Since january 1st of this year, people over 65 years old had a fall in Europe, sometimes with serious consequences.
Since january 1st of this year, people over 65 years old had a fall in Europe, sometimes with serious consequences.
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A fall is often only a mild accident with no consequences and can happen to anyone. Regardless of age, however, falls unfortunately sometimes have immediate consequences which can be more or less traumatising.
As we age, we also become exposed to secondary consequences which may be serious, and to psychological and social consequences.
- Immediate consequences
- Secondary consequences
- Psychomotor consequences
- Social consequences
Falling can happen at any age, but the seriousness of falls increases with age and the reduction in mobility. It is therefore more frequent for falls to have complications as we get older, all the more so since we become frailer.
Immediate consequences can go from a contusion or haematoma (a.k.a. 'bruise'), to more severe traumatisms (dislocation, fracture).
Sometimes, the only consequence is pain. It must not be overlooked, for it can have an impact on autonomy, but more importantly, we must make certain, if it persists, that it is not the expression of a fracture or fissure which has gone unnoticed.
As skin becomes more brittle and less elastic with age, a fall can lead to cutaneous wounds. However, they seldom require stitches (7% of cases according to a study).
Most falls do not lead to a serious physical traumatism. 6 to 8% of falls only are responsible for fractures, of the upper end of the femur in 1 case out of 3.
For more information:
- In France: each year, fractures of the femur and upper limbs among people over 75 result in 91,000 hospital stays and 4 out of every 5 stays give rise to a surgical intervention.
- Among the traumatic complications of falls, femoral neck fractures are the most frequent. In France, falls among the elderly are responsible for 50,000 fractures of the neck of the femur.
- Traumatisms are responsible for a short-term mortality rate which increases with age and can reach over 10% for people 80 and older.
However, the morbidity of falls can in no way be limited to their mere traumatic consequences.
Secondary consequences are related both to remaining on the ground for an extended period and to the fact that the person can no longer move.
The people who find themselves in these situations are mainly frail seniors, which explains why they are extremely affected by this type of complications.
- Eschars:
Being forced to remain on the ground, in an unpleasant and uncomfortable position, is responsible for prolonged pressure points on a same spot, with no possibility of shifting position. This excessive pressure crushes blood vessels, thereby suppressing blood circulation, which gradually leads to tissue hypoxia, i.e. a lack of oxygen. If this situation continues for an extended time, tissues start to deteriorate more or less quickly, leading to wounds known as eschars.
- Thromboembolic complications:
Phlebitis can be described as the formation of a blood clot in a vein, blocking it and preventing normal blood flow. Immobilisation is conducive to phlebitis, for it entails the stagnation of blood in the veins, which is favourable to the appearance of a clot. The phlebitis of the lower limbs is a serious illness, for the risk of an acute complication is associated with it: a pulmonary embolism, i.e. the migration of one of the clots into pulmonary veins.
For more information:
The phlebitis of the lower limbs is a frequent pathology (about 250,000 cases per year in France) and is responsible for (around) 10,000 deaths/year by pulmonary embolism.
- Infectious complications
- The rhabdomyolysis syndrome:
Prolonged muscled compression leads to the destruction of muscle cells, the content of which is released into blood circulation. Massive rhabdomyolysis can be life-threatening, with the sudden appearance of severe hyperkalemia which can affect heart rhythm and lead to acute renal failure.
- Dehydratation and undernutrition
- Hypothermia:
Hypothermia occurs when body temperature drops below 35°C.This drop in temperature occurs very gradually when a person is immobilised on the ground and exposed to cold for an extended period of time (bathroom tile, fall on a non-heated floor, etc.). In severe situations, the person can suffer from sleepiness or confusion.
- Lack of medical follow-up:
People lying down on the ground often do not have access to their usual treatment and if this situation continues for too long a time, they can miss taking several doses of their medicines. Should their treatment require regular intakes, this can have serious consequences: anticoagulants, treatment of diabetes, antiarrhythmics, etc.
- A high mortality rate
Even though 2/3 of seniors who fall do not sustain any serious injuries, it does not mean that they are safe from psychological consequences which can have a great psychomotor impact. Anxiety when walking and the fear of falling can lead to reducing one's outings for fear of falling once again. This loss of motor habits is detrimental and can entail a sideration of acquired automatisms, leading to a loss of postural adaptation reactions, with a difficulty to maintain an orthostatic position: this is the post-fall syndrome. It combines a motor element and a psychological element. This geriatric emergency calls for prompt care provided by a specialised team in order to avoid the destructive spiral towards the total loss of walking capacities.
Falls can have important social consequences: whether because of a fear to walk or because functional sequelae of the fall remain, seniors' autonomy is often reduced following a fall, which can entail a limitation of social contacts. They become dependent upon a third person or can no longer leave their home.
Consequences can involve increased isolation, which as we know is a fall risk factor. The elderly person therefore becomes caught into a dangerous spiral.
In some cases, falls can be an indication that home support is no longer appropriate: their frequency is such that it removes the possibility of home support. This often convinces the person or her family that institutionalisation has become necessary.
For more information:
- A fall with no injury especially has an impact on social activities while fall accompanied by an injury has an impact on physical activities (Tinetti 98).
- In the 8 weeks following a fall, a limitation of usual activities appears (Grisso 92).
- The 1st fall and the ones that follow cause difficulties in daily life activities (Kiel 91): the person who fell reduces their activities (Vellas 87).
- The risk of institutionalisation is multiplied threefold following an injury sustained during a fall (Wilkins 99); a 1st fall and the ones that follow increase the risk of hospitalisation and institutionalisation (Kiel 1991).
