Adults over 65 are more likely to injure muscles ligaments, and tendons, partly because they are more likely to fall. They are more likely to fall for the following reasons:

• Some normal age-related changes in balance, vision, sensation (mainly in the feet), and muscle strength make older people more likely to fall and to injure themselves.

• Some older people feel dizzy or light-headed when they sit or stand up because their blood pressure drops excessively.

• They are less able to protect themselves during falls.

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

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

• Older adults 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 an injury is harder, and returning to daily activities is more difficult.

• When older people are inactive or immobilized (by casts or splints), 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 injuries can greatly interfere with older adults' 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 adults.

In older adults, being immobilized is more likely to cause the following:

• Blood clots, usually in the legs (as occurs 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 adults, 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 adults, treatment of musculoskeletal injuries focuses on helping older adults return to daily activities as quickly as possible.