Geriatric fractures or fractures in elderly people is a special category of fractures in adults.
With age the bones lose their mineral content and become weak, a situation called osteoporosis.
Therefore old people are prone to injuries with minimal trauma. A trauma which would be tolerated easily in young adults would result in fractures in elderly. Sometimes, the fractures in elderly can be caused by routine movements of getting up or bending down.
This subgroup of fractures in the elderly is also known as geriatric fractures.
Types of Fractures in Elderly
A few fractures are more common and typical of old age. These include
- Fracture neck of femur
- Fracture of the intertrochanteric region in the femur
- Fracture of distal end of the radius
- Osteoporotic compression fractures of the spine [Back fractures in elderly]
- Fractures of the upper end of humerus
Associated Medical Illnesses
Elderly people also have many other problems or medical illnesses. Diabetes, hypertension, cardiac problems, respiratory illness, neurological problems are a frequent accompaniment of old age. Therefore elderly people are at more risk when compared to young adults for any kind of surgical procedure.
The associated medical illnesses may force the surgeon to exercise a treatment option which has lesser risk rather than going for the best treatment.
There are a lot of associated problems too and that makes the fractures in the elderly different category for treatment purpose. As the joints age, they are more prone to get stiff with immobilization. That demands watchfulness and extensive physiotherapy for these persons.
Lesser Demands and Expectations From Treatment
Another factor in the treatment of fractures in the elderly is that they have lesser physical demands, unlike young adults.
With an increase in our understanding of the causes of associated morbidity, newer devices and newer treatment methods aim at the reduction of all these. But still, elderly people are a subgroup of the population who stand the higher risk.
There is a social problem too. Many of the old people are not provided a reluctant care by their family. Many stay alone because their children have moved to some other place. This frequently results in depression and lack of enthusiasm to live. We need to have a relook into our social structure.
Most practical is to avoid trauma. This would prevent getting injured and the morbidity that follows. With some simple precautions, one can avoid falling or tripping.
Elderly people should also make an active effort to maintain an active lifestyle and take a good diet.
This would help them to keep a good bone stock for a long time.
Prevention of Fractures in Elderly
Prevention of the fractures involves any or all of three basic measures
- Fall prevention
- Prevention and treatment of bone fragility
- Use of protectors.
Fall Prevention in Elderly
Preventing a fall in elderly needs to target factors that lead to fall.
The factors can be categorized as either
Intrinsic – (related to such internal factors as the patient’s medical or physical condition
Extrinsic – related to external causes, such as environmental hazards or weather condition
Intrinsic Causes of a Fall
Two things are responsible for intrinsic causes
- Disease processes
It is important to note that one or more of several affected body system or condition may play a contributory role in a fall
Vision can be affected by [hazy or cloudy vision, altered depth perception, night blindness, and poor peripheral vision]
- Macular degeneration
- Diabetic retinopathy
- Improper use of corrective lenses
Condition affecting the Ears
A defective hearing could lead to a failure to listen to warning noises, horns and misjudgments.
Vestibular dysfunction from degeneration of the structures of the inner ear results in loss of balance
Many neural conditions affect the elderly including parkinsonism, transient ischemic attacks, residual weakness from stroke, neuropathy etc. All of these affect gait and cause weakness, tremor and imbalance, dizziness, and sensory disturbances.
Moreover, diminished reflexes, proprioception, and spatial sense could complicate matters.
Conditions like Hypertension, hypotension, peripheral vascular disease, arrhythmia, and congestive heart failure can cause weakness, dizziness, sensory disturbance, and/or fainting.
Dementia, depression, psychotic episodes, and substance abuse can cause impaired functional status, poor judgment, social isolation, and hallucinations.
Arthritis, deformities, changes in posture, impaired function status, pain, stiffness, and gait disorders, lower-extremity muscle weakness may cause fall. Foot problems like. calluses, corns, ingrown toenails, infection, tendon contractures, bunions, and neuromas can also increase fall risk.
- Acute illness
- Urinary conditions resulting in urgency and frequency of urination increase the risk of a fall
- Poor nutritional status.
- Medications like narcotics, sedatives, and antidepressants
Extrinsic Causes of a Fall
Falls arising from extrinsic causes are easier to prevent by observing simple safety precautions, particularly in the otherwise home environment.
