Falling (accident)

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Falling
Toddler running and falling.jpg
Falling is a normal experience for young children, but falling from a significant height or onto a hard surface can be dangerous.
Frequency226 million (2015) [1]
Deaths527,000 (2015) [2]

Falling is the second leading cause of accidental death worldwide and is a major cause of personal injury, especially for the elderly. [3] Falls in older adults are an important class of preventable injuries. Builders, electricians, miners, and painters are occupations with high rates of fall injuries.

An accidental death is an unnatural death that is caused by an accident such as a slip and fall, traffic collision, or accidental poisoning. Accidental deaths are distinguished from death by natural causes (disease) and from intentional homicides and suicide. An accidental death can still be considered a homicide or suicide if a person was the unintentional cause.

Personal injury is a legal term for an injury to the body, mind or emotions, as opposed to an injury to property.

Old age consists of ages nearing or surpassing the life expectancy of human beings

Old age refers to ages nearing or surpassing the life expectancy of human beings, and is thus the end of the human life cycle. Terms and euphemisms include old people, the elderly, seniors, senior citizens, older adults, and the elders.

Contents

About 226 million cases of a significant accidental falls occurred in 2015. [1] These resulted in 527,000 deaths. [2]

Causes

Accidents

The most common cause of falls in healthy adults is accidents. It may be by slipping or tripping from stable surfaces or stairs, improper footwear, dark surroundings, uneven ground, or lack of exercise. [ according to whom? ] Studies suggest that women are more prone to falling than men in all age groups. [4]

Age

Older people and particularly older people with dementia are at greater risk than young people to injuries due to falling. [5] [6] Older people are at risk due to accidents, gait disturbances, balance disorders, changed reflexes due to visual, sensory, motor and cognitive impairment, medications and alcohol consumption, infections, and dehydration. [7] [8] [9] [10]

Dementia long-term brain disorders causing impaired memory, reasoning, and normal function together with personality changes

Dementia is a broad category of brain diseases that cause a long-term and often gradual decrease in the ability to think and remember that is great enough to affect a person's daily functioning. Other common symptoms include emotional problems, difficulties with language, and a decrease in motivation. A person's consciousness is usually not affected. A dementia diagnosis requires a change from a person's usual mental functioning and a greater decline than one would expect due to aging. These diseases also have a significant effect on a person's caregivers.

Illness

People who have experienced stroke are at risk for falls due to gait disturbances, reduced muscle tone and weakness, side effects of drugs to treat MS, low blood sugar, low blood pressure, and loss of vision. [11] [12]

Stroke Medical condition where poor blood flow to the brain causes cell death

A stroke is a medical condition in which poor blood flow to the brain results in cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both result in parts of the brain not functioning properly. Signs and symptoms of a stroke may include an inability to move or feel on one side of the body, problems understanding or speaking, dizziness, or loss of vision to one side. Signs and symptoms often appear soon after the stroke has occurred. If symptoms last less than one or two hours it is known as a transient ischemic attack (TIA) or mini-stroke. A hemorrhagic stroke may also be associated with a severe headache. The symptoms of a stroke can be permanent. Long-term complications may include pneumonia or loss of bladder control.

In physiology, medicine, and anatomy, muscle tone is the continuous and passive partial contraction of the muscles, or the muscle's resistance to passive stretch during resting state. It helps to maintain posture and declines during REM sleep.

People with Parkinson's disease are at risk of falling due to gait disturbances, loss of motion control including freezing and jerking, autonomic system disorders such as orthostatic hypotension, fainting, and postural orthostatic tachycardia syndrome; neurological and sensory disturbances including muscle weakness of lower limbs, deep sensibility impairment, epileptic seizure, cognitive impairment, visual impairment, balance impairment, and side effects of drugs to treat PD. [13] [14]

Parkinsons disease long-term degenerative neurological disorder that mainly affects movement

Parkinson's disease (PD) is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. As the disease worsens, non-motor symptoms become increasingly common. The symptoms generally come on slowly over time. Early in the disease, the most obvious are shaking, rigidity, slowness of movement, and difficulty with walking. Thinking and behavioral problems may also occur. Dementia becomes common in the advanced stages of the disease. Depression and anxiety are also common, occurring in more than a third of people with PD. Other symptoms include sensory, sleep, and emotional problems. The main motor symptoms are collectively called "parkinsonism", or a "parkinsonian syndrome".

Orthostatic hypotension, also known as postural hypotension, occurs when a person's blood pressure falls when suddenly standing up from a lying or sitting position. It is defined as a fall in systolic blood pressure of at least 20 mm Hg or diastolic blood pressure of at least 10 mm Hg when a person assumes a standing position. It occurs predominantly by delayed constriction of the lower body blood vessels, which is normally required to maintain an adequate blood pressure when changing position to standing. As a result, blood pools in the blood vessels of the legs for a longer period and less is returned to the heart, thereby leading to a reduced cardiac output. Mild orthostatic hypotension is common and can occur briefly in anyone, although it is prevalent in particular among the elderly and those with known low blood pressure. Severe drops in blood pressure can lead to fainting, with a possibility of injury.

