Long Lie

Original Editor - Lauren Lopez Top Contributors - Lauren Lopez, Kim Jackson, Lucinda hampton and Nupur Smit Shah

Introduction

Falls are associated with significant mortality and morbidity. One significant aspect of falls is a "long lie". A long lie is when a person who has fallen spends a prolonged period of time on the floor because they are unable to get up. Literature defines a long lie as being on the floor for an hour or more. Long lie is a marker of weakness, illness and social isolation.

Epidemiology

Getting up from the ground after a fall is a challenge for the older adult, with or without sustaining an injury in the fall. Tinetti et al reported 47% of non-injured fallers were unable to get up without assistance. Those who have fallen often end up in emergency departments for assessment where 20% of fallers have been found to have been on the ground for more than an hour.

In a study of 322 MS sufferers over the age of 55, 27.6% experienced a delayed initial recovery of >10minutes on the ground after falling. Fifteen people (4.7%) reported a long lie of more than one hour on the ground.

In a one year follow up study of 110 "oldest old" adults >90 years, 59% (n=66) were found on the floor at some stage. Eighty percent of those who fell were unable to get up. Eighty eight percent of those who fell were alone. Thirty percent of fallers i.e. 20 people lay on the ground for more than one hour.

A study of 125 adults >65 years found that half of those who lay on the floor for more than one hour went on to die within the following six months, even without a direct injury from the fall.

Causes

The main cause of a long lie is being unable to get up from the ground independently. This could be due to a multitude of factors, including:

• Injury from fall e.g. hip fracture, concussion, loss of consciousness
• Location of fall e.g. narrow hallway, outdoors in a garden on a slope
• Muscle weakness
• Lack of social supports i.e. no one around to notice that the individual has fallen and needs help to get up

Implications

• Delayed medical treatment
• Dehydration
• Rhabdomyolysis i.e. muscle and tissue damage
• Pressure injuries
• Carpet burns
• Hypothermia
• Pneumonia
• Fear of falling

Risk Factors

Difficulty in getting up is associated with age, reported mobility and severe cognitive impairment.

Women over the age of 90 are six times more likely to have difficulty getting up from the floor by themselves.

Residents in supported living facilities have a 16 fold increased odds of being unable to get up without help.

Prevention

The best way to prevent a long lie is to prevent falls in the older adult. See both the Falls page and category in Physiopedia for further detail.

Falls prevention strategies include:

• Medical
  • Medical check up to exclude or treat acute illness
  • Optimise medications
  • Assess vision
• Musculoskeletal
  • Strength and balance exercise
• Mobility
  • Teaching older adults safe ways to get up from the floor after a fall e.g. backward-chaining.
  • Assess or reassess walking aids
  • Gait retraining
• Environmental modifications
  • Assess footwear
• Activity modification
  • Changing the way the older adult carries out their ADLs
  • Supervision by another person where possible
• Technology
  • Wearing a personal alarm or carrying a mobile phone. Older adult's perceptions of these devices and their usefulness can be challenging, requiring some education and encouragement.