Fall in old age

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The fall in old age is emphasized as a separate medical problem in geriatrics , because about a third of people over 65 years of age fall at least once a year (old age syndrome ). About 20% of the consequences of these falls require medical attention. The fall itself is initially a symptom of a possible deficit from various causes. These don't have to be obvious or known.

Broken bones (fractures) occur in less than 10% of cases, but can then lead to morbidity over a very long period of time. Likewise, falls without resulting fractures can reduce the mobility of old people (fear, severe contusion pain) and result in an increased need for care. Falls should be a reason to examine the prevention options ( secondary prevention ) against further falls that could ultimately lead to the need for care. A geriatric assessment is recommended for repeated falls .

causes

The different causes of falls in old age can be physical, mental, environmental or a mixture of them. Differential diagnosis come u. a. in question:

Falling out of bed is less noticeable in living areas than in hospitals or nursing homes. A lower bed height can be assumed (10–20 cm lower than in a hospital). An ISO standard for senior-friendly construction aims to address these risk factors. B. prevent with more sockets and better lighting in a room.
  • Visual and hearing impairment

Risk factors

The following common causes of fall injuries are found in living areas:

  • Smooth and / or wet floor surfaces (floors, tiles, stairs, etc.)
  • Falls from a ladder etc.
  • Bad lighting
  • Ground level stumbling blocks
    • self-laid auxiliary cables (power supply)
    • loose carpets
    • Discarded objects (bags, garbage bags, etc. e.g. on a staircase) that are no longer thought of.
    • no sturdy shoes
    • inadequate clothing (trouser leg too long)
    • missing handrail on both sides of the stairs

A drop in blood pressure can also lead to falls:

Above all, however, many people fall on stairs. In 2005, over a thousand people in Germany died when falling on or off stairs. This affected 588 men and 483 women. With 781 accidents, the majority of them took place at home. Even when it comes to the statistically known causes of further injuries, falls on stairs are the front runners. Deaths from falls have decreased since 1980. In 1980, 100 people per 100,000 inhabitants lost their lives as a result of a fall; in 2008 it was 40 people per 100,000 inhabitants.

Older people are particularly affected because of their age-related restrictions. Over 80 percent of all staircase accident victims come from the age group over 60 years. With osteoporosis, the risk of injury is particularly high. If an elderly person falls, the fear of falling comes as a further consequence after the possible femoral neck fracture , which can lead to (further) withdrawal from public life and a lack of exercise . Around half of older fall patients do not regain their old mobility. Other consequences can be cerebral haemorrhage that initially remains undetected ( subdural hematoma ), infections after cooling down or serial rib fractures .

Frequently known triggers for falls are unsteady gait, imbalance (possibly as a result of a sudden fluctuation in blood pressure), tripping hazards such as floor coverings or steps, missing handrails / handrails, missteps as a result of an unrecognized step limit.

Fall in hospital

Falling out of bed occurs most frequently in hospitals (0.5–3.7%) and care facilities (0.2–3.6%). Preventive measures are being taken more and more frequently to avoid falling out of bed or to reduce the consequences.

Occasionally, measures are taken to alleviate the consequences of falls. The use of special beds is particularly effective here. As a result, patients can feel safer when they are lying in the hospital bed and getting in and out of the bed is also safer. This is z. B. achieved with various new types of partial delimitation instead of full grid. There are also so-called low-floor properties. These beds can e.g. In some cases, it can be lowered to 20-25 cm without losing the height of up to 90 cm in order to minimize the risk of falling. With 55 to 95 cm, normal hospital or care beds are usually even above the standard height for the lower limit (which makes sense for ergonomic reasons to facilitate care measures, but does not do justice to the risk of falling for endangered patients) Losing grip, which is very often the cause of critical bed falls. Modern hospital and care beds take into account the requirements of the patient (safety, comfort including underfloor properties), the caregiver (ergonomic care) and the cleaning team (floor clearance).

