They are more likely to fracture bones and become bed-bound. It leads to other health complications which may be fatal. APRIL CHONG reports

IIf you are young and fit, picking yourself up after a fall is effortless and may result in nothing more than a few bruises. However, this is not the case for the aged.

When aged people fall, they may become bed-bound from a fracture and even waste away, sometimes within weeks or months.

Falls, the usual cause of fractures, may not break a younger person’s bones, but they can be deadly to older people who are likely to have brittle bones, said Dr Ganesan Naidu, an orthopaedic surgery consultant at Tan Tock Seng Hospital.

In addition, the aged may also be more prone to falls because of poor vision, a cluttered dwelling, giddiness or weakness, he added.

As one gets older, the risk of fracturesincreases. Women are also more prone because of a faster rate of
osteoporosis, said doctors.

Common fracture points include the hip, spine and wrist.

However, fractures of the hip and spine are more debilitating among the aged who are more likely to become bed-bound. This can lead to complications and even an early death.

The consequences in older adults are many, including pain, loss of independence and depression, said Dr Reshma Merchant, the head of general medicine and geriatrics at National University Hospital.

She said that fewer than four in 10 of those aged 65 and above will return to their original mobility after a fracture. Mortality within the first year after a hip fracture can be as high as 25 per cent, she added.

When one cannot walk, problems will set in. These include possible blood clots in the legs, pneumonia, constipation, retention of urine and urinary tract infections, and changes in blood pressure, said Dr Merchant.

Some of these conditions can be fatal.

If an aged person falls on his or her buttocks, it can cause a spinal fracture resulting in the patient being bed-bound and in pain over two to four weeks, said Dr Lee Haw Chou, a consultant orthopaedic surgeon at Changi General Hospital.
 
In many cases, fractures will eventually heal with rest but the patient can be in danger of wasting away during this period.

So, if an aged patient is going to be bed-bound for a prolonged period, the doctor may need to intervene with a “cement” needle operation to get him out of bed as soon as possible to avoid complications, said Dr Lee.

This is done by injecting a special cement into the fracture area. It decreases the pain and allows the patient to be more mobile. However, this procedure may not be suitable for everyone.

In the case of a fractured hip bone, the surgeon will usually recommend surgery so the patient will regain his mobility and be relieved of the pain, Dr Lee said.

However, some families may not want the operation to take place because of the high complication rate in surgery for the aged.

When surgery is not performed, deconditioning or getting out of shape can happen very quickly. This is especially so for those with dementia, who will find it difficult to articulate their discomfort or those above 80 who are physically frail, said Dr Lee.

Being bed-bound after a fracture leads to the start of musculo-skeletal degeneration, loss of mobility and an accelerated degeneration of the patient’s health in general.

Given the consequences, prevention is better than cure, doctors said.

Preventing falls at home and maintaining strong bones and good balance is important.

Besides building bone strength through diet and supplements, the elderly can also do regular exercises such as qigong and walking. They should also get enough sunshine and check their vision as cataracts are common among the elderly, said Dr Ganesan.

Fracture that would not heal

A fall at home in September last year left Madam Khew Lun Yeh, 82, in excruciating pain.

However, as it was not uncommon for her to fall, family members did not think anything was amiss until they noticed her leg seemed to be at a strange angle when she tried to walk.

In hospital, she was found to have suffered a left hip fracture.

Her 10 children agonised over whether she should have hip surgery.

Madam Khew’s youngest son and caregiver, Mr Peter Chong, who is 42 and in the finance line, said that the elderly woman is frail and has problems like high blood pressure and high cholesterol levels. Eventually, surgery was ruled out because she had a chest infection.

She was discharged two weeks later, still very much in pain.

Her family decided to allow her fractured hip to heal by itself.

However, the pain persisted and the broken bone had shifted out of position, making healing impossible.

Mr Chong said his mother, who was usually able to tolerate pain, was in so much agony that she broke out in cold sweat.

In November, the family finally decided, on doctors’ advice, that Madam Khew should undergo a partial hip surgery to replace the damaged bone.

After two weeks in hospital and another month of recuperation, Madam Khew was able to walk again with a walking frame.

Mr Chong said that if his mother had not had that operation, she would have remained bed-bound as it would have been difficult for her fracture to heal. She could have developed bed sores and been in pain all the time, he added.

He also believed that a prolonged period of inactivity would do his mother no good.

He had noticed that when she was lying in bed with the fracture, her memory deteriorated. She was often disoriented and her physical condition worsened, he said.

This was one reason why the family decided to go ahead with the operation in spite of her age.

“I will encourage her to move as much as possible and do regular exercises,” he said.

Precautions to take
Dr Vina Doshi, a geriatric medicine consultant at Changi General Hospital, said that aged people can prevent deadly falls and fractures by taking a few precautions.

Reducing risk of falls
■ Prevent chronic diseases
■ Keep fit
■ Pay attention to one’s eyesight and correct any cataract problems
■ Ensure a safe environment, including having enough lighting and wearing the correct footwear
■ Reduce risk-taking behaviour, like climbing a ladder if you have pain in the knees.

Improve bone health
■ Ensure adequate calcium intake. Women, in particular, should take more care because of their higher risk of osteoporosis
■ Exercise