Dizziness and disequilibrium tend to increase as we age due to the natural deterioration of the balance and other bodily systems. This is often compounded by the presence of other conditions that can impact balance function, known as co-morbidities.
Additionally, the use of multiple medications can contribute to these issues. Age-related dizziness and imbalance are prevalent among senior citizens, presenting as one of the most common problems they face.
Identifying the exact cause can be challenging, as it varies greatly from person to person. Another term for this condition is presbystasis, which refers to the age-related decline in balance function.
Several risk factors are associated with this condition, including an unsteady gait, fear of falling, muscle loss, vision impairments, dehydration, blood pressure abnormalities, cognitive impairments, bladder or bowel conditions, foot problems, alcohol consumption, degenerative brain diseases, and heart disease.
It is important to note that senior citizens experiencing dizziness face a significantly higher risk of falls and related injuries. Falls among older adults are particularly concerning as they carry a substantial risk of bone fractures, dislocations, and severe head injuries.
Factors of Fall
A fall is typically the result of a complex interplay involving the following factors:
Intrinsic factors:
Age-related cognitive decline, medical conditions, and adverse effects of medications contribute to falls. Aging leads to diminished visual acuity, contrast sensitivity, depth perception, and dark adaptation. Changes in muscle activation patterns and decreased muscle power and velocity may impair the ability to maintain balance or recover equilibrium when faced with disturbances, such as stepping on an uneven surface or experiencing a bump. Muscle weakness, in any form, is a significant predictor of falls. Furthermore, the risk of falls increases with the number of medications taken, especially psychoactive drugs.
Extrinsic factors:
Environmental factors independently or in conjunction with intrinsic factors can heighten the risk of falls. Environments that demand greater postural control and mobility, such as slippery bathroom surfaces, pose an increased risk. Unfamiliar surroundings, such as moving to a new home, can also contribute to fall risk.
Situational factors:
Specific activities or decisions can escalate the risk of falls and fall-related injuries. For example, walking while engaged in conversation or distracted by multitasking may cause individuals to overlook environmental hazards like curbs or steps. Rushing to the bathroom, particularly at night when not fully awake or in insufficient lighting conditions, can increase the likelihood of a fall. Additionally, rushing to answer a ringing mobile phone may divert attention from potential fall risks. Understanding these various factors that contribute to falls is crucial in developing strategies to prevent and mitigate their occurrence. By addressing intrinsic, extrinsic, and situational factors, we can work towards creating safer environments and promoting individual awareness and caution. Together, we can reduce the frequency and impact of falls, safeguarding the well-being and independence of older adults.
Complications
Falling poses a heightened risk of severe injury, hospitalization, and even death, particularly for frail senior citizens with pre existing disease comorbidities like osteoporosis, as well as deficits in activities of daily living such as urinary incontinence. Long-term consequences may include diminished physical function, a persistent fear of falling, and the need for institutionalization. In fact, falls are reported to contribute to over 40% of hospital admissions. More than 50% of falls among seniors result in some form of injury, with approximately 5% of those injuries leading to hospitalization for individuals aged 65 and above. While most injuries are relatively minor, such as bruises or abrasions, approximately 5% of falls result in fractures of the humerus, wrist, or pelvis, while 2% result in hip fractures. In addition, about 10% of falls lead to more severe injuries like head trauma, internal injuries, or lacerations. Tragically, certain fall-related injuries can prove fatal, with around 5% of seniors with hip fractures passing away during their hospital stay. Over half of seniors who experience a fall are unable to rise unaided, which can lead to complications such as dehydration, pressure ulcers, rhabdomyolysis, hypothermia, and pneumonia if left unattended for more than two hours. The impact of a fall can be drastic, significantly deteriorating function and quality of life. Shockingly, at least 50% of seniors who previously had mobility are unable to regain their prior level of independence after fracturing a hip. Furthermore, the fear of falling again often leads to reduced mobility as self-assurance diminishes. Some seniors may even avoid certain activities, like shopping or cleaning, due to this fear, which can further contribute to joint stiffness, weakness, and a continued decline in mobility.
