From the Guidelines
A ground level fall can be serious and requires immediate assessment, especially in older adults, as it may indicate underlying health issues and can lead to significant morbidity and mortality. If someone has fallen, check for injuries such as cuts, bruises, broken bones, or head trauma. According to the study by 1, ground-level falls are the most common mechanism of injury in patients aged ≥ 65, and 6% of these patients will sustain a fracture, with a mortality rate as high as 7%. If the person is conscious, help them to a comfortable position and assess for pain or limited movement. For minor injuries, apply ice to reduce swelling (20 minutes on, 20 minutes off), take acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6 hours for pain, and rest the affected area.
Key Considerations
- Seek immediate medical attention if there is severe pain, inability to bear weight, visible deformity, head injury with confusion or vomiting, loss of consciousness, or if the person is elderly or on blood thinners.
- Falls in older adults should always be taken seriously, as they may indicate underlying health issues like balance problems, medication side effects, or vision changes.
- Prevention is crucial - remove tripping hazards, improve lighting, use assistive devices if needed, and consider strength and balance exercises to reduce future fall risk, as recommended by 1.
Prevention Strategies
- Home-based exercise programs and home safety interventions can be effective in reducing the risk of falling, but may have limited applications in active and independent people due to high costs for healthcare systems 1.
- Early assessment and management of "frail" patients is essential to provide them with proper treatment and improve clinical outcomes 1.
From the Research
Ground Level Falls
- Ground level falls are associated with significant mortality in elderly patients, with a mortality rate of 4.4% in patients older than 70 years compared to 1.6% in non-elderly patients 2
- The elderly are more likely to sustain long-bone fractures, pelvic fractures, and intracranial injuries from ground level falls 2
- A study of 596 patients with ground level falls found that the lower limbs, upper limbs, and face were the most common areas of injury, and that the elderly (>60 years) had a higher odds of sustaining a fracture or dislocation 3
Risk Factors and Outcomes
- Multivariate analysis showed that a Glasgow Coma Scale (GCS) score <15 and age older than 70 years were significant predictors of mortality in patients after ground level falls 2
- Patients older than 70 years and with a GCS score <15 represent a group with significant in-hospital mortality 2
- A study of elderly patients who fell from ground level at home with normal vital signs at the scene found that higher levels of care did not significantly affect outcomes, but a significantly higher proportion of patients from lesser-care facilities required follow-up services after discharge 4
Prevention and Management
- Rehabilitation nurses play a crucial role in preventing falls and fall injuries, particularly in vulnerable populations such as the elderly 5
- Multidisciplinary teams are essential to provide expert, age-specific health care delivery to this population across settings of care 5
- Determining specific risk factors and initiating multifactorial fall risk factors tailored to the individual is important for preventing falls 5
Related Conditions
- Acute lung injury and acute respiratory distress syndrome have been reported in a significant proportion of patients with critical neurologic illness, and risk factors include pneumonia, circulatory shock, and absence of a gag or cough reflex 6