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.