The elderly at risk falling
 Falls among the elderly should be considered a great risk. From studies carried out and illustrated in the figure on the left, it’s easy to see how the risk of falling over increases with age, reaching a high point betwen 80 and 90 years.
Every year about 1/3 of the elderly living in communal residences fall over. Of these, half more than once. The percentage rises in nursing homes, up to 50% of patients. In hospital this percentage goes down to 10%. (1). The causes are to be found precarious equilibrium and weakness for about 20% of cases, accidents for 35-40%, confusion, sight problems and hypotension for the remaining part.
Falls of the elderly also constitute 40% of accidents in first aid, other than being one of the first causes of death related to accidental injuries. In the USA, over 65s who suffer fractures to the hip after falling are about 200,000 a year. Following the event, a small part of the elderly who fall over suffer fractures and dislocations (5-15%); 1/4 need assistance and the rest suffer functional limitations. Environmental risk factors are mostly steps, little lighting, lack of support devices and unsuitable footwear. Biological factors due to old age, which constitute a cause of falls, go from muscular weakness to reduction of proprioceptor sensibility, sight and balance problems, nervous illnesses to exogenous substances (medicines, alcohol). The cause of muscular weakness is to be found in the reduction of muscular mass and consequently of strength which, after 60 years of age, undergoes strong and gradual regression.
Also illnesses which strke in old age (ictus, Parkinson’s, neuropathies, myopathy and cognitive deterioration, foot and sight pathologies, cardiac pathologies) only increase the risk exponentially. The cognitive causes are, like physical and environmental factors, due to accidental trauma. One of these is the fear of falling, and more serious are dementia and confusion. Rehabilitation and prevention strategies aim to stimulate the control of balance and optimise efficiency and muscular strength. Training of maximum efficiency of the hip and knee extensors and control of the trunk and balance are necessary.
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1 Tinetti, Rubenstein , Morgan
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