Tag Archives: falls

Falls In The Elderly: The Consequences

Falls among the elderly are a huge problem. Our trauma service typically has 6-12 elders who have sustained significant injuries on it at any given time. About a third of people living at home over the age of 65 fall in a given year. At 80 years and up, half fall every year.

Because of this, falls are the leading cause of ED visits due to an injury for those over 65. What exactly are the societal consequences of all these falls? A yet to be published study from the Netherlands looked at injuries, costs and quality of life after falls in the elderly.

The top 5 most common injuries included simple wounds, wrist and hip fractures, and brain injuries. Although hip fracture typically was #5 in the 65-74 age groups, it was uniformly #1 in the 85+ group. Patterns were similar in both men and women. Interestingly, hip fractures were by far the most expensive, making up 43% of the cost of all injuries (total €200M). The next closest injuries by total cost, superficial injuries and femur fracture, made up only 7% of the total each!

As you can imagine, quality of life suffered after falls as well. A utility score based on the EQ-5D, a validated quality of life score, was lower in fall victims. Even after 9 months, this score did not return to baseline. About 70% of elders who were admitted after their falls described mobility problems and 64% had problems with their usual activities. Over a quarter expressed problems with anxiety or depression.

Bottom line: An array of falls prevention programs are available. They need to be more aggressively implemented to reduce costs and improve the quality of life of our elders.

Reference: Social consequences of falls in the older population: injuries, healthcare costs, adn long-term reduced quality of life. J Trauma (in press), 2011.

Pneumomediastinum After Falling Down

Finding pneumomediastinum on a chest xray or CT scan always gets one’s attention. However, seeing this condition after a simple fall from standing is very simple to evaluate and manage.

There are 3 potential sources of gas in the mediastinum after trauma:

  • Esophagus
  • Trachea
  • Smaller airways / lung parenchyma

Blunt injury to the esophagus is extremely rare, and probably nonexistent after just falling down. Likewise, a tracheal injury from falling over is unheard of. Both of these injuries are far more common with penetrating trauma.

This leaves the lung and smaller airways within it to consider. They are, by far, the most common sources of pneumomediastinum. The most common pattern is that this injury causes a small pneumothorax, which dissects into the mediastinum over time. On occasion, the leak tracks along the visceral pleura and moves directly to the mediastinum.

Management is simple: a repeat chest xray after 6 hours is needed to show non-progression of any pneumothorax, occult or obvious. This image will usually show that the mediastinal air is diminishing as well. There is no need for the patient to be kept NPO or in bed. Monitor any subjective complaints and if all progresses as expected, they can be discharged after a very brief stay.

Up In The Air: Tree Stand Injuries

Deer hunting season is upon us, so it’s time for emergency departments to start seeing an increase in hunting injuries. Although you would think this would mean accidental gunshot wounds, that is not the case. The most common hunting injury in deer season is a fall from a tree stand.

Tree stands typically allow a hunter to perch 10 to 30 feet above the ground and wait for game to wander by. They are more frequently used in the South and Midwest, usually for deer hunting. A recent descriptive study by the Ohio State University Medical Center looked at hunting related injury patterns at two trauma centers.

Half of the patients with hunting-related injuries fell, and 92% of these were tree stand falls. 29% were gunshots. The authors found only 3% were related to alcohol, although this seem very low compared to our experience in Minnesota.

Most newer commercial tree stands are equipped with a safety harness. The problem is that many hunters do not use it. And don’t look for comparative statistics anytime soon. There are no national reporting standards.

The image on the left is a commercial tree stand. The image on the right is a do-it-yourself tree stand (not recommended). Remember: gravity always wins!

Commercial tree stand Do-it-yourself tree stand