Seniors’ falls in Canada Second report published by Health Canada

According to this report:

Injury in Canada is a serious public health concern. It is a leading cause of hospitalization for children, young adults and seniors, and it is a major cause of disability and death.

Falls remain the leading cause of injury-related hospitalizations among Canadian seniors, and between 20% and 30% of seniors fall each year.

Falls and associated outcomes not only harm the injured individuals but also affect family, friends, care providers and the health care system.

However, we do know that these personal and economic costs can be avoided through injury prevention activities

Among Canadian seniors, falls remain the leading cause of injury-related hospitalizations, and absolute numbers are on the rise. Falls can lead to negative mental health outcomes such as fear of falling, loss of autonomy and greater isolation, confusion, immobilization and depression. In addition to the negative physical and mental health consequences of falling, there are significant associated financial costs, estimated at $2 billion annually, a value 3.7 times greater than that for younger adults.

Biological or intrinsic risk factors include those pertaining to the human body and are related to the natural aging process, as well as the effects of chronic or acute health conditions. In 2008/2009, 20% of Canadian seniors in the household population reported at least one fall; falling was even more prevalent among older ages (i.e., 80 years and over). The following conditions often associated  with aging are contributors to falling:

a.  acute illness: Symptoms of acute illness such as weakness, pain, fever, nausea and dizziness can increase the risk of falling.102 For example, one study found that infections, in particular urinary tract infections, were a precipitating factor in 8% of falls.82 Furthermore, the effects of medications taken to treat the condition or symptoms can also increase the risk of falling.169

b.  balance and gait deficits: Balance impairments result when there are changes to the normal functioning of the systems underlying postural control, which can involve biomechanical, sensory and cognitive changes.76 Changes to these systems result in context-specific instabilities that may lead to falls.76 Research consistently shows that balance deficits are significantly linked to  risk of falling among older adults.  Similarly, a number of studies have found that variability in one’s  gait (e.g., timing, placement) is a risk factor for falling.

c.  chronic conditions and disabilities: A wide range of chronic conditions can increase an individual’s risk of falls, including neurological disorders such as Parkinson’s disease, diabetes, arthritis, cardiovascular disease, end-stage renal disease, chronic obstructive pulmonary disorder or the effects of a stroke.

a.  These chronic conditions result in physical limitations that affect one’s mobility, gait and balance. For example, in samples of community-dwelling individuals with Parkinson’s disease, estimates show that over 60% of participants fell at least once each year, and the risk of a fracture has been shown to be approximately twice that of comparable older persons who fall. Furthermore, complications related to diabetes, such as neuropathy, retinopathy and nephropathy, likely contribute to an increased risk of falls.

d.  Other chronic conditions include bowel or bladder incontinence and urgency, which can lead to rushing and frequent trips to the bathroom.

a.  A recent meta-analysis conducted by Bloch et al. found a strong link between taking laxatives and falls, such that patients taking laxatives were twice as likely to fall as those not taking them.

b.  Similarly, foot disorders such as corns, bunions, toe deformities, ulcers and general pain can contribute to balance and gait difficulties.

e.   cognitive impairments: For those older people with dementia or other cognitive impairments, the risk of falling and sustaining a fall injury is two to three times that of older people without cognitive impairments. Cognitive impairments affect one’s ability to anticipate and adapt to environmental stimuli to maintain or restore balance. In addition, researchers are beginning to explore the link between dementia, gait instability and delirium, has also been shown to increase the risk of falls. Delirium may result from acute infection, medication, dehydration, sensory impairment, emotional distress etc. Research has found that normal age-related cognitive changes can also affect balance, for example, through delays in switching attention from an ongoing cognitive task to the task of responding to an unexpected loss of balance.

f.   low vision: Changes to vision, such as decreases in visual field sensitivity, acuity, contrast sensitivity and stereopsis, are associated with aging and increase the risk of falls. For example, a systematic review of risk factors found that older adults with low vision were 2.5 times more likely to fall than older adults without visual deficits. Indirectly, changes in vision are linked to a decrease in physical activity, which is another risk factor for falling. Low vision can impede one’s ability to walk safely because one cannot detect hazards

g.  muscle weakness and reduced physical fitness: Decreases in muscle strength and endurance can leave one unable to prevent a slip, trip or stumble from becoming a fall. The panel of the American Geriatrics Society, British Geriatrics Society and American Academy of Orthopaedic Surgeons found muscle weakness to be the most important risk factor, increasing the risk of a fall by four to five times. Furthermore, weakness in the lower extremities was found to be a risk factor for fall- related hip fractures.