People who are over 65 are more likely to fracture bones for the following reasons:

• They may have osteoporosis, which makes fractures more likely.

• Some normal age-related changes in balance, vision, sensation (mainly in the feet), muscle strength, and control of blood pressure make older people more likely to fall. In older people, blood pressure tends to drop excessively when they sit or stand up, causing dizziness or light-headedness.

• They are less able to protect themselves during falls.

• They are more likely to have side effects of drugs (such as drowsiness, loss of balance, and dizziness), which can make falls more likely.

In older people, fractures often affect the ends of long bones, such as those in the forearm, upper arm, lower leg, and thigh. Fractures of the pelvis, spine (vertebrae), and wrist are also common among older people.

In older people, recovery is often more complicated and slower than it is in younger people because

• Older people usually heal more slowly than younger adults.

• Older people typically have less overall strength, less flexibility, and poorer balance than younger people. Thus, compensating for the limitations caused by a fracture is harder, and returning to daily activities is more difficult.

• When older people are inactive or immobilized (by casts, splints, or bed rest), they lose muscle tissue more quickly than younger adults, Thus, immobilization can lead to muscle weakness. Sometimes muscles become permanently shorter, and scar tissue forms in tissues around the joint such as ligaments and tendons. This condition (called joint contractures) limits movement of the joint.

• Older people are more likely to have other disorders (such as arthritis or poor circulation), which can interfere with recovery or slow healing.

Even minor fractures can greatly interfere with older people’s ability to do normal daily activities, such as eating, dressing, bathing, and even walking, especially if they used a walker before the injury.

Immobilization: Being immobilized is a particular problem in older people.

In older people, being immobilized is more likely to cause

• Blood clots (as occur in deep vein thrombosis)

• Pressure sores

• Loss of muscle tissue

• Deterioration in physical conditioning

Pressure sores develop when blood flow to an area is cut off or greatly reduced. In older people, blood flow to a limb may already be reduced. When the weight of an injured limb rests on a cast, blood flow is reduced even more, and pressure sores may form. If bed rest is required, pressure sores can develop on areas of skin that touch the bed. These areas should be diligently inspected for any sign that the skin is breaking down.

Because immobilization is more likely to cause problems in older people, treatment of fractures focuses on helping older people return to daily activities as quickly as possible rather than making sure that the fractured bone is perfectly aligned.

To shorten the time people are immobilized and to help them return to daily activities sooner, doctors are increasingly using surgery to repair or replace a broken hip. People are instructed to move and walk (usually with help of a walker), often as soon as the first day after surgery. Physical therapy (for example, after a hip fracture) is also started. If hip fractures are not treated surgically, they require months of immobilization in bed before people are strong enough to bear weight.