Definition: Demographics Older adults are the fastest growing segment of the population, in part because the baby boomers are moving into old age. The growth rate of the older population has outpaced the growth rate of the population as a whole. By 2030, it is projected that 1 in 5 people in the United States will be 65 years of age or older (about 20%). Although today’s older adults benefit from healthier lifestyles, better nutrition, and more advanced medical care, a proportion of older adults still require emergency medical care due to fallout trauma. For older adults 65 years of age or older, falls are the leading cause of fatal or nonfatal injuries. Approximately 1 in 3 older adults fall each year, and 50% of those will fall again. The number of falls and the severity of the injuries they cause rise with age. The most common serious injuries include head trauma, wrist fractures, spinal fractures, and hip fractures. Of these, hip fractures incur the highest medical costs (approximately$35,000 per patient); even more staggering is the annual cost of treating falls in the elderly, which amounts to approximately$20.2 billion. Thus, fall prevention and treatment of the elderly who fall is a major health economics issue. This issue will become increasingly important as the population of older adults over the age of 65 continues to grow. Risk Factors A number of risk factors increase the risk of falls in older adults. These risk factors can be classified as: medical, personal and environmental. Medical risk factors are known health problems that increase the risk of falls. Personal factors vary from person to person. Age plays an important role, and the incidence of hip fractures is higher in patients over 50 years of age, with the incidence increasing approximately one-fold for every five years of age. Lack of weight-bearing activity contributes to decreased bone strength, which increases the risk of falls. Decreased estrogen levels in women lead to decreased bone strength, putting women at higher risk for falls than men. Hip fractures are two to three times more common in women than in men. Personal hobbies such as smoking and excessive alcohol consumption also increase the risk. Genetic factors play an important role in the incidence of fall injuries. Caucasians and Asians with slender bone tissue are at higher risk than African Americans and those with larger body size. We know that poor nutrition, lower calcium intake or absorption significantly increase the risk of falls and flutter injuries in patients. Environmental factors are considered to be external. About 60% of falls occur at home, 30% in the community and 10% in nursing homes. Wet floors, poor lighting and cluttered walkways account for a quarter of falls. Although approximately 4.5 million older adults need assistance with activities and activities of daily living, most do not receive the guidance and support they need. As a result, they are forced to avoid activities that put them at risk for falls and serious injury, including climbing high to retrieve items from closets, bathing alone, or navigating difficult terrain without assistance. Symptoms: Symptoms depend on the specific injury caused by the fall. Wrist fractures are most commonly seen in falls with the hand extended and the main symptoms include pain, swelling, and significant deformity. Spinal fractures in the elderly are usually compression fractures caused by osteoporosis and usually occur in the lower thoracic and upper lumbar spine. Patients complain of pain and occasionally deformity, and complaints of neuropathy are rare. Patients with hip fractures are usually bedridden patients who complain of groin pain, shortened lower extremities, and external rotation. Examination Radiographs should be performed to assess the integrity of the bone. CT and MRI may be necessary to examine soft tissue injuries and may show bone injuries that are not identified on radiographs. Dual-energy X-ray absorptiometry (DEXA) scans may be used to diagnose osteoporosis. Dangers of the disease Falls and the severe injuries they cause can be fatal for older adults. Prolonged braking can cause permanent loss of mobility, resulting in the inability to live independently. Hip fractures have the highest incidence and result in the highest mortality rate among older adults, some of whom fracture and never return to their functional baseline. Although approximately 25% of hip fracture patients fully recover, 40% require nursing home placement, 50% require crutches or a walker, and 20% die within 1 year. Prevention Given the high morbidity and mortality associated with flutter injuries in older adults, it is important to consider how to prevent falls from occurring. This is best addressed by examining each risk factor category and developing programs to reduce or eliminate the factors that are most at risk in a stratified analysis. It may be that it is unlikely to eliminate health problems that are already present. However, older adults are able to take good control of health problems and treatment through regular visits to the doctor, which may reduce the medical risk of falls. Personal factors, such as age, gender, and genetics, are unchangeable, but exercise, hobbies, and diet, can be changed. Weight-bearing exercises help increase bone strength and improve coordination, thus reducing the risk of falls and the risk of fractures after a fall. Adequate intake of calcium and vitamin D can make bones stronger. Avoiding smoking and drinking alcohol will also reduce the risk. Since 60 percent of falls occur in the home, the home is a prime place to change environmental factors. For example, stairwells and hallways should be cleaned and well lit, shower rooms should have grab bars and non-slip rubber mats, and small pieces of carpet and loose electrical cords should be removed. Treatment The goal of treatment is to restore the patient to the pre-injury level of function. Treatment is patient-specific and injury-specific and includes enabling the patient to join therapy and comply with rehabilitation. Complicating health issues complicate the treatment of trauma in older adults. For example, cardiopulmonary disease increases the risk of general anesthesia and surgery. These risk factors must be taken into account when considering treatment options. Wrist fractures are usually fixed in a closed reduction, cast or splint for 6 weeks. Some wrist fractures require surgery. Spinal compression fractures without neurologic impairment can be treated with rest and medication. Short-term bracing and early activity follows. Patients are advised to continue to be followed by a spine surgeon because neurological impairment, although uncommon, can still occur. Severe collapse (compression) of the vertebral body may still require surgery to restore stability, even if there is no neurological damage. Most hip fractures require surgery. Delaying surgery for more than 3 days after injury results in a significant increase in mortality. After surgery, early activity and rehabilitation are necessary. Collaboration with the patient, the patient’s family, and the primary care physician (if this primary care physician is not the treating physician) in treatment is important to ensure early activity, appropriate treatment of the underlying disease, and continued follow-up. These are simple ways to prevent loss of independent living skills. Loss of independent living, on the other hand, can lead to catastrophic psychological, social, and health consequences for older adults. Referral decisions/red flags The decision to refer depends on the specific injury. However, if the patient has loss of distal arterial pulsation, nerve damage (e.g., inability to move a muscle group, no change in sensation), cerebral hemorrhage, displaced or open fractures, or pain that continues to worsen after appropriate treatment, the patient should be referred. At the same time, it should be noted that abuse of the elderly is on the rise. Therefore, if the surroundings of the fall are suspicious or the loss is inconsistent with the mechanism of injury, the intervention of a social worker should be sought to investigate the possibility of abuse, or neglected abuse.