The busiest trauma centre here is seeing a worrying increase in the proportion of elderly patients – highlighting the need for fall prevention as Singapore ages.

Tan Tock Seng Hospital’s (TTSH) emergency department handles 38,000 trauma cases a year – about a third of all such cases here.

In 2012 and 2013, one in five patients needed to be warded. Among the elderly, however, more than half needed to be hospitalised, the hospital has revealed.

Over this period, seniors with fall-related injuries made up nearly half of all cases of trauma, which refers to physical injury due to causes ranging from traffic accidents to burns.

“Trauma used to be thought of as a condition that afflicts only the young and road users,” said Senior Minister of State for Health Amy Khor, in her opening address at a two-day international trauma conference yesterday at TTSH.

But National Trauma Database statistics show that one in three cases of severe trauma occurs in those above 65 years old, she pointed out. “Injury and falls prevention should therefore be a priority for elderly Singaporeans, and all the more as we prepare for a rapidly ageing population.”

Older people fall more often because their reflexes are slower, and they have poorer eyesight. “Sometimes falls are due to pre-existing conditions like diabetes or hypertension,” said Dr Chua Wei Chong, a consultant trauma surgeon at TTSH. The problem is made even more acute since the elderly take longer to recover. Not only are they warded up to eight days more than younger patients, the risk of death for older patients is also 1.5 times higher than for those under 65.

“Some also have pre-existing medical conditions that can cause complications and affect their recovery,” said Dr Chua.

Most elderly trauma patients at TTSH come in with fractured wrists, spine or hips. The last of these, said Adjunct Associate Professor Ganesan Naidu Rajamoney, is the most debilitating. “When you have a hip fracture, the patient is unable to walk and becomes bedridden,” explained TTSH’s head of orthopaedic surgery.

About 600 patients come in with hip fractures every year, all of whom are above 65. The average age of this group is also growing, making recovery even harder. “Now, the majority are about 75 or 80 years old,” said Prof Ganesan.

In her speech, Dr Khor highlighted various nationwide schemes to help prevent falls among seniors, such as the Health Promotion Board’s 12-week exercise programme for the elderly to help strengthen their muscles.

The Housing Board also started a programme in 2012 to subsidise the installation of elderly-friendly features, such as grab bars, in flats. Falls can be caused by insufficient lighting in homes and cluttered surroundings. This is where family members can play a part, said Mrs Sofie Moreels, a caregiving consultant at Active Global Specialised Caregivers.

Something as simple as anti-slip mats in bathrooms can help. “You should also make sure to monitor their medication and that they get regular exercise, because these can affect balance,” she said.

The elderly also have to accept that they may not be as mobile as before and be willing to get help. "They can use a walking aid for instance,” Prof Ganesan said. “But sometimes, the elderly don’t want to be seen as being weak."

4/12/2014Linette Lai (The Straits Times)

Category: Trauma News