Basically, a fall is an unintentional coming to rest on the ground or other lower surface with or without loss of consciousness and other than a consequence of sudden paralysis, epileptic seizure, or an overwhelming external force.

According to WHO 2018 global statistics; globally, an estimated 646 000 people die from falls each year, making it the second leading cause of unintentional injury death, after road traffic injuries. Over 80% of fall-related deaths occur in low- and middle-income countries. In all regions of the world, death rates are highest among adults over the age of 60 years.

Also, estimated 37.3 million people sustain non-fatal falls that are severe enough to require medical attention occur each year. About 20 to 30% of older persons who fall suffer serious injuries such as; hip and other fractures, dislocations, head injury and other soft tissue injuries

Those who survive a fall suffer significant morbidity with greater functional decline in activities of daily living (ADLs) and physical and social activities, and are at a greater risk of institutionalisation. Falls that do not result in serious injuries may still have serious consequences for an older person who may fear falling again, leading to reduced mobility and increased dependence through loss of confidence. This is even worse when a much younger person is affected by a fall as they have a much longer life to live with a debilitating disability  

It is, however, important to note that much as everyone that falls has a risk of being injured, some people have been found to have an increased risk of falls as well, developing serious injuries from the fall. 

Older people above 60 years have the highest risk of death or serious injury arising from a fall and the risk increases with age. This is partly due to the decreased muscle strength and bone density as well as age related vision, neurological or judgment deficits.  

However, children also have a higher risk of falls and these occur largely as a result of their evolving developmental stages, curiosity in their surroundings. Older women and younger children are especially prone to falls and increased injury severity. Worldwide, males consistently sustain higher death rates and this is to a big extent due to most of their risky job nature.

Some of the other risk factors include; alcohol and substance abuse, vision disturbances such as elderlies with uncorrected vision disorders e.g. cataracts, neurological diseases affecting balance or judgment, poor social-economic status (poverty with overcrowding and poor infrastructures increasing risks of falls). 

Some of the prevention measures to prevent falls and the associated injuries include; screening the environment for risk factors such as unleveled grounds, higher risk bathrooms (risks can be reduced by putting in place something to grab on while getting off a toilet seat and bathroom tub especially for the elderly, as well as bathroom floor carpets).

Clinical evaluations and interventions to identify risk factors, especially in the elderly, can reduce the risk of falls significantly. These might include current medication reviews and modification, treatment of low blood pressure, vitamin D and calcium supplementation which help to strength muscle and bones, treatment of correctable visual impairment such as cataract surgeries, as well as correction of age related vision loss with appropriate lenses.  Management of neurological diseases appropriately including home care of patients with degenerative diseases such as Parkinson’s disease, Alzheimer’s disease. Muscle strengthening exercises and balance retraining prescribed by a trained health professional for the elderly.

For elderly at much increased risk of falls and hip fractures from the falls, use of hip protectors can significantly reduce the risks of hip fractures due to a fall. These can include elderlies with balance, neurological disturbances, low bone density or a previous history of a fall.

For children, effective interventions can include community education programmes against falls such as modification of furniture and playing areas equipment in nurseries, as well as wearing appropriate protective gear while playing, proper supervision while playing or in the bathrooms.

Dr. Ian Shyaka, Resident, Plastic Surgery Rwanda Military Hospital iangashugi@gmail.com