Montreal seniors often fall at home, risking the worst injuries: CIUSSS report

Just because a senior is independent doesn’t mean they are completely safe in their homes. The main danger they face is falling, especially when they just wake up.

A new report released Monday by the CIUSSS du Centre-Sud de l’Île-de-Montréal public health department tells us that falls among people aged 60 and over occur more often in the morning, especially in the bedroom and bathroom.

“I expected the bathroom to be the most common place for falls, but the bedroom surprised me,” said Barbara Fillion, occupational therapist and lead author of the “Report on Indoor Falls Among the Population Aged 60 and Over in Montreal for the Period 2015 to 2021.”

She says she then checked other research to see that she and her team weren’t the first to make this observation. “I did find articles where the bedroom and bathroom were the most common, along with stairs, for example, for falls occurring inside the home, but for me, it was a surprise.”

Also, she says, the preferred time of day wasn’t what she expected. “I would have expected falls to be mostly at night, when you wake up and are still a little sleepy or under the influence of medication, but the increase, the peak increase when you wake up, actually makes sense when you think about it, but it’s one of the surprises we had when we looked at the data.”

Leading cause of death among seniors

The issue of falls among seniors, regardless of location, is not trivial. A survey released last January by the Institut national de la santé publique du Québec (INSPQ) revealed that “falls are the leading cause of death from unintentional injuries among people aged 65 and over in Quebec” and that from 2000 to 2021, “the number of deaths attributable to falls quadrupled among the Quebec population aged 65 and over.”

According to this study, entitled “Mortality Attributable to Falls Among People Aged 65 and Over in Quebec from 2000 to 2021,” the rate of deaths attributable to falls increased from 79 deaths per 100,000 people in 2015 to 136 deaths per 100,000 people in 2021.

Fillion mentioned that stairs were excluded from the study published Monday due to Montreal’s unique architecture, with its countless exterior staircases. However, the Urgences-santé reports, which served as the basis for this study, do not distinguish between interior and exterior staircases. It was therefore preferred to exclude this type of fall in order not to confuse the issue, as a previous report from the same team led by Fillion focused on data from outdoor falls in 2023, where weather conditions with ice, snow and wind play a much more important role in the causes of falls.

Women: surprising results

The study has other significant methodological limitations, the researcher acknowledges, particularly when it highlights the disproportionate number of falls among women, who represent two-thirds of the approximately 60,400 Urgences-santé records analyzed. In other words, for every fall by a man, the records show two falls by women.

“Women live longer, and there are also more of them as they age, but equally, they don’t fall more. It’s just that, for women, there are often more serious consequences for a fall, largely related to osteoporosis, which further weakens women’s bone density with age, so that when a fall occurs, it can have more serious consequences for women than for our older men.”

Here again, we come up against the methodological limitations of the study, warns Fillion. “These results are just the tip of the iceberg. We already have a large number of falls, but there are also a large number that go under the radar, either because they aren’t recorded there or because they aren’t reported. Some people won’t call Urgences-santé after falling and will try to organize themselves.”

We can also suspect that men call Urgences-santé less, although this doesn’t mean they are unharmed. But even when they do call, only 58 per cent of them will require transport to the hospital, compared to 67 per cent of women.

Prevention tips

How can we intervene, from a prevention perspective, to reduce the risk of falls among seniors? A look at the risk factors provides some insights. These risk factors fall into three categories: individual, behavioral, and environmental. The first depends on each person: “their age, their chronic illnesses, medication use for this or that reason, their vision, hearing problems, existing balance problems, things that put them at risk of falling and that can’t necessarily be changed,” Filion said, while reminding that it’s wise to have an annual eye exam, free for those over 65, and to have their medications checked.

It’s easier to influence behaviors, for example, breaking a sedentary lifestyle and moving around, eating better, and sometimes even accepting their age and the limitations it imposes. “When you live alone, when you’ve always done things by yourself, and then you climb to get things from high up, you put yourself at risk.” As for the environment, clutter, common among the elderly, is mentioned, sometimes transforming their living space into an obstacle course.

It doesn’t stop there, Fillion points out: “It could be that there are rugs that aren’t secured, that there aren’t grab bars in the bathroom, or that there isn’t good lighting everywhere,” she listed.

The report contains multiple recommendations in this regard, but does not go so far as to ask the RAMQ to cover the cost of fall alert bracelets or necklaces. “We may come to that, but for now, we’re not there yet,” said Fillion.

Although her study looked at events that occurred in Montreal, the results should be similar elsewhere in the province. “We can still think, and I’m not certain about this, but we can still think that this is possibly what we find everywhere.

“It is well established in the literature that from the age of 65, approximately one in three people will fall each year, and from the age of 80, there is a more marked increase to one in two.” Hence the need to focus on prevention in a society where the demographic curve is leading to an aging of an increasingly large proportion of the population.

With a health-care system that is struggling, the authors of the report point out that “in 2018, in Canada, it is estimated that the direct cost associated with falls among people aged 65 and over was $5.6 billion.”

–This report by La Presse Canadienne was translated by CityNews