Falls are the leading cause of injury-related hospitalisation in persons aged 65 years and over and account for four percent of all hospital admissions in this age-group. Hospital admissions resulting from falls are uncommon in young adulthood but with advancing age, the incidence of fall-related admissions increases at an exponential rate. Beyond 40 years, the admission rate due to falls increases consistently by 4.5% per year for men (doubling every 15.7 years) and by 7.9% per year for women (doubling every 9.1 years). In those aged 85 years and over, the levels have climbed to 4% per annum in men and 7% per annum in women.
Falls account for 40% of injury-related deaths and one percent of total deaths in this age group. Depending on the population under study, between 22-60% of older people suffer injuries from falls, 10-15% suffer serious injuries, 2-6% suffer fractures and 0.2-1.5% suffer hip fractures. The most commonly self-reported injuries include superficial cuts and abrasions, bruises and sprains. The most common injuries that require hospitalisation comprise femoral neck fractures, other fractures of the leg, fractures of radius, ulna and other bones in the arm and fractures of the neck and trunk.
In terms of morbidity and mortality, the most serious of these fall-related injuries is fracture of the hip. Elderly people recover slowly from hip fractures and are vulnerable to post-operative and bed rest complications. In many cases, hip fractures result in death and of those who survive, many never regain complete mobility. Another consequence of falling is the “long lie” - remaining on the ground or floor for more than an hour after a fall. The long lie is a marker of weakness, illness and social isolation and is associated with high mortality rates among the elderly. Time spent on the floor is associated with fear of falling, muscle damage, pneumonia, pressure sores, dehydration and hypothermia.
Falls can also result in restriction of activity and fear of falling, reduced quality of life and independence. Even falls that do not result in physical injuries can result in the “post-fall syndrome” – a loss of confidence, hesitancy, tentativeness with resultant loss of mobility and independence. It has been found that after falling, 48% of older people report a fear of falling and 25% report curtailing activities. Finally, falls can also lead to disability, decreased mobility which often results in increased dependency on others and hence an increased probability of being admitted to an institution. Falls are commonly cited as a contributing reason for an older person requiring admission to a nursing home.
