Small slip can be fatal for elderly

If there's one room in the house that deserves a skull-and-crossbones sign on the door, it's the bathroom. More people get hurt in the bathroom than out on the road. But when the injured are in their 60s, doctors say, the chances of a fall proving fatal shoot up.

Hip fractures, and damaged spine and forearm are the most common injuries associated with a fall. But among the elderly, who have weaker structural muscles, poor balance, reflexes and vision, and bones attenuated by years of dietary neglect, a slip often leads to more dangerous injuries.

"The elderly are vulnerable to head injuries in falls, which can prove fatal," says Dr MC Misra, chief of AIIMS Trauma Centre, adding only 35-40% of orthopaedic injuries and fractures among them occur in road accidents.

Doctors at the Centre say an equal number of orthopaedic injuries involving the elderly result from minor falls at home - while bathing or climbing stairs.

More worrying than the initial injury is the slow course of recovery in people aged more than 60. Doctors say reduced activity and higher stress reduce life expectancy in patients bedridden by a hip fracture or spine injury.

"Elderly people are not able to recover quickly from injuries and fractures. They are bedridden for months, which leads to depression and worsening of other health issues like diabetes and infections," says Misra.

Dr Yatinder Kharbanda, consultant with the orthopaedics department at Apollo Hospital, also says life expectancy in people who have suffered multiple fractures decreases significantly.

However, houses are seldom designed keeping safety aspects in mind. The use of slippery floor tiles and even marble is quite common.

Grab rails are not provided in bathrooms and the drainage is seldom perfect, so a dangerous film of water is left behind on the floor after use.

A few simple design rules can bring down falling related injuries at home. For the elderly, especially, rooms should be well lit and not cluttered with wires and low furniture. Bathrooms should have grab rails running around, and the stairs, too, should have railings rather than plain walls.

"Constant monitoring of medical conditions like arthritis, impaired vision and hearing, and regular review of the dose of sedatives and psychotropic drugs is necessary," says Misra.

A healthy diet and active lifestyle are also beneficial. Calcium- and vitamin D rich diets help ensure good bone health.

"Our body needs one gram of calcium every day. Often, our daily meal does not provide this. So, nutritious meals, particularly milk and milk products and supplements advised by a doctor, can be helpful," says Dr PK Dave, head of orthopaedics at Rockland Hospital.

A recent study of bone health in people aged 50 years and above by AIIMS, Institute of Nuclear Medicine and Allied Sciences (INMAS) and Army Research and Referral Hospital showed that one in three elderly people had osteoporosis or dangerously low bone strength.

"We get many cases of young people - aged 40 to 50 years - complaining about pain in the legs and weakness in the muscles, which are symptoms of degenerating bone strength.

Sedentary lifestyle, lack of exposure to sun, unhealthy food habits are some of the reasons for this. One should lead an active lifestyle and exercise for at least 30 minutes every day," says Dr Shuchee Madhusudan, specialist in endocrinology, Fortis C-Doc.

While precautions help, nothing protects the elderly like direct supervision by the younger family members.

Piyali Mitra, a 27-year-old school teacher, says, "My mom lives with my 82-year-old grandmother, who can walk around and eat on her own. "But my mom bathes her and usually helps her go to the bathroom to ensure she doesn't slip and fall. She had slipped and hurt herself once."

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