to hospital in the elderly population. Not all falls result in a fracture but after examination and investigation an undetected underlying medical condition may be found and treated during a short period of assessment and rehabilitation.

There are several ways of classifying the causes of falls. Poor lighting may be an environmental cause of a fall. Many elderly people's houses are badly lit for various reasons, e.g. use of low wattage light bulbs to save electricity, curtains kept closed because of fear of burglars or nosy neighbours. Another related cause is lack of bedside lighting, i.e. an old person may fall while walking across the bedroom in the dark to reach the light switch. A high proportion of falls occur when elderly ladies, with a history of osteoarthritis, fall while getting out of bed to go to the bathroom during the night.

Trips and slips can happen both indoors and out. Rugs scattered throughout the house, a candlewick bedspread trailing on the floor, loose wires and mats strategically placed on highly polished floors or in the bathroom are a few of the many extrinsic hazards to be found in homes of the elderly.

In cases where the fall has occurred indoors with no apparent trip or slip, the client is investigated fully for any underlying condition, e.g.

hypotension, osteoporosis.

Outdoors there are many dangers facing the elderly; traffic, impatient bus drivers, uneven kerbs, and, of course, the weather.

Defective vision can also be a cause of falls. Following a cerebral vascular accident (stroke), hemianopia -- which is a defect in vision in half of the visual field -- can develop. This, coupled with the more common visual problems found in the elderly, e.g. cataracts, glaucoma, macular degeneration, can transform a familiar living room into a hazardous obstacle course.

Incorrect lenses in glasses can be equally dangerous. Some elderly people may not have visited an optician in several years because of poor mobility or fear that it may cost too much to have a new pair of glasses.

Drop attacks are commonly seen in the elderly. These attacks can occur at any time and can be extremely incapacitating and dangerous to the patient.

People suffering from Parkinson's Disease are prone to falls which are mainly a result of the typical shuffling gait associated with the condition.

Confusion and dementia are probable amongst the most common underlying causes of falls. Disorientation, disturbances of thought processes all predispose to a general lack of awareness of hazards and particularly dangerous situations.

Hypotension in the elderly can predispose them to falls. The drop in blood pressure leads to a decrease in cerebral blood flow causing syncope.

Osteoarthritis and rheumatoid arthritis, because of their debilitating nature, lead to generalised weakness and instability rendering the clients of these diseases prone to falls and fractures. Osteoporosis causes a reduction in the density of bone, allowing fractures to occur with little force. Often a sharp twisting of the body, usually seen when turning to answer the telephone for example, can cause a fracture which can result in a fall rather than the fall causing the fracture.

Whatever the cause, falls can be very traumatic experiences for elderly people, leaving both mental and physical scars. One of the most common complications seen is that of loss of confidence and fear of more falls.

SHARON GODWIN Community Occupational Therapist Health Department