Postural orthostatic tachycardia syndrome (POTS) is a condition in which a change from lying to standing causes an abnormally large increase in heart rate. This occurs with symptoms that may include lightheadedness, trouble thinking, blurred vision, or weakness. Other commonly associated conditions include irritable bowel syndrome, insomnia, chronic headaches, Ehlers-Danlos syndrome, chronic fatigue syndrome, and fibromyalgia.

People with multiple sclerosis are at risk of falling due to gait disturbances, drop foot, ataxia, reduced proprioception, improper or reduced use of assistive devices, reduced vision, cognitive changes, and medications to treat MS. [15] [16] [17] [18]

Workplace

At-risk workers without appropriate safety equipment Construction workers not wearing fall protection equipment.jpg
At-risk workers without appropriate safety equipment

In the occupational setting, falling incidents are commonly referred to as slips, trips, and falls (STFs). [19] Falls are an important topic for occupational safety and health services. Any walking/working surface could be a potential fall hazard. An unprotected side or edge which is 6 feet (1.8 m) or more above a lower level should be protected from falling by the use of a guard rail system, safety net system, or personal fall arrest system. [20] These hazardous exposures exist in many forms, and can be as seemingly innocuous as changing a light bulb from a step ladder to something as high-risk as installing bolts on high steel at 200 feet (61 m) in the air. In 2000, 717 workers died of injuries caused by falls from ladders, scaffolds, buildings, or other elevations. [21] More recent data in 2011, found that STFs contributed to 14% of all workplace fatalities in the United States that year. [22]

Companies must make sure that they follow the applicable safety legislation (e.g., the Occupational Safety and Health Act in the United States) to keep their work environments safe.

Risk factors

The National Institute for Occupational Safety and Health has compiled certain known risk factors that have been found responsible for STFs in the workplace setting. [19] While falling can occur at any time and by any means in the workplace, these factors have been known to cause same-level falls, which are less likely to occur than falls to a lower level. [19]

Workplace factors: spills on walking surfaces, ice, precipitation (snow/sleet/rain), loose mats or rugs, boxes/containers, poor lighting, uneven walking surfaces

Work organization factors: fast work pace, work tasks involving liquids or greases

Individual factors: age; employee fatigue; failing eyesight / use of bifocals; inappropriate, loose, or poor-fitting footwear

Preventive measures: warning signs

Intentionally caused falls

Injurious falls can be caused intentionally, as in cases of defenestration or deliberate jumping.

Height and severity

The severity of injury increases with the height of the fall but also depends on body and surface features and the manner of the body's impacts against the surface. [23] The chance of surviving increases if landing on a highly deformable surface (a surface that is easily bent, compressed, or displaced) such as snow or water. [23]

Injuries caused by falls from buildings vary depending on the building's height and the age of the person. Falls from a building's second floor/story (American English) or first floor/storey (British English and equivalent idioms in continental European languages) usually cause injuries but are not fatal. Overall, the height at which 50% of children die from a fall is between four and five storey heights (around 12 to 15 metres or 40 to 50 feet) above the ground. [24]

Prevention

Workplace safety campaigns attempt to reduce injuries from falling. Prevent falling accidents - NARA - 535301.jpg
Workplace safety campaigns attempt to reduce injuries from falling.

Rates of falls in hospital can be reduced with a number of interventions together by 0.72 from baseline in the elderly. [25] In nursing homes fall prevention problems that involve a number of interventions prevent recurrent falls. [26]

Epidemiology

Deaths due to falls per million persons in 2012
.mw-parser-output .refbegin{font-size:90%;margin-bottom:0.5em}.mw-parser-output .refbegin-hanging-indents>ul{list-style-type:none;margin-left:0}.mw-parser-output .refbegin-hanging-indents>ul>li,.mw-parser-output .refbegin-hanging-indents>dl>dd{margin-left:0;padding-left:3.2em;text-indent:-3.2em;list-style:none}.mw-parser-output .refbegin-100{font-size:100%}
0-15
16-21
22-33
34-44
45-55
56-69
70-88
89-106
107-129
130-314 Falls world map-Deaths per million persons-WHO2012.svg
Deaths due to falls per million persons in 2012
  0–15
  16–21
  22–33
  34–44
  45–55
  56–69
  70–88
  89–106
  107–129
  130–314
Disability-adjusted life year for falls per 100,000 inhabitants in 2004.
no data
less than 40
40-110
110-180
180-250
250-320
320-390
390-460
460-530
530-600
600-670
670-1000
more than 1000 Falls world map - DALY - WHO2004.svg
Disability-adjusted life year for falls per 100,000 inhabitants in 2004.
  no data
  less than 40
  40–110
  110–180
  180–250
  250–320
  320–390
  390–460
  460–530
  530–600
  600–670
  670–1000
  more than 1000

In 2013 unintentional falls resulted in 556,000 deaths up from 341,000 deaths in 1990. [28] They are the second most common cause of death from unintentional injuries after motor vehicle collisions. [29] They were the most common cause of injury seen in emergency departments in the United States. One study found that there were nearly 7.9 million emergency department visits involving falls, nearly 35.7% of all encounters. [30]

See also

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Falls in older adults age-related health problem

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Classification
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