Text: Andrée-Marie Dussault
Photo: Linda Roberts Matzinger

Falls: A Difficult Challenge

As the Swiss population has become older, falls and the problems they cause have become a real public health issue. While the key to preventing the worst is often catching yourself, new technologies can also make it easier to anticipate falls.

At age 88, Berthe was healthy, fully independent and living on her own with her cat. That is, until the day she tripped at home, bumped into a piece of furniture and fractured her hip. The former librarian is one of the 30% of people aged 65 and older who fall every year in Switzerland according to data from the Federal Statistical Office.

Currently, falls are second only to car accidents as a cause of fatalities from accidents or involuntary trauma. In addition to suffering, time away from work, surgeries, and hospitalisations, falls cost millions of Swiss francs in health expenses every year.

Unavoidable falls and self-protection

While children heal from broken bones caused by falls in a matter of weeks, the same fracture can mean the beginning of the end for the elderly according to Olivier Borens, physician in chief at the Trauma and Septic Surgery Unit at Lausanne University Hospital: “A fall can cause elderly patients to start to lose their independence and lead to a significant decrease in quality of life.”

"Broken bones caused by falls can mean the beginning of the end for the elderly."

Children’s bones are more elastic and less frail – plus, they’re used to protecting themselves, explains the doctor. “When children fall, they tend to fracture a bone in their arms, whereas people over the age of 65 tend to break a bone in their legs, like their ankle, knee, or femur, rather than a bone in their arms, like the wrist, radius, or humerus.”

There are two groups of people who are especially vulnerable to injuries caused by falls. Men between the ages of 20 and 30 are the most at risk; the falls that occur in this age bracket are most often associated with high-intensity activities such as car or work accidents. Women aged 70 to 80 are just as much at risk, however, because they are more likely to suffer from osteoporosis, which reduces bone mass and density, explains Olivier Borens. “In this age group, in absolute terms, women are three times more likely than men to break a bone in a fall”.

After a certain age, falls become practically unavoidable. “We become less stable, we lose our balance more easily and we react more slowly,” says the specialist. “Naturally, if a patient has been an athlete all her life, she will have stronger bones and muscles and will be more active. On the other end of the spectrum, if she has led a sedentary life, eats a poor diet, and doesn’t get enough calcium and vitamin D, her bones will be more fragile.”

After completing two sessions of physical therapy, some older people can become more alert, have a better posture, learn to protect themselves better, and – most importantly – get better at catching them selves when they start to fall. Indeed, the seriousness of falls often depends on how people catch themselves.

Illustration: Linda Roberts Matzinger

A tool to bring falls to heel

Given that the population is ageing and more prone to falls, geriatric trauma must evolve, says Olivier Borens. “In the near future, we’ll have to invest in fall preven-tion, methods for strengthening porous bones, surgical techniques, and centres for accommodating and rehabilitating elderly patients after a fall.”

Technological solutions could also help prevent and anticipate falls. One example is the smart exoskeleton developed by researchers at EPFL and Italy’s Scuola Sant’Anna; this robotic suit prevents the wearer from loosing his or her balance. A walk analysis system designed by Vaud start-up Gait Up has created quite a stir. “It’s a type of mobility ‘thermometer’ specifically developed for use by health professionals, clinicians, physical therapists and researchers,” says Sales Manager Cléo Moulin.

The device, which is just three centimetres long and one centimetre wide and attaches to the patient’s shoe, takes a range of measurements, including walking speed, symmetry, and foot height. Walking is a good indicator of a person’s general health, according to Moulin. “Mobility is the result of a patient’s cardiac, pulmonary, muscular and bone condition. By analysing mobility, we can precisely predict an individual’s fall and morbidity risk. For example, it has been shown that a walking speed of 1.2 metres per second is needed to cross a road safely and that walking 0.6 metres per second predicts a risk of falling and hospitalisation,” she says. Tracking how these statistics change over time makes it possible to anticipate risk even before the patient starts exhibiting the early signs of decreased mobility.

As with a patient’s temperature and blood pressure, many gerontologists are now incorporating the device into their daily routine and medical exams. The mobility system’s main advantages are its speed, precision, and user-friendly design. The test, which consists of asking the patient to walk 10 metres and then walk back, can be completed in two minutes. The results are then analysed and can be viewed on a tablet or computer.

“The system replaces a laboratory of sophisticated equipment requiring trained personnel.”

Costing between 3,000 and 7,000 Swiss francs, the device can also show how a patient is recovering after a joint replace-ment surgery, if a treatment is effective, and even diagnose neurological disorders like Parkinson’s disease. “In a society where you always have to justify your decision to prescribe or not prescribe a treatment, it’s useful to have such precise and concrete data. It also helps you find the right treatment plan for the patient.”

At Lausanne University Hospital, the Geriatric Service has been using Gait Up’s device for about 15 years. “It’s improved significantly over the years. Nowadays, it’s as small as a matchbox and provides much more data than before,” says Christophe Büla, chief of the geriatric and geriatric rehabilitation service, who is happy to see that use of the device is growing. /



Falls and Figures

280,000: the average number of victims of falls in Switzerland between 2010 and 2014. Out of this group, 1,400 people died from their injuries. Ninety-six percent of these deaths involved the elderly. One-third of people aged 65 and over fall each year. The vast majority of falls (94%) occur at home. Nine out of 10 hip fractures are caused by falls. In a report published this year, the World Health Organization estimates that nearly 37.3 million falls are serious enough to require medical attention each year, and that 424,000 of these falls are deadly.

Strategies for reducing risk

It's important to eat well and exercise to increase your strength and balance. Another strategy is to carefully examine your home and behavior for any potential risks. For example, you could cover any cables lying on the ground, secure corners of rugs to prevent them from curling up and improve your lighting. You can also wear non-slip socks and shoes, add a mat and handles in the bathtub, and hold on to the railing when climbing or going down stairs. Finally, another strategy is to avoid the abuse of alcohol, drugs and medicines.