Causes of falls in elderly

Question 1

What is the net effect of aging on balance?

Answer 1

• Increased sway
• Flexed posture - kyphosis - changes centre of gravity. Giving patients a frame gives them a wider base of support.
• Gait- slower, shorter steps = less time on one leg.
• Compensatory reflexes slower.
• Shuffling leads to more stumbles which in turn leads to more falls
• Reduced muscle mass & reduced muscle strength & more fat

NOTE: Ageing also effects vision, vestibular system, brain & muscles

Question 2

What is the effect of ageing on vision?

Answer 2

• Reduced acuity (sharpness or keeness) e.g. lense may become cloudy in cataracts.
• Reduced contrast sensitivity
• Reduced adaption to low light levels
• Glare - scattering of light on lense due to degeneration.
• Loss of near vision - lense becomes less flexible.
• More difficult to perceive depth & see what kind of surfaces you may trip on

Question 3

What is the effect of ageing on the vestibular system? What is the vestibular system?

Answer 3

• Reduced number of hair cells and nerve fibres
• Vestibular reflexes are slower and less accurate.

Vestibular system consists of:
1. Otolith organs - detect linear acceleration of head.
2. Semi-circular canals - detect angular acceleration
- Inolves 3 tubes at right angles to each other.
- The hair cells are wafted in endolith.
- The hair cells transeduse the mechanical movement into electrical impulses that go to the vestibular nuclei.
- Info from the vestibular nuceli go to cerebellum - for eye movement, resipartory rate, posture, heart rate.
- Goes to thalamus - informs conscious control.

Question 4

What is the effect of ageing on the brain?

Answer 4

Fewer neurones

Slower reaction times

Impaired integration of sensory information - less able to cope w/ conflicting info.
- e.g. problem w/ vestibular system on one side but not other.
- Less reserve e.g. if low light, uneven ground and loss of hearing = can’t process all this at once.

Question 5

What is the effect of ageing on muscles?

Answer 5

• Reduced muscle mass & strength
• Slower contraction

NOTE: active muscles age less e.g. vocal muscles or physically active elderly.

Question 6

What is the effect of ageing on the proprioception?

Answer 6

• Weaker sense of where we are, how we move & velocity of our movements
• Weaken stretch tendons- Goli tendon organs
• Mechanoreceptors of joint- hip, kness

Question 7

What are the main reasons people fall?

Answer 7

1. Accident:
   - Mechanical trip
   - If you fall, it makes you afraid of falling = scared of staying active.
   - Then lose muscle mass, frightened and reduce movement further.
2. Disease:

Eye e.g. catarcats, bifocal glasses, macular degeneration

Middle ear:
- Vertigo - the feeling of rotation when you are stationary.
- Cerebellar stroke
- Benign Paroxysmal Positional Vertigo - the Dix-hallpike test & Epni manoever can be used to diagnose & treat this.
- Maniers disease - vertigo, tinnitis & deafness - excess production of endolith.

Brain:
- Stroke - depends where it occurs
- Parkinson’s - falls are multifactorial - ridgity, bradykinesia & delay processing. If body tells the leg to move to stop a fall, they have a delay that they don’t have time to correct their balance & move their leg.
- Severe head trauma

Nerve - neuropathy e.g. diabetes, autoimmune, post-chemo
- Peripheral sensory neuropathy - can’t feel pain in foot & deformity. Not even realising that they have ulcers because they can’t feel it.

Muscle:
- myopathy- muscle weakness
- muscle wasting
- steroid induced muscle weakness

Joints - arthritis, foot deformity

Infections- acute confusional state
- hypotension if sepsis

3. Poison - drugs or alcohol

Psychotropics & sedatives
- Diazepam
- Amitriptyline
- Risperidone
- Haloperidol

Blood pressure lowering agents
- ACE inhibitors e.g. ramopril
- Beta blockers e.g. bisoprolol
- Calcium channel blockers e.g. amlodipine
- dizziness due to hypotension

Polypharmacy
- polypharmacy hypoglycaemia
- drug interactions can cause dizziness, confusion= falls

Sleeping tablets

Analgesics e.g. opioids, codeine.

Muscle relaxants e.g. tamsulosin

Alcohol- causes confusion, disorientation & clumsiness

4. Environmental factors:
   - Slippery surfaces
   - Trailing wires
   - Loose carpets or rugs
   - Poor lighting
   - Cluttered stairs
   - Pets
   - Risk taking e.g. not turning lights on…