Observing safe measures and avoiding risky behavior goes a long way. A thorough home assessment and making it elderly safe, helps in curbing the risks of fall.
Slippery bathroom surfaces are often responsible for a fall. Safety equipment like a tub bench and hand-held shower to allow bathing from a seated position. Should be used.
Study handrails positioned next to tub and toilet areas assist in making a safe transfer.
Many people fall in the kitchen when reaching or bending for stored items. Frequently used items should be stored at waist level. Step stool should have a wide base of support.
Night lights are a simple effective remedy to prevent falls as falls occur when a person gets up and moves in the dark. Patients should also be reminded to allow time for their bodies to adjust to an upright position before standing and walking bedroom slippers should cover the entire foot and be supportive, with non-slip soles.
The living room, dining room, and hallways should be well lit and free of obstacles, torn carpets or scatter rugs.
Telephone and electrical wires should be secured to walls and not strung across the floor.
These steps are not in personal control and require policy decisions. Weather, bad pathways, potholes, and crowds become a hazard.
Weather becomes a factor when slippery and it is better for elderly persons to plan ahead and avoid foul weather if possible.
Ill-fitting or worn shoes can lead to a fall both directly and indirectly. Shoes should be low-heeled and have non-slip soles with sufficient treads for good traction. Slippers should cover the foot and have non-slip soles.
Living alone, inability to afford food and other necessities, and isolation from family and/or community increase the risk.
General tips to prevent falls
Falls are very common causes of fractures, especially in old age. With age, bones start getting weak and prone to fracture with the slightest trauma.
With age also come many medical problems, joint stiffness, loss of agility and one tends to fall more often.
But even that should not prohibit you to move around and enjoy what you do. You need to be extra cautious though.
First to deal with is osteoporosis itself. Osteoporosis can be improved by taking good diet in calcium and exercise and if required, medications to increase bone mineral density.
For exercises, one should choose low impact activities like walking, or swimming.
Get Yourself Checked
Do you have any medical condition that affects your balance? Eyes and ears are important elements in the maintenance of the balance and their problems are especially likely to upset your balance.
Avoid Medicines That Make You Dizzy
Talk to your doctor if you are on medication and you feel sleepy or dizzy. Some medicines can cause these adverse effects. Talk to your doctor and find if some of the drugs could be replaced with those that do not cause these effects.
Watch your steps. Avoid slippery places. Highly polished marble or tile floors can be slippery. Avoid tripping on carpet edges or corners, uneven surfaces, curbs, and high door thresholds.
Choose proper fitting footwear with low heels and soles that are slip resistant. Always replace the worn out shoes and tie your laces. Walking barefoot or with socks increases your chances of fall.
Arrange things at home so that it is easy to walk in and around your home. Avoid chairs, stools and other obstacles out of your path. Keep your flooring clean and remove every littered object to avoid any unwanted tripping.
Avoid electric and other cords on the floor. Keep them high on the wall even if you need to invest in more length of the cord.
Make sure electric cords and phone lines are out of the way. Don’t forget your yard — rake leaves to keep walkways clear.
Watch out for pets too. They can come under the foot and make your trip.
Do not rush. Accidents, mostly, happen when you are in rush.
Use safety devices as per your and surroundings’ requirement. Grab bars, rubber mats in the bathroom, handrails on both sides of the stairs, skid-proof rugs, canes are few examples.
Amount of lighting affects your vision. Keep your rooms bright. Install light switches near the entrances of rooms and at the top and bottom of the stairs. Use lots of nightlights.
Keep multiple flashlights handy in case of power outages.
Alcohol makes you unsteady and can cause bone loss and make them weak further. Instead, shift to healthier drinks like fortified juices.
Prevention and Treatment of Bone Fragility
Bone mass is related to fracture risk and that bone strength and mass decrease with increasing age.
Alendronate and estrogen replacement are the most effective methods to stop bone mineral loss and consequently reduce the incidence of fracture. Thiazide diuretic is most appropriate in patients with elevated urinary calcium levels.
External Protective Devices
External trochanteric padding and external hip protectors protect against hip fracture but could be cumbersome to wear.