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					FALLS
In most developed countries where life expectancy is higher, and where a
significant proportion of the population is elderly, accidental falls are the leading
traumatic cause of mortality and morbidity. Researches made in Italy by the
monitoring system of accidents at home (SINIACA System) show that the overall
risk of hospitalization increases with age, reaching in subjects older than 80
years values equal to 17 times to those that are observed in a lower class impact
(15-19 years) for males and 25 times for females (RR*=17 and 25 respectively).
This is due to the increasing role that has accidental falls with age. Accidental
falls are the most frequent events but also the most serious and often happen at
home.
According to common perception home is considered a safe place, but especially
in older people most of the major events (falls first of all) happening at home,
where the relative risk of hospitalization of the elderly due to accidents is
particularly high (19 and 32 time respectively for male and female aged >80
years compared to the class 15-19 years)
Falls account for almost half of injuries recorded in Emergency Room (ER), while
falls and bumps together cover more than 65 percent of events and are
associated to the use of structural elements of the house and the furniture. This
is the general scenario, but looking at the classes of older age, the proportion of
access to emergency rooms because of falls increases, up to nearly 80%.
In domestic accidents falls are the cause of 80% of traumatic brain injury (TBI),
85% of fractures to the trunk and neck, 70% of fractures to upper limbs, and
almost all fractures of the femur and pelvis, the most serious problem for elderly.
When we are young these adverse conditions are offset by the good degree of
calcification of the bones. In contrast, in old age, due to the decrease of bone
(senile osteoporosis) and changes in its mineral composition, especially calcium
(osteomalacia), the region of the femoral neck are substantially weakened.
Fractures of neck of femur are the most frequent fractures in men and women
after the seventy years, and for that reason, constitute a serious social and
welfare issue, and the gradual lengthening of life has resulted in a significant
increase of this type of problem.
Bathroom, bedroom and stairs are primarily places where a higher risk of falls.
Wet surfaces (floors, bathtubs, showers), carpets, and in particular the ladders
on which we climb to clean the glass or fix the curtains are the main dangers of
home for the elderly.
The analysis of the external causes of domestic mortality confirms accidental fall
as highly frequent and severe cause of trauma with a proportion of more than 2/3
of fatalities, greater even than the correspondent one observed in
hospitalizations and in ER admissions.
Which are the risk factors for falling? A review of fall risk factor studies shows
that the risk of falling increases as the number of risk factors increases (JAGS,
2001) and the main risk factors are muscle weakness (RR=4,4), History of falls
(RR=3,0) Gait deficit (RR=2,9), Balance deficit (RR=2,9).
How to reduce the chances of falling? There is good evidence of benefit from
non-strenuous exercise in fall prevention because physical activity makes the
body stronger, it helps to be better in general, and improves balance and
coordination. A facilitated environmental home assessment should be considered
in light of the risk of future falls, including the use of safety devices as a element
of multifactorial intervention.
Must be considered that the use of drugs against osteoporosis, although reduces
the probability of fracture of the bone, do not reduce the incidence rate of falls,
except those caused by spontaneous bone fracture.
Among elderly living in their own homes intervention should include also a
rewiew and modification of medications (especially psychotropic drugs),
treatment of hypotension and cardiovascular disorders (JAGS, 2001).

RR*= Relative Risk: the relative risk is the ratio of the incidence in the exposed and the
incidence in non-exposed (where “incidence” means the proportion of new cases)

Reference:
   1. National Information System on Accidents at Civil Residences (SINIACA),
      law n. 493 December 3rd 1999, article 4
   2. American Geriatric Society panel on falls prevention, JAGS, may 2001-vol
      49, n°5

				
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