Garth Rattray | New Year, ageing bodies

The advent of every new year reminds us that we are ageing. According to WHO 2020 data, the life expectancy of Jamaican males is around 74.4 years (the worldwide life expectancy for males is 70 to 71 years), and Jamaican females are expected to live to just over 75 years (compared to worldwide figures of between 75 and 76 years). Anecdotally, I am seeing higher figures for patients.

About 73 per cent of Jamaicans are between 15 and 64 years of age. Approximately 18.7 per cent are 14 years old and younger. Importantly, in 2013, Jamaicans over 65 made up about 6.3 per cent of the population. Currently, citizens over 65 years old make up about 8.2 per cent of our population (2024 data). But by 2030, the number of Jamaicans of 65 and over is expected to be around 11.2 per cent.

A lot of attention is [rightfully] put on the [chronic] non-communicable diseases (NCDs) that cause suffering and death as we grow older. According to 2023 WHO data, the top cause of death among the elderly in Jamaica is cardiovascular disease, which accounts for approximately 215.2 deaths per 100,000 people (ischemic heart disease and stroke are the main contributors in that category). Diabetes Mellitus alone causes 79.9 deaths per 100,000 population, and various types of cancer deaths are (116.6 per 100,000 population).

However, aside from the chronic NCDs, unintentional injuries, especially falls, constitute a significant public-health issue,that deserves a lot more publicity. Among Jamaicans 60 and over, injuries and injury-related deaths occur from road traffic crashes, assaults, and falls. But falls are the leading cause of injuries and deaths in people 65 and over in Jamaica and globally.

INCREASED TENFOLD

According to one analysis, falls among the elderly increased tenfold between 2006 and 2020. It is likely that those figures represent our ageing population and better reporting, but still, very little attention is being given to this major public-health concern that is amenable to risk reduction with education and intervention.

Because falls are the top causes of injuries, hospitalisation, and death in elderly Jamaicans, our citizens deserve to know more about them. The major cause of falls is sarcopenia - from Greek “sarx” (flesh) and “penia” (loss). It is a significant loss of skeletal muscle with age.

As we age, we will all experience sarcopenia to a lesser or greater extent. Although ageing is the main driver of sarcopenia, there are several other contributing factors. These include inactivity (a sedentary lifestyle with little physical activity or prolonged bed rest), poor nutrition (inadequate protein /calorie intake), chronic inflammation, diseases like COPD, diabetes, and cancer, reduced hormone levels, nerve cell loss, being overweight, and genetics. People with sarcopenia complain of shrinking muscles, experience weakness, have issues with balance, fall easily, fatigue easily, walk slowly, are less mobile, and have difficulty with some tasks of daily living.

Our muscle mass peaks when we are around 30 years old. Gradual muscle loss begins as we age towards 40 years old. After 40, the muscle loss accelerates at one to two per cent annually. In our 50s and 60s, muscle mass and strength decrease more noticeably. Once we age past 65, the muscle loss speeds up significantly, up to around eight per cent per decade. By then, whether we are aware of it or not, our balance and function are impacted.

When elderly people fall, they can suffer head injuries, soft tissue damage, deep lacerations (cuts), torn ligaments or tendons, serious damage to the internal organs, fractures, lost teeth, lung puncture, dislocations, brain injury or brain bleeding, permanent paralysis, and [sometimes] psychological issues. One important psychological sequel is the fear of falling. This often leads to the patient becoming very inactive, which is a death knell in the elderly.

PERMANENT PARALYSIS

I have seen falls in the elderly that led to spinal injuries and permanent paralysis (sometimes from the neck down). Skeletal bone and rib fractures are bad enough, but one of the most devastating is fall injuries that result in intracranial bleeds. The brains of the elderly shrink over time, and, therefore, they bounce around with head trauma. Sometimes seemingly minor head injuries cause significant bleeding in the elderly. Head trauma leads to bleeding more easily than in younger people. The bleeding may be slow and persistent and leads to delayed onset of the effects.

The blood vessels of elderly individuals are stiff and brittle when compared to the vessels of the young. Consequently, whenever bleeding begins, it is difficult to stop. Over the years, I have had several patients who died from a simple fall and fairly minor traumatic head injury that results in fatal brain bleeding. For that reason, any elderly with any head trauma must be closely observed even if the initial investigations reveal no obvious problem.

Another major problem with falling in the elderly is hip fracture. The older the person, the more challenging the surgical intervention. However, more importantly, even if the surgery is successful, the resultant inactivity hastens death. I recall a patient who fell and broke her hip when she was 105 years old. She underwent surgical intervention and recovered well. Unfortunately, when overseas relatives visited and saw how active she was after surgery, they confined her to bed. Sadly, that led to inactivity, and she developed pneumonia and died.

Fall risk reduction includes exercises for strength and balance, managing home hazards (mats, rugs, pets, children’s toys), avoiding having to step in and out of tubs, installing grip rails, adequate lighting, maintaining good vision, and ensuring safe outdoor walkways.

Garth Rattray is a medical doctor with a family practice, and author of ‘The Long and Short of Thick and Thin’. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com