How can we tackle the causes of falling?
Because of the wider prescription of blood-thinners, a nasty bump to the skull could be fatal
The uncertainties surrounding the recently noted decline in life expectancy in elderly people, which was commented on in this column last week, are clarified at least in part by the rising incidence of traumatic injury in this age group, as documented in a revealing report from the Trauma Audit and Research Network (Tarn). This “first comprehensive review” of major trauma in older people could scarcely be more impressive, collating the relevant data over a 10-year period – stratified by age, nature of injury and outcome.
While the major causes of trauma in the young and middleaged are, as might be expected, road traffic and other accidents and violent assault, most of those aged 70 and over who require admission to hospital do so following a relatively minor fall (from standing) when in the safety of their own homes. Until just over a decade ago this type of misfortune was rare – with just 350 cases recorded in England and Wales in 2005. Come 2014, that figure had risen almost 20-fold to 6,200.
There are, it is reasonable to infer, two contributory factors at work here. First, the risk of a person falling is now considerably greater than in the past, for which the main culprit (though difficult to prove) is likely to be the muscle weakness, unsteadiness, low blood pressure or other causes of impaired balance associated with over-medication.
But in addition, the consequences of falling are much more serious than in the past. Here, significantly, the commonest type of trauma warranting hospital admission is the consequence of head injury; whereas previously a fall from standing may only have resulted in a nasty bump to the skull, it is now more frequently complicated – because of the much wider prescription of blood-thinning drugs – by bleeding into the brain. This potential catastrophe is readily diagnosed on a CT scan, but despite the best efforts of neurosurgeons it carries a high mortality rate – with a fatal outcome in a third of those sustaining this type of injury. So what is to be done?
Not a lot apparently, or perhaps doctors are so mesmerised by the gravity of the situation they feel unable to respond to it appropriately. That impressive Tarn report argues, not unreasonably, for extra resources to deal with these injuries more expeditiously; however, it says nothing about those underlying causes and how they might be avoided.
This leaves little alternative other than for the public to take the initiative. There may be reason enough to prescribe those blood pressure-lowering or bloodthinning medicines, but it is only sensible to ask searching questions about the balance of benefit and harm when taken in combination.
Keeping tight-lipped
Finally, the recently featured remedy of taping the lips together at night with a vertical piece of micropore to prevent the dryness and dry throats associated with mouth breathing has prompted considerable interest. “After reading about this I resolved to give it a try,” writes a woman woken several times at night with a parched mouth following a major operation and radiotherapy on her tongue. “I can now sleep for five hours without needing to wake for a glass of water. I am extremely grateful.”
On the same theme, if more conventionally, another reader commends Xylimelt discs that adhere to the gums, releasing a non-sugary substance that keeps the mouth moist for several hours. They are not available on prescription but can be purchased on the internet for a modest sum.
Email medical questions confidentially to Dr James Le Fanu at drjames@telegraph.co.uk To order his latest book, Too Many Pills (Little, Brown, £13.99), for £10.99 plus p&p, call 0844 871 1514 or visit books.telegraph.co.uk