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.
