Even Short Falls
Can Be Deadly For Senior Citizens Age 70 and Older
These elderly people
are three times as likely to die following low-level falls
Nov. 1, 2010 -
While simple falls, such as slipping while stepping off a curb, may seem
relatively harmless, they can actually lead to severe injury and death
in elderly people, according to a new study published in The Journal
of Trauma: Injury, Infection, and Critical Care.
As the
population continues to age, it is important for physicians and
caregivers to be aware of and prepared to deal with this issue, which
could significantly impact the overall health and wellbeing of older
adults.
In contrast to
falls from greater heights, ground-level falls – essentially falls from
a standing position, with feet touching the ground prior to the fall –
have traditionally been considered minor injuries. But, the new study
found senior adults – 70 years or older – who experience ground-level
falls are much more likely to be severely injured and less likely to
survive their injuries compared to adults younger than 70 years.
Elderly patients
are three times as likely to die following a ground-level fall compared
to their under-70 counterparts.
Trauma surgeon
and researcher Julius Cheng, M.D., M.P.H, conducted the largest analysis
to date of trauma patients experiencing ground-level falls. His team
identified 57,302 patients with ground-level falls from 2001 through
2005 using the National Trauma Data Bank and analyzed demographics, type
and severity of injuries and final outcomes.
“There is the
potential to minimize what people see as a relatively trivial issue,
such as slipping and falling on a wet tile floor. Our research shows
that falls from low levels shouldn’t be underestimated in terms of how
bad they can be, especially in older patients,” said Cheng, associate
professor in the
Department of Surgery at the University of Rochester Medical Center
and lead author of the new study.
Between 1993 and
2003, there was a 55 percent increase in the rate of fatal falls for
elderly adults. Because of the increasing age in the general population,
the number of elderly patients visiting the emergency department with
ground-level falls is increasing, and will likely continue to rise in
the future.
It is now
estimated that 30 percent of adults older than 65 years will experience
an unintentional fall each year.
“Instead of an
influx of ‘traditional’ knife-and-gun club victims, trauma centers of
the future may need to prepare for treatment of a less dramatic but no
less relevant form of injury that may very well have a substantial
impact on the health and independence of our older citizens,” said
Thomas S. Helling, M.D., from the Department of Surgery at the
University of Mississippi Medical Center who wrote an editorial
accompanying the study.
The negative
effect of age on health outcomes has been well established in past
studies in other areas as well. Many elderly adults are frail and have
pre-existing medical conditions, such as heart disease. In these types
of patients, a low-level fall that results in a broken hip could have
serious, far-reaching consequences.
According to
Cheng, “An 80 year old often can’t tolerate and recover from trauma like
a 20 year old.”
Cheng’s team
found that approximately 4.5 percent of elderly patients (70 years and
above) died following a ground-level fall, compared to 1.5 percent of
non-elderly patients.
Elderly patients
remained in the hospital and the intensive care unit longer and only 22
percent were able to function on their own after they left the hospital,
compared to 41 percent of non-elderly patients.
Though low-level
falls can potentially lead to significant injury and death, the reality
is that almost three-quarters of patients with ground-level falls are
not severely injured. Given the limited resources available to most
medical centers across the United States and the increasing number of
elderly patients needing treatment, Cheng’s team identified two major
predictors of death in patients who have experienced ground-level falls:
1. Age older than 70 years and
2. a Glasgow Coma Scale (a widely used indicator of brain injury)
score of less than 15.
These specific
factors may help emergency department staff better determine which
patients have a higher risk of death and are more likely to require
aggressive evaluation and treatment.
While more
research is needed on the management and treatment of the ever-expanding
subpopulation of elderly patients in trauma centers, Cheng emphasizes
the need to focus on prevention as well.
“This study
brings up the important question of what we need to do as a society to
help our older folks take care of themselves,” said Cheng.
“Instead of just
treating falls as they happen, the focus should be on what we can do to
help older people avoid them in the first place. This can be as simple
as making sure there is no loose carpeting in their home and putting
railings on both sides of stairways and in bathtubs and showers.”
In addition to
Cheng, Konstantinos Spaniolas, M.D., Mark Gestring, M.D., Ayodele
Sangosanya, M.D., Nicole Stassen, M.D. and Paul Bankey, M.D., from the
University of Rochester Medical Center contributed to the study.
One-point decrease on social activity scale was
equivalent to being approximately five years older at the start of the
study - risk of death, disability jump
