Fields of Study

Critical Care; Emergency Medicine; Family Medicine; Geriatrics and Gerontology

Abstract

Measures taken to prevent accidents among the elderly. The elderly are at higher risk of accident and injury than younger adults, due to their decreasing physical abilities and the increasing fragility of their bodies. Safety issues for the elderly are remarkably similar to those for children, ranging from cuts and bruises to broken bones. Falls and broken bones in the elderly have the potential to end an elderly person’s mobility.

Key Concepts

The Importance of Safety Measures

The age-related changes that elderly people experience often alter what constitutes a risk to their safety. The family home environment can be dangerous for an elderly person, not because the aspects of the house have changed, but because of the change in the physical abilities of the elderly person. Elderly people with intact cognitive abilities may choose to take the risk of staying in their familiar home environments with full knowledge of the increased risk. The dilemma for others, especially health providers, is defining what constitutes an acceptable level of risk for the elderly.

The elderly may experience mobility problems that pose a threat to safety. Falls are much more serious with advanced age because bones are more easily broken and tissues do not heal as quickly or completely as in youth.

Unintentional injuries (accidents) are the sixth leading cause of death in people over sixty-five years of age. The death rate is 51 per 100,000 people for those sixty-five to seventy-four years of age, rises to 104 per 100,000 for those aged seventy-five to eighty-four, and reaches a high of 256 per 100,000 for those who are eighty-five years of age or older. In the over-eighty-five age group, accidental injury is the fifth leading cause of death. Generally speaking, injuries cost the United States between 75 billion and 100 billion dollars each year. In 2010, the direct adjusted medical cost of falls came to $30 billion, comprising a significant portion of resource allocation for the cost of treating those injuries. Accidents are usually viewed as random events over which individuals have little or no control. Many other types of injuries are preventable, and safety enhancement may decrease the number of serious outcomes.

Falls

Falls account for a considerable number of deaths and injuries among elderly people. Falls are the leading cause of fatal and nonfatal injuries in the elderly population. Previous studies from 2000 found that 46 percent of fatal falls are due to traumatic brain injury. Falls are not an uncommon event for elderly people; approximately one-third of noninstitutionalized elders report a fall each year. One-half of the people who report falls experience multiple falls. Although falls are a common occurrence, they are not always dangerous: Only 11 percent result in a serious injury, and an estimated 1 percent result in hip fractures. The number of hip fractures yearly in the United States (200,000) is substantial and serious. They lead to death in 12 percent to 20 percent of cases and account for 2 percent of the mortality rate in the United States. More than 40 percent of deaths from falls occur in the home. Stairs account for a large proportion of falls, many occurring because the elderly individual misses the last step. Falling injuries account for 40 percent of nursing home admissions; however, more than 20 percent of all fatal falls occur in the nursing home setting. Over the past decade, mortality from falls in the elderly has risen impressively, with about 21,700 older adults dying from unintentional fall injuries in 2010.

Falls among the elderly may be caused by a variety of factors: physical frailty, pathological states, psychological stress, drug interactions, and multiple environmental hazards. The risks of falling increase with the following: increasing age, the number of chronic diseases present, the number and type of medications being taken, cognitive impairment, and physical disability. The risk of falling is often associated more with the intake of some types of drugs (antidepressants, sedatives, or vasodilators) than with medical conditions. Most doctors provide elderly patients with information concerning the effects of drugs that they may be taking, including the risk of a drop in blood pressure related to these medications. Instruction concerning how to decrease the effects of orthostatic hypotension, a condition in which blood pressure drops upon standing, is an example of how to instruct patients to be more aware of what may result in a fall. They may be instructed to dangle their feet before getting out of bed or rising slowly from seated or reclining positions to prevent falls due to orthostatic hypotension.

Falls may cause bruises, abrasions, pain, swelling, or fractures. Changes in cognitive function related to pressure from edema or blood clots within the brain may also be evidenced. Psychological damage resulting from falls is subtler. An older person who sustains little or no injury in a fall may delay or avoid discussing it in order to avoid embarrassment or risk of being viewed as less competent. Falls may also prompt changes in behavior, such as decreased thoroughness in housekeeping tasks or discussion of fears of living alone. Changes in grooming, dress, and personal appearance may also be observed. Increased fear of venturing out into the neighborhood may lead to a decreased ability to meet the daily requirements of shopping and food preparation. Affected individuals may further decrease other activities, resulting in their becoming increasingly sedentary. This leads to a relative reduction in physical fitness, impacting their quality of life and increases the risk of future falls.

Falls are better prevented than treated. People aged 75 and older who fall are four to five times more likely than those aged between 65 to 74 to be admitted to a long-term care facility for a year or longer. Because quality of life is as important as length of life, limiting activity in the hope that falls will not occur is the least acceptable method of prevention. A more realistic approach is to modify the environment. Although cost may be a limiting factor, many alterations can be implemented that are both acceptable to the older person and minimal in expense. Many environmental modifications are relatively easy to perform.

Many falls occur in the bathroom. Nonslip bath mats and adhesive-backed, nonskid strips in the bathtub or shower are important safety measures. Grab bars may be placed at critical locations near the bathtub and toilet to lend support. Railings may be installed on stairways for support. A piece of fabric, a knob, or some other marker can be attached to the rail to indicate the level of the top and bottom steps.

Other steps can be taken to prevent falls in older adults. Regular exercise, focusing on leg strength and improving balance, can prevent falls as these physical attributes diminish greatly with age. The Centers for Disease Control and Prevention (CDC) maintains that Tai Chi programs are especially conducive to improving these weaker areas. Reviewing medicines with a physician or pharmacist may help to identify medications causing side effects such as dizziness and drowsiness. Yearly eye exams and updating eyeglasses to maximize vision is also helpful.