Prevention of Falls
The primary focus should be on preventing or reducing the occurrence of future falls and fall-related injuries and complications, all while striving to maintain the patient’s function and independence to the greatest extent possible. As part of regular physical or wellness examinations, it is important to inquire about any falls experienced by patients within the past year, as well as any difficulties they may be facing with balance or ambulation.
Patients who report a single fall and do not exhibit balance or gait problems during the Get-Up-and-Go Test or a similar assessment should be provided with general information on reducing the risk of falls. This should include education on safe medication usage and how to identify and minimize environmental hazards. On the other hand, patients who report multiple falls or present with balance or gait issues should undergo a comprehensive fall evaluation to identify specific risk factors and opportunities for risk reduction. Physical therapy and exercise programs play a crucial role in the management of patients who have experienced multiple falls or who exhibit problems during initial balance and gait testing. Referral to physical therapy or enrollment in an exercise program is recommended. If patients have limited mobility, these programs can be conducted in their homes. Physical therapists customise exercise programs to address balance and gait impairments, as well as to target specific issues contributing to the risk of falling.
For some elderly patients, the use of assistive devices such as canes or walkers can be beneficial. Canes may suffice for individuals with minimal unilateral muscle or joint impairment, while walkers, particularly wheeled walkers, are more suitable for those with increased fall risk due to bilateral leg weakness or impaired coordination (note: wheeled walkers can be hazardous for patients who lack proper control). Physical therapists can assist in fitting and sizing these devices, as well as provide instruction on their proper usage. Medical management is an important aspect of fall prevention. Talk to your doctor and drugs that can increase the risk of falls should be discontinued or their dosage adjusted to the lowest effective amount. Patients should also be evaluated for osteoporosis, and if diagnosed, appropriate treatment should be initiated to reduce the risk of fractures resulting from future falls.
Environmental modifications in the home setting can significantly reduce the risk of falls. Additionally, older adults should receive guidance on minimizing risk related to situational factors. For example, footwear should have flat heels, provide ankle support, and feature firm, nonskid midsoles. Individuals with chronic limited mobility can benefit from a combination of medical, rehabilitative, and environmental strategies. Wheelchair adaptations, such as removable foot plates and antitip bars, can prevent tripping and backward tipping during transfers. Removable belts and wedge seating may enhance stability for patients with poor sitting balance or severe weakness. Restraints should generally be avoided, as they can lead to increased falls and other complications. Surveillance by a caregiver is a safer and more effective alternative. Motion detectors can be employed, but their effectiveness depends on the presence of a caregiver who can promptly respond to triggered alarms.
While hip protectors have been shown to reduce hip fractures in high-risk patients in nursing facilities, their effectiveness is less pronounced among senior citizens residing in the community. Moreover, many patients may be reluctant to wear protectors over the long term. The use of accommodating flooring, such as firm rubber, can help dissipate impact forces, although overly compliant flooring like soft foam may destabilize patients. It is important to teach patients what to do in the event of a fall and an inability to get up. Techniques such as turning from a supine to a prone position, assuming an all-fours position, crawling toward a sturdy support surface, and pulling oneself up can be valuable. Maintaining frequent contact with family members or friends, having a phone within reach from the floor, using a remote alarm, or wearing a wearable emergency response system device can significantly decrease the duration of time spent on the floor following a fall.
By implementing these multifaceted approaches and raising awareness about fall prevention, we can make significant strides in safeguarding the well-being and quality of life for our aging population. It is crucial for individuals, communities, and healthcare providers to join forces and actively contribute to this essential campaign, fostering a safer and more supportive environment for our elderly population.
Dr Zubair Saleem is a Senior Geriatric Consultant and Gerontologist and Dr Showkat Rashid Wani is a Senior Coordinator, Directorate of Distance Education, University of Kashmir
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK