As we age our bones get more brittle: What you need to know about falling

Supreme Court Justice Ruth Bader Ginsburg, 85, was hospitalized Thursday morning with three broken ribs after falling on Wednesday evening. She went home after her fall, but had discomfort throughout the night and was later admitted to the hospital for broken ribs on her left side. This is not the first time Ginsburg has suffered this kind of injury; she broke two ribs in 2012 as well. Unfortunately, this is a common injury for the elderly.

How common are falls in the elderly?

Falls are the leading cause of injury and death among older Americans. According to the U.S. Centers for Disease Control and Prevention, one in four Americans age 65 and over falls each year. Every 11 seconds, an older adult is treated in the ER after a fall, and every 19 minutes, an older adult dies from a fall.

What causes falls in the elderly?

Accidents, environmental hazards, and falls from bed are leading causes. As we age, our senses dull, our sense of balance is compromised and we can have difficulty walking, weakness, pain related to arthritis, confusion, cognitive impairment, and poor vision, which all contribute to the problem.

What injuries happen after falls?

Every case is different and a fall may result in nothing serious or severe damage. Common injuries after a fall can include bruising, broken bones, internal bleeding and head injuries. These range from minor injuries to life threatening injury, particularly if there is internal bleeding or head injury. Rib fractures can lead to potentially life-threatening conditions including pneumonia and lung collapse. Falls also have a heavy impact on quality of life -- many older adults fear falling, and as a result decrease their daily activities often leading to physical decline and depression.

“In patients with rib fractures, it’s important to adequately manage pain and pay careful attention to fluid status to help ensure a good outcome,” said Dr. Robert Glatter, emergency medicine physician at Lenox Hill Hospital in New York City. “It’s especially important to avoid excessive administration of IV fluids -- without evidence of ongoing bleeding -- since this can lead to fluid overload in the lungs known as pulmonary edema.”

What is the recovery time after a fall?

This really depends on the injuries sustained. Broken ribs usually heal on their own and this often takes about six to 10 weeks. In some cases, if you have many broken ribs, your doctor may recommend rib fixation which is a surgery that uses plates and screws to stabilize broken ribs; the recovery time for this varies.

“Rib fractures in the elderly population are quite common following even the most seemingly innocuous falls from ground level,” said Dr. David Forsh, chief of orthopedic trauma for the Mount Sinai Health System. “Generally these injuries heal rather readily in a matter of eight to 10 weeks, but may be a source of significant pain and debilitation for a short time. Treatment is usually supportive with pain medication and expectant management. If patients have intractable pain that causes respiratory dysfunction they may be candidates for an epidural to alleviate symptoms and facilitate improved breathing mechanics.”

Dr. Gisele Wolf-Klein, Director, Geriatric Education, Northwell Health, Great Neck, New York, said “the number of ribs broken is also a major factor in recovery.”

“Three or more rib fractures will double the risk of death,” said Wolf-Klein. “Pre-existing conditions such as cardiopulmonary disease, and congestive heart failure also increase the risk of potential complications after rib fractures. Therefore, older patients may require admission to hospitals for monitoring and management of their rib fractures.”

How the injuries will impact Justice Ginsburg is yet to be seen, but her history suggests they are not likely to keep her away from the next Supreme Court term beginning on Nov. 26. In 2012, she broke two ribs without missing work.

When should the elderly see a doctor after falling?

Following up with a doctor after a fall is critical to identifying injuries and discussing the best ways to prevent additional falls. People can be seen in an ER immediately after the fall or be seen by their primary care physician. The elderly should be seen in the ER if they hit their head, lose consciousness, are on blood thinners, have chest pain, have difficulty breathing, can’t walk after falling, have an obvious broken bone, or have been on the ground for a prolonged period of time. They should also be seen in the ER if they fell from passing out (as opposed to tripping and falling), if the fall was unwitnessed, or for anything else that is concerning to them.

How can falls be prevented?

Talk with a doctor about falls and fall prevention. Medical assessment by a doctor can identify risk factors and provide appropriate interventions to reduce the risk of falling. These interventions include making the home safer by removing loose rugs from the floor, removing objects scattered on the floor, proper lighting, and placing hand rails in commonly used spaces. Get an eye exam and update glasses or contacts as needed. Talk to a doctor about medications that may make it more likely to fall and be evaluated for any mental status changes including increased confusion. Participating in programs to improve balance and strength is also helpful.

“With elderly individuals at risk for trips or falls it’s important to consider making space in the home or office to mobilize freely and eliminate clutter or items that one could trip over,” said Dr. Forsh. “Keeping active with exercise or doing physical therapy can also help with proprioceptive neuromuscular coordination/control to help prevent missteps or falls.”

Dr. Johanna Kreafle is an emergency medicine physician at the Carolinas Medical Center in Charlotte, North Carolina, and a member of the ABC News Medical Unit.