The need for light increases with age. An environment can be illuminated at a safe level by increasing either the number of lights or the intensity of the lightbulbs. Adequate illumination that does not cause shadows, which may cause problems with perception, is extremely important in high hazard areas, such as stairways and stair landings. Night lights or lighted switches enable those who get up at night to orient themselves more easily within the environment and minimize the risk of falling. The removal of obstructions and obstacles can also help increase the safety of the home. Among the objects that may cause elderly people to trip are extension cords and long phone cords, low furniture, carpet edges, and throw rugs. These can easily be removed from high-traffic areas or taped down to minimize the risk of causing injury.

Traffic Injuries

In modern societies, an important rite of passage for adolescents is to receive a driver’s license. Driving an automobile is viewed as the first step toward adult life because it fosters independence. On the other hand, driving a car also calls for a sense of responsibility to others who share the roads. Many roads are crowded, and traffic moves at a rapid and sometimes confusing rate. Drivers must be physically and mentally alert to handle the hazards of the roads. Elderly people with impaired physical capabilities must make a choice between continuing to drive, and therefore maintaining their independence, or taking measures to increase safety for themselves and others on the road.

Traffic injuries in the elderly population are divided into two categories: pedestrian injuries and vehicle-related injuries. Elderly people are more at risk for injury at street intersections than anywhere else, both as pedestrians and as drivers or passengers in an automobile. As pedestrians, many elderly people are at risk because of an inability to cross the street in the time allotted between changes in the traffic lights. Factors that may influence pedestrian injuries are curb height, driver error, and physical and cognitive impairment of the elderly pedestrian.

A major problem for older drivers is the motor vehicle accident, in which the risk for injury in these crashes increases dramatically with age. The majority of such accidents take place in daylight, on good roads, and with no alcohol involvement. Elderly people experience a higher mortality rate with less severe injuries in vehicle crashes; the risk of death is three times greater for a seventy-year-old person than for a twenty-year-old person. The major factor that influences the high susceptibility of involvement in traffic injuries may be the decreased skill of the elderly person in operating an automobile. This change in skill level may be caused by age-related changes, such as decreased visual acuity or a slower neurological response time.

Citations for traffic violations, such as failure to yield right-of-way and failure to obey traffic signs, increase after the age of sixty. Although older adults have lower accident rates and fewer traffic violation citations than those under twenty-five years of age, elderly people have an increased risk of fatality in traffic accidents. One group of elders at increased risk for vehicle-related injury is those who are experiencing the early signs and symptoms of dementia. The American Association for Retired Persons (AARP) operates special classes in driver education to help older adults cope with age-related changes that affect their driving abilities.

Safety Considerations

Safety is a major concern when assessing living conditions. Many older adults live in unsafe housing. Relatively minor nuisances—such as excessive clutter, loose flooring or floor coverings, poor lighting, and unstable stairs—can pose safety risks for the older adult. Financial constraints may prompt older adults to settle for living in less desirable areas. Other safety concerns are related to the older adult’s physical or mental functioning. People who have trouble walking or climbing stairs are prime examples of those at risk as the result of impaired physical functioning. People who are forgetful or who wander off and get lost pose a significant risk to themselves and others as the result of impaired mental function.

It may be necessary to observe the elderly actually moving about in their environment to locate any potential problems. If the elderly person uses an assistive device, such as a cane, walker, or wheelchair, the environment may require further modifications. Ramps may need to be installed, or living arrangements may need to be changed to accommodate the need for special access.

Most elderly people prefer to stay in their own homes in familiar communities for as long as possible. As people get older, they often fear that they may have to leave home for health reasons. Such fears are realistic because acute and chronic health problems associated with aging often dictate at least temporary changes in environment, leading the elderly to reside in places they do not prefer. Their desire to stay at home challenges the health care system to study their special needs and devise solutions that will accommodate them in the most acceptable way.

Elderly individuals who live alone are well advised to learn how to summon emergency help and to make home adaptations to compensate for decreased mobility and dexterity. Cognitive impairments often present a more serious threat to safety than physical impairment. People who know they are having problems are likely to call for help and remain safely in the home until help arrives. However, individuals with impaired judgment may present a hazard to themselves, as well as to their neighbors, through such behavior as forgetting to turn off the stove. In isolated instances, a choice may be made to preserve such a person’s autonomy at the risk of serious injury; however, few would agree that the impaired older person has a right to put others at risk of serious injury.

Medication usage is another important factor to consider when evaluating whether or not an older person can safely remain at home alone. Sometimes the deciding factor in whether a cognitively impaired individual can remain at home alone is the nature of the medication regimen. Some individuals must have regular medication to maintain health. There are various systems to help forgetful people take their medicines. Preparing and labeling medications for each day is one strategy for simplifying medication administration. Medication calendars, which show each type of pill with its time of administration and which have a space for marking when the pill is taken, are useful to individuals with early memory impairment. Functionally impaired individuals who want to stay at home but require assistance or supervision with activities of daily living are often helped by paraprofessional personnel.

It is clear that injuries in the elderly population are costly both financially and in terms of independence. By preventing the most common causes of injury, adjusting medications, and altering acceptable aspects of an older person’s lifestyle, the risk of such injuries can be decreased. These changes will hopefully result in fewer injuries and a greater quality of life.

See also Accidents; Aging; Death and Dying; Fracture and Dislocation

Further Reading