Why We Fall

President Jimmy Carter is recovering from surgery for a broken hip sustained after a fall at home. The 94-year-old is, thankfully, doing well by all reports. Though the broken hip warrants immediate intervention, determining why we fall is paramount.

Did an individual accidentally trip and fall while otherwise completely intact? Or, was there a medication or disease state that impaired mobility or sturdiness? Often— but, not always— these occurrences go hand in hand.  

When it comes to public release of information about the former President’s health, you may recall he was successfully treated with surgery, radiation and immunotherapy in 2015 for metastatic melanoma that spread to his liver and brain (read full account here) or his 2017 bout with dehydration while working in the hot sun (review at this link). No matter a patient’s age or any other consideration, all of these factors will play a vital role in informing a proper medical assessment is performed and treatment plan developed.

Consider a few years ago the famous singer-songwriter Leonard Cohen, as per his manager Robert B. Kory’s statement,

“died during his sleep following a fall in the middle of the night on November 7th. The death was sudden, unexpected, and peaceful.”

Ironically at that time in 2016, the Centers for Disease Control and Prevention (CDC) released their estimates of preventable deaths from the five leading causes. With preventable cancer, stroke and heart disease deaths down, it was unintentional injuries that surged 23% —mainly due to drug poisoning and falls.  

Entertainment Weekly had reported

“According to recent interviews with the New Yorker, Cohen battled cancer and came to terms with his own mortality. “I am ready to die,” he said. “I hope it’s not too uncomfortable. That’s about it for me.”

Given Mr. Cohen’s public record of an apparent cancer diagnosis, an accurate nature of the fall, therefore, got a bit cloudy.  

The following data from that CDC report showed the five leading causes of death in 2014 in the United States for those under 80 where premature deaths were deemed avoidable—compared to 2010. Though highlighting unintentional injury here, you can review all causes at this link.

Potentially Preventable Deaths from UNINTENTIONAL INJURY increased by 23%

Falls are an enormous cause of catastrophic injury and death. They impact millions of those over 65 as 1 in 4 older people fall per year with less than 50% informing their physician. Happening once is a risk factor for recurrence. Fear of falling becomes a very real symptom that limits daily activity. The more immobile a person is, the more at risk he is of other disease sequelae.

The CDC estimates fall injuries prompt $31 billion of direct medical costs. Home improvements as well as a firm grasp of what medical conditions and medications or drugs are in the mix can aid preventive efforts. Each of these significantly contributes to unintentional injury and death as also evidenced by the opioid epidemic.  

As I always say with respect to trauma, it is location, location, location that determines the outcome. High real estate pays the ultimate price. Head injury is a very dangerous one with falls being the #1 cause of traumatic brain injury. One in five falls triggers such serious consequences that also include hip fractures and broken bones. Fall injuries account for over 800,000 hospitalizations.  

Why we fall and our cascade of injury reveals a lot

Who among us hasn’t been a bit clumsy or distracted and fallen as a result. This consequence simply is what it is, what got broken might need fixing. That’s why we call them accidents. But, the better a person’s clinical status prior to a fall, the more resilient he will be after it.

When enduring one, the key issues surround the context of it. For example, did someone simply accidentally trip or did lightheadedness or dizziness incite the trauma? This can speak to more worrisome reasons that need to be addressed (e.g. arrhythmias, stroke, dehydration, infection).

Did the mechanism of injury match the resulting physical sign? For instance, bumping into a desk while walking should expectedly cause nothing or a minor bruise. A forceful hug, for example, should not break someone’s ribs and if it does then it is necessary to consider what are called pathological fractures (ones from disorders of bone itself like severe osteoporosis or cancer).

To read about Justice Ruth Bader Ginsburg’s rib fractures after her fall, see here. Or, why we faint in general along with Minnesota’s Governor Mark Dayton’s collapse while giving the State of the State address here. President Trump’s former National Security Advisor, General H.R. McMaster, lost his father from complications of a "suspicious" and "accidental" head trauma secondary to a fall while a resident of a senior living facility, see story at this link. A nurse was ultimately charged "with neglect of a care-dependent person, involuntary manslaughter and tampering with records stemming from the death," read Washington Post piece here.