Improved living standards, better healthcare, greater awareness of the importance of a healthy diet and taking regular exercise have led to more and more people enjoying life into their 80s and 90s. However older people, in particular the frail elderly, are one of the groups of our population most vulnerable to accidents, particularly in and around the home.
Those over 65 years of age are most at risk, suffering both the highest mortality rate and the most severe injuries. In 2009 in England and Wales alone, people aged 65 or over accounted for 7,475 deaths as a result of an accident of which 49% were due to a fall. More dated figures relating to A&E attendances after home accidents show that falls are by far the single largest cause of attendance. In 2002, 2.7million people attended an A&E department in the UK following a home accident, of whom 1.2million had suffered a fall. Over-65s accounted for 19 per cent of the total number of A&E home accident attendances, but 30 per cent of the attendances were due to accidental falls at home.
The majority of accidents in the older age groups also involve females rather than males.
Many of the fatal and non-fatal accidents to older people are attributable wholly or in part to frailty and failing health. This can lead to failure or slowness to see and avoid risks. By drawing the attention of older people and their carers to danger spots and unsafe habits then accidents can be reduced.
What injuries occur?
The great majority of both fatal and non-fatal accidents involving older people are falls. Almost three-quarters of falls among the 65-and-over age group result in arm, leg and shoulder injuries. Older people are also more likely to injure more than one part of their body, with 25 per cent of falls causing injury to more than one part of the body, compared to an average 16 per cent among all age groups. One in every five falls among women aged 55 and over results in a fracture or fractures requiring hospital treatment.
Other main injuries suffered are bruising or crushing, cuts, wounds resulting from piercing and straining or twisting a part of the body.
Although most falls do not result in a serious injury, being unable to get up exposes the faller to the risk of hypothermia and pressure sores.
Where do accidents happen?
The most serious accidents involving older people usually happen on the stairs or in the kitchen. The bedroom and the living room are the most common locations for accidents in general.
The largest proportion of accidents are falls from stairs or steps with over 60 per cent of deaths resulting from accidents on stairs. Fifteen per cent of falls are from a chair or out of bed (on two levels) and a similar number are caused by a slip or trip on the same level, e.g. falling over a mat or a rug.
The risk of falling in the home increases with age. A substantial number of falls are due to unspecified reasons and whilst moving about on one level. This may reflect instability associated with impaired general health.
The cause of a fall is often multi-factorial, involving both environmental hazards and an underlying medical condition. Strength, balance and gait, decline in vision, mental health problems and deficiencies in the diet are all contributory risk factors. Although prescription medicines are seldom the cause of falls, they may also be a major risk factor.
Falls affect over a third of people over 65 years old and 40% of people over 80.
Incorporating small changes into everyday routine can be beneficial in preventing an accident at home.
In addition to removing hazards that could cause a trip, engaging in regular physical activity, to develop and maintain strength and balance, is also particularly important as we get older. Exercises designed to improve muscle strength
Risk factors for falls
Research has indicated a wide range of multiple risk factors for falls.
Physical ability and lack of mobility, balance and gait disorders
Nutritional status - vitamin D and calcium deficiency
Medication - analgesics, antidepressants etc.
A history of previous falls.
Fractures, particularly hip fractures are one of the most debilitating results of an accidental fall. Ninety per cent of hip fractures occur among those aged 50 and over.
Hip fracture is a major cause of morbidity and mortality. It can result in medical complications, infections, blood clot in the leg and failure to regain mobility.
The increased popularity of hip protectors has been very useful in preventing the severity of a falls-related injury.
Avoid leaving items on the stairs - they can become a tripping hazard
Ensure stairs are carefully maintained - damaged or worn carpet should be repaired or removed
Try to avoid repetitive carpet patterns that may produce a false perception for those with poor eyesight
Landings, stairs and hallways should be well lit with two-way light switches
Make sure banisters are sturdy. The fitting of two easy-grip handrails gives more stability
Older people need to be made aware of:
The importance of using the right equipment to carry out the task in hand
Loss of balance through sudden movements, e.g. getting out of bed or a chair too quickly
The danger of slipping and tripping created by worn rugs, slippery floors or paths, uneven surfaces, trailing flexes, and items left lying around
Loose or badly worn footwear. Well-fitting shoes can help with balance and stability
Grab rails and places to sit down in the bathroom and kitchen could be an advantage if dizzy spells occur
Spills on the floor should be cleaned up immediately to prevent slipping on them.
What to do if you have a fall:
Don't panic - you will probably feel a little shocked and shaken but try and stay calm
If unhurt look for something to hold onto and something soft to put under the knees
Hold onto a firm object for support and out the soft object under the knees; place one foot flat on the floor with the knee bent in front of the body
Lean forward putting weight on hands and foot until it is possible to place other foot beside the one on the floor
Sit down and rest for a short time.
What to do if hurt:
Try to get comfortable until help arrives
Keep warm, starting with feet and legs
It is uncomfortable to keep still for any length of time and this may lead to pressure problems. Moving position every half hour and moving feet helps the circulation and improves comfort.
143 people over the age of 65 died in 2010 in fires to which fire brigades are called. Poor mobility, poor sense of smell and a reduced tolerance of smoke and burns contribute to fatalities. Major sources of ignition include cookers, materials, candles, coal fires, heaters and electric blankets.
Take care with smoking materials and try to avoid smoking in bed
Fit a fireguard
Use electric blankets correctly and have them checked regularly
Fit a smoke alarm preferably main-operated or one with a ten-year battery
Do not dry clothes on fireguards or heaters.
Medicines and gases, mainly carbon monoxide and pipeline gas, predominantly cause accidental poisoning of people over 65.
Have fuel burning devices checked regularly by an expert
Have chimneys and flues swept at least once a year
Be aware of the dangers of exceeding prescribed drug doses.
Burns and scalds
For older people the rate of risk for severe accidents involving burns and scalds is lower than other age groups. However, older people are at the highest risk for fatal injuries from burns and scalds - four to five times greater than the population as a whole. Pre-existing conditions often contribute to their deaths.
Contact burns to those over 65 can prove to be fatal. Frail and poor health of the victim are often contributing factors. The main sources of heat include radiators, electric fires and cookers. Many are scald injuries, involving the use of kettles.
This may prevent a child from seeing above an obstruction or being seen by an adult.
Encourage the use of:
Coiled kettle flexes or a cordless kettle
Spout-filling or jug kettles (boil only sufficient water for immediate needs)
Wall-mounted heaters instead of kettles
Try not to carry hot liquids further than necessary. (Re-arrange tea/coffee-making area to accommodate this.)
Water at the point of delivery to the bath should be no more than 46° C to help prevent scalding
Fit a thermostatic mixing valve
When running a bath, turn the cold water on first
Always use rear hot plates and turn the panhandles away from the front of the cooker
Ensure that hot water bottles are of good quality and do not show signs of wear.
Hypothermia occurs when the body temperature drops to 35° C. It is the main contributing factor in cause of death for more than 400 people in the over-65 age group each year.
The cost of providing adequate heating in winter is undoubtedly an important factor.
Wear several thin layers of clothing
Natural fibres like wool are warmer than synthetic fabrics
Eat regular meals and take hot drinks during the day
Move about at regular intervals
Contact local electricity and gas boards if difficulty is experienced in meeting bills.