were alone at the time. Four out of five needed help getting up, and 30 percent remained on the floor for over an hour. Those who lay on the floor for a long time, many of whom had cognitive problems, were at the greatest risk for serious injury, repeated falls, hospital admission, and long-term care during the year of follow-up.

Difficulty getting up from a fall was strongly associated with a history of mobility problems, such as difficulty walking or climbing stairs.

Most of the participants had access to call alarm devices, but the devices often went unused. (Nearly all the people who lay on the floor the longest had an alarm system that they didn't trigger.) The reasons given during follow-up interviews were an inability to activate the system, a fear of being hospitalized, and a desire to get up unaided.

The authors suggest that fall prevention programs should teach older people how to get up from a fall.

They also call for more research on alarm system designs. In particular, automatic fall detectors that don't rely on wearer activation could be a boon to the cognitively impaired, who were the least likely in this study to summon help.

More tips for reducing the complication of falls:

If you're at home a lot, consider getting a medical alert system that allows you to activate a call by pressing a wearable button (models for women include bracelets and necklaces). A loudspeaker and microphone installed in your telephone permit two-way communication between you and a trained operator who will alert emergency personnel, contact a relative or friend, and arrange for other services.

Medical alert systems vary in quality and price, so it's important to shop around.

If you don't have a medical alert system and are alone a lot, carry a cell phone or other cordless phone with you at all times. Or install telephone extensions in several rooms, and place the telephones at a level you can reach from the floor.

If you live alone, arrange for a friend or family member to check in with you daily at a particular time.

Make sure she or he has a key, in case you don't respond in a reasonable length of time.

If you've ever fallen, and especially if you've fallen more than once, let your clinician know, so that you can discuss ways to avoid future falls.

Hip protectors (undergarments with extra padding at the hips) are often promoted as a way to reduce the risk of hip fractures from falls. Few of these have undergone rigorous testing, and studies of their effectiveness haven't yielded consistent results. Nevertheless, they may provide some protection for very elderly individuals who wish to use them.

Additional Resources:

U.S. Centers for Disease Control and Prevention 800-232-4636 (toll-free) www.cdc.gov/ncipc/preventingfalls

National Institutes of Health, Senior Health http://nihseniorhealth.gov/falls/toc.html

-- Harvard Health Letters

(C) 2009. PRESIDENT AND FELLOWS OF HARVARD COLLGE. ALL RIGHTS RESERVED DISTRIBUTED BY TRIBUNE MEDIA SERVICES, INC.

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