The elderly are particularly prone to suffering fractures due to several factors, namely, physical decline in terms of loss of muscle mass (sarcopenia), osteoporosis (loss of bone substance) and poor balance due to vision or inner ear issues. Pre-existing conditions like diabetes can compound the problem due to nerve damage. Certain medications may cause drowsiness or lightheadedness.

The severity of the fracture determines if and when the patient recovers or go into rapid decline and death from complications. In general, the more severe the fracture, like hip fractures, the worse the outcome will be. Mortality rate for hip fractures is 20-30% in the first year due to complications caused by prolonged immobility. The more common causes of death for these cases are pneumonia and deep vein thrombosis leading to pulmonary embolism, where blood clots form in the legs and travel to the heart and lungs.

My 95-year-old sister had a bad fall and fractured her upper arm bone (humerus), was hospitalized for several days and discharged only to succumb to a heart attack due to the stress and pain of the fracture. There are many more instances of such deaths following a bad fracture.

Falls are the leading cause of death in Americans over 65. But 89 percent of fall-related fatalities occur in lower and middle-income countries. Hip fractures kill up to one third of patients within a year. Vertebral fractures raise long-term mortality eightfold. Women fall more often but men die more often (74.2 percent vs 66.3 deaths per 100,000).

Beyond the frightening statistics, there are measures we can do to reduce the possibility and complications of falls and fractures.

The time it takes to get a fractured person to the hospital is a major factor for survival. The longer one is given medical assistance (four to six hours) exponentially increases the likelihood of severe medical deterioration. Post-fall rehabilitation is critical. Physical therapy to regain strength and mobility is essential for improving long-term outcomes and preserving independence.

A great example of a good outcome is the case of my 77-year-old classmate. He tripped and fell in an inclined driveway, and was brought right away to a trauma hospital where X-rays showed a hip fracture.

The following day, he had hip replacement surgery, only because he was taking blood thinners. Otherwise, they would have done the surgery the same day. The day post-surgery, the orthopedic surgeon recommended ambulation and physical therapy. He was able to walk with support from the bed to the bathroom and back.

He started physical and occupational therapy on day two post-surgery, for 1 ½ hours twice a day. He will be in rehab therapy for the next four weeks, followed by outpatient occupational and physical therapy for four weeks (three days a week) by a team of nurse, PT and OT and nursing aide.

All these was possible because he had good health insurance, being retired from work in the USA.

We also have excellent orthopedic surgeons, but the difference is how we manage these fracture cases. Due to the expense of a hip prosthesis, many patients are put in a cast while the family has to scrounge around for money to buy the prosthesis, which can run into six figures. That factor alone, with the prolonged period of immobility can be lethal for many. Pneumonia can develop, especially in a hospital setting. Without proper precautions, blood clots can form in the leg veins and embolize to the lungs, which can be fatal. But at least, PhilHealth now covers some hip prostheses.

Even after surgery, proper rehabilitation can be costly and oftentimes not available, more so for poor patients. The lack of physical and occupational therapy facilities in the provinces means patients have to fend for themselves or go to Manila and other cities where such facilities are available.

So, wonder no more why we have poorer survival statistics for elderly patients with fractures. With this scenario in mind, it is best to be pro-active and be more aware of the possibility of getting a fracture.

Better still, be properly informed of fall prevention measures. More physical activity, especially weight-bearing exercises, can prevent the onset of sarcopenia and osteoporosis (Preventing sarcopenia, Sept. 30, 2025). With stronger bones and muscles, the more confident one will be in daily activities without fear of falling.

For those who are unsteady on their feet, the options are to use a cane or even a walker. Falls are frequent in the bathroom, where the tiled surfaces can be slippery. Install grab bars in shower stalls. Avoid bathtubs. Put rubber matting on slippery areas (bathrooms and kitchens). Evaluate all walkways for tripping hazards. If one is taking medications that can cause dizziness or drowsiness, be especially vigilant in walking.

Let’s be careful out there.