As people age, no fall is minor

Same-level falls — those that occur when standing on the ground or sitting — have traditionally been considered minor mishaps that rarely require medical care. But new studies, including one from Mayo Clinic, show that low falls can lead to serious injuries and death in older adults.

Using data from the National Trauma Data Bank, an analysis of nearly 60,000 patients who experienced falls from 2001 to 2005 found that adults age 70 or older are far more likely to experience serious injuries from a low-level fall than younger people are and three times more likely to die.

According to the trauma data, older adults also remain in the hospital and intensive care unit longer than younger ones and fewer than a quarter are able to function independently when they return home.

Echoing these findings is a retrospective study of 670 patients treated for falls at Saint Marys, one of Mayo Clinic's hospitals in Rochester, Minn., between January 2008 and December 2009.

All patients presenting to the emergency department after falls were included in the study. Most were adults age 65 and older with head injuries, especially intracranial bleeds.

"Older folks who are anticoagulated and have head trauma are at risk of serious, even fatal, bleeds," says study author Mark D. Sawyer, M.D. "We also saw injuries to the liver, kidneys and spleen. Patients with those injuries who were anticoagulated were more likely to need surgical intervention and more likely to experience morbidity and mortality. There is also a strong correlation between the number of comorbidities and the chances of dying after a low fall."

Other significant injuries from ground-level falls included facial, rib, wrist and hip fractures.

"It was very illuminating to see that people were a lot more seriously injured after a same-level fall than we thought," Dr. Sawyer says. "These studies show that the seriousness of such falls shouldn't be underestimated, especially in older people."

Emergency care

The number of fatal falls among seniors rose significantly over the last two decades. Those most likely to die were older than 70 or had a GCS less than 15. Patients with these risk factors, as well as those who are anticoagulated, are more likely to need aggressive evaluation and treatment in the ED.

But Dr. Sawyer points out that given the seriousness of the problem and the growing number of older adults, it is not enough to just treat falls — the focus should be on how to prevent them in the first place.