Alcohol and Falls

On a common sense level, you would think that there is an obvious relationship between alcohol and falls. In the Seniors Health Study, a significant proportion of the outreach clients had experienced serious falls or fractures (broken hips).

Alcohol literature usually lists frequent falls as a sign that a senior may have an alcohol problem. Alcohol is well recognized as having an important role in falls among young people.(1) And many of the health consequences of long term drinking, such as peripheral neuropathy, are known to be associated with older adults falling. Brain imaging research also indicates that heavy alcohol consumption leads to shrinkage of the cerebellum which helps regulate coordination and balance. (2)

Somewhat surprisingly, people who work in the area of falls research do not talk about alcohol as a risk factor for falls among older adults. However, they do talk about medications such as benzodiazepines as a risk factor. (3) The effects of alcohol and benzodiazepines are very similar in many respects.

It may be that the research studies are not asking the right questions. Or people may feel embarrassed asking a senior who has fallen "Were you drinking?" Many seniors feel embarrassed answering truthfully if alcohol might have had a role in the fall. There may be significant time delays between drinking, the fall, and actual hospitalization and any blood alcohol testing.

Researchers seem to be uncertain about whether they should be focussing on short term effects (drinking too much on one occasion); or whether they should be focussing on the long term effects of alcohol consumption (poor health, poor balance, cognitive impairment).

Falls are the leading cause of injury admissions to Canada's acute care hospitals. The rate of falls is almost five times higher among seniors aged 65 years and older, at 154.8 per 10,000 population compared to the average rate. (4)

Falls were the cause of 85% of all injuries requiring hospitalization among seniors aged 65 years and older. The majority of these are preventable.

New Research

New research reported in the Academy of Emergency Medicine looked at "at risk drinking" and injury among older adults ( age 60+) coming to an Emergency Department. (5) The researchers looked at 284 injured older adults coming to a university hospital emergency department over a two and half year period.

They found that approximately 1 in 10 (11%) of the injured older adults was an "at risk drinker"*, and "a significant minority of these patients were taking medications which may result in a moderate or severe adverse drug reaction with alcohol." There were gender differences --at risk older drinkers were more likely to be male (71%). Among the at risk drinkers, 30% were taking one or more medications that could cause a moderate or severe drug interaction with alcohol.

In the study, the researchers found that falls (66%) were the most common injury for older adults, and most of these injuries were fracture/dislocation (34%), laceration (23%), or contusion/abrasion (23%). 30 (11%) of the older patients were admitted to hospital.

*At risk drinking typically refers to where a person drinks more than 1-3 drinks per day and/or 3-4 drinks per occasion. The people are considered at risk of trauma, accidents, or depression. However, many may never run into any of these problems.

See About Bones and Alcohol

Sample Prevention Resources Linking Medications/ Alcohol to Falls

Some communities have developed great resources that link medications and alcohol to falls. For example, see this handout developed by the City of Hamilton Program for Aging Well: www.hamilton.ca/PHCS/Publications/Fact-Sheets/Falls.PDF

An excellent "Falls Prevention" calendar for seniors was developed in 2002 by FOCUS Community Coalition in the Smith Falls area of Ontario. It has been reprinted each year since.

Quote of Week:

Don't drink yourself helpless in beer gardens. You speak and don't know what you say. You fall and break your limbs and no one helps you. Your drinking companions say "Away with this drunkard."

(attributed to a Egyptian temperance tract 1000 BC)

For more information on research on the role of alcohol in falls among seniors, see Spencer, C. (1999) GRC News, Vol. 17 (No. 4) The Role of Alcohol in Falls: Bridging Disciplines www.harbour.sfu.ca/gero/grcn_pdfs/vol17no4.pdf.

References:

1. Malmivaara, A., Heliovaara, M., Reunanen, A, & Aromaa, A. (1993) "Risk factors for injurious falls leading to hospitalization or death in a cohort of 19,500 adults" Amer. J. Epidemiology 138 (6) 384-394.
2. National Institute on Alcohol Abuse and Alcoholism (NIAAA) , Alcohol Alert, No. 47 April 2000. Imaging and Alcoholism: A Window on the Brain. www.niaaa.nih.gov/publications/aa47.htm
3. Tideiksaar R. (1996) Falling in Old Age Springer Publishing Co. at 151.
4. Canadian Institute for Health Information. www.cihi.ca/medrls/27feb2002.shtml
5. McLean, S.A., Blow, F.C., Walton, M.A., Barry, K.L., Maio, R.F., & Knutzen S.R. (2003) At Risk Drinking among Injured Older Adults Presenting to the Emergency Department. Academy of Emergency Medicine; 10(5): 536.

    

    

 Page last updated Wednesday March 02, 2005

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