Falls

Falls are the most common accidental injury in patients over 75 years of age and the second most common injury in the 65 to 74 age group. Fifty percent of elderly persons who fall do so repeatedly. Most individuals who fall will do so on a level surface, and most will suffer an isolated orthopedic injury. 14 Falls are reported as the underlying cause of 9500 deaths each year in patients over the age of 65 years. Many falls in the elderly population occur in residential institutions such as nursing homes. In the over 85 age group, 20 percent of fatal falls occur in nursing homes. 4

There are age-related changes in postural stability, balance, motor strength, and coordination that make the elderly more prone to tripping and falling and may explain the increased incidence of falls in this population. Also, decreased visual acuity and increased memory loss can cause the patient difficulty in recognizing and avoiding environmental hazards. Acute, preexisting, and chronic diseases also may lead to falls. Syncope has been implicated in many cases of elderly patients who fall, and this may be secondary to dysrhythmias, venous pooling, autonomic derangement, hypoxia, anemia, or hypoglycemia. Other contributing factors include alcohol and medications, most notably sedative, antihypertensive, antidepressant, diuretic, and hypoglycemic agents. 4

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