Falls are very common in older people, with about one third of women and a smaller proportion of men over the age of 65 falling each year. The incidence of falls increases dramatically with age, with those aged 85 or over five times as likely to fall as someone aged 65.

The consequences of falling include:

fractures (in 1% or less of falls; those with thin bones associated with osteoporosis sustain fractures more often),

occasionally hypothermia (from prolonged lying on the floor in cold weather),

less serious physical injuries such as bruising. Most importantly, the psychological consequences of falling can result in loss of confidence in walking and mobility which can greatly impair quality of life and reduce independence.

Falls may be the first sign of illness (see below) and may precipitate calls for institutional care.

Causes

There are three kinds of causes associated with falling, and in many instances more than one cause operates.

ENVIRONMENT

Falls are often due to the environment outside the home -uneven pavements, high steps, activities such as getting onto buses - and inside the home such as poor lighting, missing a step (usually the bottom one) on a staircase, tripping over a loose rug or a trailing flex. The list of hazards is long.

BALANCE

Many falls are due to disturbances in the complex mechanisms of balance which depend on:
· Information reaching the brain from four sources - the soles of the feet, joints, the vestibular apparatus in the inner ear (which signals the position of the head and the direction and speed of its movement) and from the eyes.

· Processing of this varied information takes place in several places in the brain.

· Signals being sent from the brain to the muscles to order them to undertake those movements which will correct the displacement of the body, and the muscles reacting sufficiently quickly and powerfully.

In older people many of the balance mechanisms become less efficient in varying degrees, most probably as part of normal ageing. These mechanisms are also sensitive to sedative drugs such as sleeping tablets or tranquillisers and alcohol.

DISEASES

Two main kinds of diseases, those that affect the brain directly, and/or the blood supply to the brain, can produce falls or become evident because of a fall. An accurate medical diagnosis is vital.

The commonest example of the first group of diseases is stroke which may show itself with a fall due to paralysis. A fall will be more common after a stroke that results in long lasting or permanent paralysis.

In Parkinson 's disease the rapid movements required to maintain balance cannot occur; treatment with drugs will greatly improve balance.

The cerebellum at the back of the brain is also important in maintaining balance and when it is permanently damaged (which is quite rare), falls are common; unfortunately, treatment is often not effective.

In an epileptic seizure the working of the brain is suddenly but temporarily disrupted, and the sufferer falls to the ground. Treatment with drugs that prevent seizures will prevent these falls.

In the second group of diseases, the failure of the blood supply to the brain causes a partial or complete blackout preceding the fall, as when:

There is a failure of the normal mechanisms maintaining blood pressure on standing up. This is often due to drugs given for another complaint, and will be corrected if they can be reduced or stopped.

·The amount of blood circulating is reduced, as when a substantial loss of blood or of salt and water occurs.

·The heart beats too slowly to sustain the blood supply to the brain. A heart pacemaker which restores the normal rate is very effective treatment.

·The carotid sinus (a small structure in the neck which is part of the mechanism of blood pressure regulation) becomes oversensitive and either slows the heart rate or lowers the blood pressure excessively. The former can be treated with a pacemaker.

Other conditions, such as an unstable knee due to the combination of arthritis and muscle weakness, can also cause falls.