The elderly are more likely to fracture bones and become bed-bound.
If 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 can be deadly for older people who are likely to have brittle bones, said Dr Ganesan Naidu, an orthopaedic surgery consultant at Tan Tock Seng Hospital.
As one gets older, the risk of fractures increases. Women are more prone because they develop osteoporosis earlier than men.
Common fracture points include the hip, spine and wrist.
Less than half return to their original mobility after a fracture
Fractures of the hip and spine are more debilitating for the aged, as they cause them to be confined to bed. This can lead to physical and emotional complications and even an early death. The consequences of a fall in older adults are many, including pain, loss of independence and depression, said Dr Reshma Merchant, 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, urinary tract infections and changes in blood pressure.
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 for over two to four weeks, said Dr Lee Haw Chou, a consultant orthopaedic surgeon at Changi General Hospital.
Being bed-bound after a fracture leads to the start of musculo-skeletal degeneration, loss of mobility and an accelerated deterioration of the patient’s health in general. Given the consequences, prevention is better than cure, doctors advised.
Prevention is better than cure
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 patients will regain their mobility and be relieved of the pain, Dr Lee said.
However, some families may not agree to the operation 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 dementia patients, who will find it difficult to articulate their discomfort, or those above 80 who are physically frail, said Dr Lee.
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 sunlight and have their vision checked, as cataracts are common at this age, said Dr Ganesan who pointed out that older people are more prone to falls because of poor vision, a cluttered dwelling, giddiness and weakness.
A 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 ten children agonised over whether she should have hip surgery. Eventually, surgery was ruled out because Madam Khew, who was frail and had problems like high blood pressure and high cholesterol, had a chest infection.
She was discharged two weeks later, still in pain. Her family decided to allow her fractured hip to heal by itself but the pain persisted and the broken bone was found to have shifted out of position, making healing impossible. Madam Khew’s youngest son and caregiver, Mr Peter 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 the advice of doctors, 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 also believed that a prolonged period of inactivity would not have done his mother any good.
He said that when his mother was lying in bed with the fracture, her memory deteriorated. She was often disoriented and her physical condition worsened. This was one reason why the family decided to go ahead with the operation in spite of her age. “I encourage her to move as much as possible and do regular exercises,” he said.
Precautions to take
According to Dr Vina Doshi, a geriatric medicine consultant at Changi General Hospital, aged people can prevent deadly falls and fractures by taking a few precautions.
How to reduce the risk of falls