Falls in the elderly: making sense of the numerous causes

Today I consulted on a 90-year-old lady who had been admitted to the hospital for evaluation of frequent falls. Even though she was 90, she was a young 90. Very alert and interactive and with normal strength in bed and mentation.

Since falls in elderly is a common problem, I thought why not discuss about this here. Falls are an important cause of morbidity and mortality especially in the elderly. This is a complicated topic and I shall tackle it by first discussing about how we maintain our balance.

Balance in humans is maintained due to a complex interaction of various neurological and muscular systems. There are added inputs from the visual and auditory systems which help in maintaining stability.

Hence problems with balance and stability may arise from primary neurological conditions, either problems involving the central nervous system such as the cerebellum or the peripheral nerves as in neuropathies. The peripheral nerves carry the sensation of joint sense (where the joints are with respect to space, vibration sense and position sense (suppose you are standing on a cold floor. Even with your eyes closed you are able to make out that the floor is cold, is it even or uneven, is it soft or hard. Now if you had a severe neuropathy and had no joint sense or position sense, then if your eyes were closed you shall be unstable and liable to fall).

We also need visual and auditory cues to maintain balance  (imagine trying to walk to the bathroom at night in a pitch dark room. You shall be unsteady and liable to fall and hurt yourself).

Then there can be mechanical, neuromuscular and othopedic causes of gait instability.Example you have had a stroke in the past and hence you are weak in one leg, have had a fracture of one of the long bones of the leg or you have a myopathy, all these conditions make you prone to falls.

So how does one make sense of the numerous causes of falls in the elderly? Diagnosing the etiology of falls can be one of the toughest tasks in clincal medicine. At times in a given patient the etiology is multifactorial (combination of old age and general deconditioning, poor eyesight as we age, poor hearing as we age, superimposed neuropathy etc).

You need to see an astute physician who is willing to spend time to pinpoint the problem. The workup starts with a good history and a thorough neurological examination. Is the problem confined to the central nervous system or is it coming from the peripheral nervous system? Are there any orthopedic causes contributing to the problem? Does the patient have poor eye sight?

Your doctor shall make you walk to see your balance, test your reflexes, test your coordination with the eyes open and then closed. Further workup may include an imaging study of the brain or spinal cord and nerve conduction studies.

So if falls are your problem or that of a loved one, please do see a doctor. You can be helped!!!

Personal Regards,

Nitin Sethi, MD

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2 thoughts on “Falls in the elderly: making sense of the numerous causes

  1. I have been reading a lot on fall prevention, simply because my father has been taking a lot of tumbles here lately. We have gone through our home and “dad proofed” every room in the house, moving furniture, changing flooring, and even as far as putting up baby gates across certain rooms. But I have found that I can not fully prevent him from every fall that is why I purchased ResponseLINK Emergency Medical Alert. He wears a pendant now sometimes as a necklace, and sometimes as a bracelet, so that if he encounters a fall. He just has to push the button on the pendant and the central station is alerted, they then alert us and medical services if warranted. One time he pushed the button by accident, and the operator responded in just a matter of seconds! She then called me to let me know that it was a false alarm, but just the added security of knowing he has someone when he needs it has really taken a strain off of my mind!

  2. That is indeed good information K, I have read about these medical alert bracelets. Also like your comment on “dad proofing” the house. Simple things like making sure the bathroom is well lighted, leaving the bathroom light on at night as a lot of falls occur at night when the patient wakes up to go and use the restroom, making sure there are no loose carpets, nothing which would catch your feet and cause a fall and like you did for your dad removing furniture with sharp edges and putting baby gates across rooms and at the top of stairs can go a long way in preventing falls in the elderly.
    I thank you for your comments and wish your dad my very best.
    Personal Regards,
    Nitin Sethi, MD

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