What are the common types of injuries from falls in the elderly, including fractures, head injuries, and soft tissue damage, and what are the initial diagnosis and treatment steps?

Common Types of Injuries from Falls in the Elderly: Diagnosis and Treatment

Falls in elderly patients frequently result in fractures (particularly hip fractures), head injuries, and upper limb injuries, requiring prompt assessment of the entire body regardless of the presenting injury to avoid missing concurrent trauma.

Prevalence and Types of Fall-Related Injuries

Fractures

• Hip fractures are the most devastating fall-related injury, with approximately 95% of hip fractures resulting from falls 1
• Fractures are strongly associated with both osteoporosis and trauma, with both factors being necessary contributors to most age-related fractures 2
• Upper limb fractures, particularly distal radial fractures, account for approximately 30% of additional injuries in patients with hip fractures 3
• Vertebral compression fractures may occur concurrently with other injuries, representing about 12% of additional injuries in hip fracture patients 3

Head Injuries

• Head injuries, including subdural hematomas, are the second most common concurrent injury in patients with hip fractures, accounting for 24% of additional injuries 3
• These injuries may be easily missed when attention is focused on more obvious fractures, highlighting the need for thorough evaluation 3

Soft Tissue Injuries

• Chest injuries such as pneumothorax represent approximately 12% of additional injuries in patients with hip fractures 3
• Multiple injury sites are common, with about 6% of patients diagnosed with hip fracture having other fall-related injuries 3

Risk Factors for Serious Fall Injuries

• A history of previous falls is the strongest independent predictor of future fall risk 1
• Non-ground level falls (from heights >1m) result in significantly higher injury burden and longer ICU stays compared to ground-level falls 4
• Falls occurring inside the home and those resulting from loss of balance or dizziness are more likely to result in hospitalization 5
• Living alone increases the risk of hospitalization following a fall 5
• Lung disease and memory problems are associated with higher risk of emergency department visits 5

Diagnosis of Fall-Related Injuries

• Whole-body assessment is crucial in patients with fall-related injuries, even when a primary injury like hip fracture is obvious 3
• Special attention should be directed to:
  • Head examination for signs of trauma or intracranial bleeding 3, 5
  • Upper extremities for concurrent fractures, particularly distal radius 3
  • Thoracic examination for pneumothorax and other chest injuries 3
  • Spine assessment for vertebral compression fractures 3
• Diagnostic imaging should be guided by physical findings but should have a low threshold in elderly patients due to decreased pain sensitivity and potential for multiple injuries 3

Initial Treatment Steps

• Prioritize stabilization of life-threatening injuries (head injuries, chest trauma) 5
• Manage fractures appropriately:
  • Hip fractures typically require surgical intervention 3
  • Upper extremity fractures may require immobilization or surgical repair depending on displacement 3
• Pain management should be prompt and appropriate for elderly patients, considering comorbidities and medication interactions 5
• Early mobilization (when appropriate) is critical to prevent complications of immobility 4

Prevention Strategies

• Multicomponent exercise programs to improve balance and strength 1
• Home hazard assessment and modification 1
• Use of hip protectors in high-risk individuals 1
• Fall prevention strategies should include active older individuals at risk of high-level falls, not just frail elderly 4
• Addressing modifiable risk factors for osteoporosis to reduce fracture risk when falls occur 2

Common Pitfalls in Managing Fall-Related Injuries in the Elderly

• Focusing only on the obvious injury (like hip fracture) and missing concurrent injuries 3
• Underestimating the severity of injury due to altered pain perception in elderly patients 5
• Failing to identify the cause of the fall, which may indicate underlying medical conditions requiring treatment 5
• Not recognizing that falls with serious injuries frequently occur in otherwise active, independent elderly individuals 4