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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The ageing of our body leads to many physical changes: modification of the muscle mass, ageing of joints and vertebral compression fractures.
In addition, senses are affected: lower eyesight and hearing, when these two senses play an important role in balance. Moving is no longer as easy as when we were younger, fatigue is more important and fall risks are higher.
Many of our sense are useful for good balance:
- The ears, of course, and especially the internal ear which governs balance. As we get older, the cells in our ears die out. This comes with presbyacousis, i.e. lower hearing, but also a loss in vestibular sensitivity.
- Eyesight, which can provide us with reference points in space. Among seniors, there is a reduction of visual acuity and sensitivity to contrasts, a narrowing of the visual field. Higher vigilance is therefore required when moving along, especially in unfamiliar locations. Good lighting also makes it possible to counterbalance these deficiencies.
- The sense of touch, or more exactly proprioception: there are thousands of sensors in our muscles and skin giving information to our brain on the position of our body in space and indicating how it is moving. With ageing, this proprioceptive sensitivity diminishes, and as the indications received by our brain become less clear, the movements following from them are less precise.
Among seniors, information processing is performed more slowly, which force centres to overlook some of the information, notably vestibular signals, and favour visual information. This results in higher postural instability and an increase in balance impairments.
- With the passing years, muscles, like other body organs, change: muscle fibres reduce in number and volume. Sarcopenia is the medical term to describe this loss of muscle mass. It can affect 20% to 40% of muscle mass. Muscular tissue is replaced by adipose tissue, which leads to an increase in the fat mass. Sarcopenia is responsible for a reduction in muscle strength and therefore physical activity. This reduction in muscle mass is most important for pelvic muscles and those of lower limbs. This favours the bad stabilisation of joints, notably those of knees or between each vertebra.
- The skeleton and joints are affected: Here again, ageing leads to fragility in bone and joints tissues:
All through our life, our bone tissue wears away and is synthesised by a balanced and dynamic system. This constant restructuring enables bone tissue to keep its biomechanical properties. Through a normal ageing process, the proliferation capacities of the bone are reduced: the quantity of formed bone then becomes lower than that of resorbed bone, which leads to a loss of bone tissue and increased bone fragility. This system is intensified by the hormonal imbalances that come with menopause: the reduction of bone density is major, and this is what is known as osteoporosis. In France, it concerns around 30 to 40% of women undergoing menopause and over half of those over 75. The main consequences are bone fractures and vertebral compression fractures, reducing motor autonomy.In the same way, ageing entails an impairment of articular cartilage: this is what is known as arthrosis. It is a source of pain but also of joint stiffness, which can impede the movement of the knees and hips.
The brain is the control centre of the body. It receives the signals sent by the senses, which give information regarding the environment, analyses the information and sends messages to the various muscles through a network of nerves that make up the nervous system.
As we age, the reaction time after the arrival of new information increases. In the same way, the conduction times increase for peripheral nerves, which bring information to the brain on proprioceptive sensitivity.
Our organs do not all age in the same way; they are sensitive to the more or less important constraints undergone over the course of life. Heart and lung tissues are modified as a result of ageing.
The respiratory system enables the storing of oxygen, which is to be transmitted to our organs thanks to red blood cells. With time and the loss in tissue elasticity, lung and thoracic compliance capacities are reduced, as is the volume of respiratory muscles: this leads to a reduction of the ventilatory capacity. In the same way, the reduction of the gauge of bronchi leads to reduced expiratory flows. This decrease in functional reserves induces a reduction of the body's capacity to adapt to physical effort.
The effects of ageing on the cardiovascular system are responsible for a decrease in cardiac output and heart rate during physical effort, because of a thickening of the ventricular wall. Heart muscle tissue, as we get older, also becomes more sensitive to heart rhythm impairments. Lastly, among elderly people, the elasticity of arteries diminishes, and the system regulating tension becomes less effective (hypertension, orthostatic hypotension).
Urinary incontinence is an involuntary leak of urine. It can occur during the day or night. It is a very frequent problem, as is affects between 14 and 18% of people over 75 living at home and up to 40% of people over 75 living in nursing homes. The risk is twice as high among women than men.
The frequency of these disorders explains why incontinence constitutes a risk factor for falling: the urgent and repeated need to urinate leads to hasty trips to the toilet which can be dangerous.
