Spotlight on Aging: Dislocations

People who are over 65 are more likely to dislocate a joint, partly because they are more likely to fall—a common cause of dislocations. Older adults are more likely to fall for the following reasons:

• Some normal age-related changes impair balance, vision, sensation (mainly in the feet), and muscle strength, making falls more likely. These changes also make it harder for older adults to protect themselves when they fall.

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

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

Other injuries tend to accompany a dislocation more often in older adults. For example, a shoulder dislocation is more likely to cause a torn rotator cuff in older adults than in younger people.

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

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

• When older adults 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 adults 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 (for example, when bed rest is necessary) is a particular problem in older adults.

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

• 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 dislocations and other musculoskeletal injuries focuses on helping older adults return to daily activities as quickly as possible.