When Tamli Bai, an elderly woman of Sandukon Ka Guda village fell down sometime back, stumbling over a protruding stone just outside her home, her family members thought that this injury would heal soon. So they gave her some home based treatment. However Tamli just could not get up and with added complications, died in a few days.
Bhamri, another elderly woman from this village located in Kumbhalgarh block of Rajsamand district (South Rajasthan) fell down twice in the uneven, stony courtyard of her home. The shoulder injury from one of these falls is still a constant source of pain for her after a long time has passed.
The difficulties faced in the case of Dolibai, an elderly woman of Kakarvar village in the same block are even more severe. She is from a slightly better placed household, but her difficulties just now are acute. She fell down in the bathroom, partly because there is no railing in the staircase close to the bathroom. As she just could not stand, somehow a vehicle was arranged to take her to a hospital in Udaipur. This had to be done twice. Despite the availability of ayushman health care scheme for free care for elderly people, the family had to spend about rupees 50,000 in various additional expenses. Still, the treatment did not have the desired impact. Dolibai is still confined to bed. The expenditure incurred and the care required have been a big setback for this household. As hospital treatment has already been tried, they are at the end of their wits regarding what step to take next.
These are only a few examples I heard in the course of recent visits to several villages of South Rajasthan.
A review of several such accidents by Prabal Yatra, a program for healthy and safe ageing in South Rajasthan, has revealed that most of such accidents could have been avoided by timely interventions to create safer conditions in and around the home. It is equally clear that even relatively smaller intensity accidents can prove more costly and serious in conditions of remote villages and poorer households because of the difficulties and delays in accessing medical care. Falls are most common among elderly people and their ability to recover from injuries is lesser.
While there are certainly some causes of special concern relating to fall related accidents among elderly people in remote rural areas and among poorer households in particular, the wider dimensions of this problem also should not be forgotten, as falls remain a very important danger for elderly people in all sections of society.
According to the latest available WHO data, after road accidents falls are the second most important cause of unintentional injury related deaths at world level. In a typical year at world level about 700,000 people die in falls related accidents. The highest fatality rate related to falls is in the age group of over 60 years. There are 31.7 million falls in a typical year that are serious enough to require medical attention. There are some indications that this may be an underestimate. Nearly 80 per cent of fall related deaths take place in middle and low income countries.
According to estimates for year 2021, fall related deaths are particularly high for older people, around 555,539. The highest number of these deaths are in South Asia—estimated at 177,938 (see paper titled 'Global, Regional and National Burden of Falls among older adults—findings from global burden of disease study 2021 and projections up to 2040).
However if one sees this issue from the lens of developed countries, the problem is still serious, as is evident from the data relating to the USA. In the USA falls are the single most important cause of injuries among the elderly people over 65 years of age. In a typical year nearly 25% of elderly people suffer from a fall injury in USA. Nearly 37% of these injuries require medical treatment.
Hence while falls in poorer households and remote villages certainly remain a special cause for concern, nevertheless the wider dimensions of the problem cannot be ignored.
All the available evidence shows that a substantial number of falls can be prevented by taking adequate safety steps. This is important at all levels, but even more so in poorer households and in remote villages where timely and adequate treatment becomes more difficult. Improving safety conditions in and around home, improving lighting, improving footwear, improving eyesight, reducing alcoholism and substance abuse can be some of the components of reducing serious fall accidents. Sometimes elderly people have to carry heavier loads that they can handle due to various factors, resulting in serious falls. Community efforts should be made to help in avoiding such conditions. While the efforts of elderly persons to keep themselves active in healthy ways should be encouraged, extreme situations for them such as carrying excessive load should be avoided with community help and other assistance.
Overall there is much greater need for safety consciousness, and according more importance to reduction of fall accidents in safety planning.
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The writer is Honorary Convener, Campaign to Save Earth Now. His recent books include Protecting Earth for Children, When the Two Streams Met, Man over Machine and A Day in 2071
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