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Many illnesses can lead to incontinence: bladder trauma, or a neurological disease such as multiple sclerosis for example. However, muscle ageing is responsible for a failure in the suspension means of the bladder which can lead to urinary incontinence during physical effort: this is known as passive incontinence and caused by a decrease in the resistance of the urethra. Leaks of urine occur when abdominal pressure is suddenly raised, for instance during coughing, sneezing or laughing.
Another form of incontinence is frequent among elderly women: urge incontinence, which is caused by the hyperreflexia of the vesical wall muscles. Their abnormal contractions occur involuntarily and lead to an urgent need to urinate.Among elderly men, incontinence problems are most frequently linked to prostate problems: it leads to a block in the urethra, the bladder distends and then, when pressure exceeds the resistance level of the sphincter, the overflow leakage occurs; this is known as overflow incontinence. Following prostate surgery, incontinence can also occur temporarily.
Footwear
- Wrong footwear: Feet are the first resource to achieve autonomy, as they make it possible to move along. Taking them into consideration is all the more important when balance or motor skills are poor. The wrong footwear, or even walking barefoot, is conducive to falling. Choosing the right shoes is very important: they must provide enough room for toes to feel at ease while holding the foot and ankle in place.
Many studies indicate that fall risks significantly vary according to the type of shoes worn by seniors. Koepsell's team showed in a study made in 2004 that, while sports shoes are associated with a low risk of falling among the elderly, this risk greatly increases for people walking barefoot.
- Overly long clothing
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- Poor lighting
- Slippery floors
- Obstacles on the ground
- Isolation
Many illnesses can be factors conducive to falling. Unfortunately, the frequency of some of these illnesses or syndromes increases with age. They can also be combined, to such an extent that they were long confused with the expression of ageing. This is the case for:
- neuropsychiatric diseases: dementia, depression, Parkinson's disease or others;
- ocular diseases: cataract, glaucoma, degeneration of the retina, etc.;
- osteoarticular diseases, etc.
In France, seniors are high consumers of drugs.The health insurance fund provided the following figures:
- people over 75 consume health care and drugs three times as much as the general population.
- drug prescriptions for people over 65 represent a third of all prescriptions, while this population only constitutes around 15% of French population.
- in 2001, nearly a quarter of reimbursed drug prescriptions were for people aged 70 or over (who represent a little more than 10% of the total population).
- only 11% of French people over 65 do not take any drugs on a regular basis.
The average consumption of this group is from 4 to 5 drugs per day, but prescription drugs sometimes contain over a dozen molecules. Multiple medication use can have numerous consequences, and notably falls: they are known as iatrogenic falls. In Greek, 'iatros' means physician, and 'gennan' means as 'as a product of': iatrogenic falls are therefore falls caused by the doctor!
Iatrogenic falls arise from various mechanisms in relation to the administration of numerous drugs. It is therefore important not to take drugs without talking to a physician first. Moreover, you mustn't hesitate to tell them about the adverse reactions you may experience when undergoing a new treatment.
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Drugs presenting the highest risk belong to different groups:
In the first place, psychoactive drugs (benzodiazepines, hypnotics and antidepressants), hypotension (whether global or orthostatic), vigilance disorders, anaemia, hypoglycaemia
- Hypotension: the drugs mainly responsible are of course antihypertensives, nitro compounds but also antidepressants, major tranquilisers and opioid analgesics,
- Hypoglycaemias: they occur when taking insulin or hypoglycaemic sulfonamides and are either atypical or severe,
- Heart rhythm and/or cardiac conduction disorders: they are often serious and in relation with an electrolytic disorder (dyskaliemia, dyscalcemia) or the prescription (alone or in combination with other drugs) of digitalis glycosides, beta adrenergic blocking agents, antiarrhythmics, non dihydropyridinic calcium channel blockers, lithium, theophylline,
- Hemorrhagic accidents.
A fall can be a brutal and fortuitous event in relation with an intercurrent factor, but can also be the symptom of an illness (see the chapter on causes of falls). In both cases, repeated falls mean that their cause (extrinsic factor or causal illness) is still present.
A medical history of falling in the previous year is thus one of the main fall risk factors. It is often combined with a lower level of autonomy.
Knowing how to identify an increase in falls is therefore interesting, for it is a good warning signal: it makes it possible to take early measures: seeking professional advice or setting up preventive measures at home (see the chapter on fall prevention).