In both cases (hospital / care facility and living area), so-called hip protectors (items of clothing with protective pads) are increasingly being used to prevent falls , which, when used consistently, have a high avoidance effect. Since they should be worn continuously, they bring in some patient groups, such as e. B. in stool , urinary incontinents or demented people but also problems with themselves.

Femoral neck fracture

In the injuries caused by falls in old age (in addition to fractures of the wrist, upper arm, pelvis, etc.), the femoral neck fracture (femoral neck fracture) plays a major role. The number of these injuries increases with age. Possible consequences of morbidity (frequency of illness) are operations, femoral head necrosis, thromboses, embolisms, infections, restricted mobility and restricted cognition. Often the patients need care afterwards, 50% temporarily, 20–30% constantly and 19% are dependent on a nursing home. The death rate of such cases with femoral neck fractures is 12–24% in the first year.

Follow-up costs from femoral neck fracture

  • Treatment (costs only for the operation and the hospital stay):
    • 1997, Switzerland: approx. 21,000 SFr or 17,000 DM or 8,500 euros
    • 1996, Germany: approx. 20,000 euros per case, totaling 2.6 million euros
    • 2006, Germany: approx. 33,000 euros (estimated)
  • Rehab measures
    • 2005, estimated minimum costs: 30 days × 210 euros = about 6300 euros
  • Care, care
  • Loss of quality of life: mobility, fear of further falls, shorter life expectancy (are serious, but not financially verifiable)

These costs can be effectively contained through fall prevention measures .

Prophylaxis, nursing prevention

In some cases, age-related weaknesses can be reversed through treatments such as muscle and movement training as well as balance exercises . Training in handling and walking with the rollator to maintain or build muscle is also very helpful . Pain in the joints or back makes the short distance from sitting to standing an ordeal for many people. This and the fear of falling lead to more frequent sitting. This makes getting up the next time even more difficult and there is a risk of becoming more and more immobile. Because the human musculoskeletal system (nerves, muscles, bones and joints) needs a certain amount of movement in order to regenerate. To make standing up easier and to make the process safer, there are standing aids such as the catapult seat or the LYFTY. So-called emergency lifting cushions are suitable for both the dignified lifting of fallen people and the back-friendly work of the rescue workers. These can also be used for lifting or transferring bariatric, paralyzed or spastic patients.

It is also important to look for so-called fall traps in the home. These have to be eliminated, the paths well-lit and sufficient opportunities to stop. Handy handrails should be attached to both sides of stairs.

“Bed rails” and, in extreme cases, insufficient insight into the elderly, restraint in bed should only be exceptional cases until other prevention options have been achieved in order to prevent serious injuries. This restriction of freedom of movement must be expressly justified and documented medically and can only be done once in the event of imminent danger, initially without consulting the official supervisor or relatives. Repeated use requires judicial approval as a measure that restricts freedom. In the case of persons capable of giving their consent, it must be urged that the measures and this consent are regularly checked.

Meta-analyzes indicate that the effectiveness of hip protectors in preventing femoral neck fractures caused by falling on the hip is not as strong as originally expected. In addition, it does not treat the cause of the fall.

See also

literature

Web links

Individual evidence

  1. ↑ According to the Federal Statistical Office
  2. ↑ In the spotlight: Older people in Germany and the EU . Federal Statistical Office, 2011, p. 86 (PDF).
  3. ↑ a b Falls in Old Age - Frequency, Consequences, Causes, and Prevention.
  4. ↑ BFU Switzerland, Accidents among seniors aged 65 and over ( memento from June 30, 2001 in the Internet Archive ). Accessed on September 24, 2015.
  5. ↑ IZG Uni Erlangen ( Memento of the original from March 6, 2009 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 3.9 MB). @1@ 2Template: Webachiv / IABot / www.izg.uni-erlangen.de
  6. ↑ Hoffmann Falk. Fall prevention: hip protectors. Dtsch Arztebl 2005; 102 (42)