By Paula Nickelson, Prevention Services Coordinator, Department of Health and Senior Services and the Executive Leadership Team of the Show Me Falls Free Missouri State Coalition.
How big is the problem?
Falls and fall-related injuries among older adults are common and present a serious public health crisis in the United States. Falls among older adults result in longstanding pain, functional impairment, disability, hospital admissions, premature nursing home admissions and death.1-3 Further, they represent a significant burden on individuals, families, society and the health care system, as evidenced through associated costs and decreased quality of life for our older adults and their families.
More than one third of adults 65 and older living in the community fall each year in the United States,4 the rate increases to 40% among those over the age of 80 years.2 Among older adults, falls are the leading cause of injury deaths.5 In Missouri, the fall death rate for older adults was more than thirty percent higher than the national death rate in 2005. The death rate of falls increases with age, and jumps sharply for older adults. Fall death rates among Missouri older adults are generally slightly higher in males than in females (Figure 1). However, females account for a larger number of falls deaths, because they are more likely to survive into the older age groups.7
Twenty to thirty percent (20%-30%) of people who fall suffer moderate to severe injuries such as bruises, hip fractures, or head trauma.8-9 Most fractures among older adults are caused by falls.10 Falls are the most common cause of traumatic brain injuries.11
Many older adults never fully recover from falls, living with chronic pain, reduced functional abilities, and often leading to reduced independence.12 One study found that falls were the major reason for 40% of nursing home admissions.13
Many people who fall also have a chronic or acute disease. The functional impairment as a result of that disease either precipitates the fall or is further complicated by the fall.14 For example, individuals with arthritis may experience decreased mobility or decreased grip which may exacerbate a fall. Or individuals prone to depression may engage in physical activity less and, once sustain a fall, experience an exacerbation of their depressive illness due to pain or limited mobility.
Many people who fall, even those who are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and physical fitness, and increasing their actual risk of falling.15
The older adult’s fall-related injury also impacts their caregiver(s). Once a fall injury occurs, the caregiver(s) may be impacted by increased time away from work, concerns over healthcare costs and coverage, and decreased time for their own family, leisure or community commitments.
The rate of emergency room visits and hospitalizations due to unintentional fall injuries increase considerably with age among older adults. In 2006, the rate in Missouri seniors 85 years and over was more than four times higher than those at 65-74 years (13,393 vs. 3,047 per 100,000). Older adult females are almost twice as likely to be hospitalized or admitted to the emergency room due to unintentional fall injuries than older adult males (6,637 vs. 3,702 per 100,000) in Missouri in 2006. Further, the rate of emergency room visits and hospitalizations due to unintentional fall injuries in Missouri varies by county, from 958 per 100,000 in Clark County to 8,980 per 100,000 in Livingston County in 2005-2006.16
Figure 2. Rate (per 100,000) of ER visits and hospitalizations due to unintentional fall injuries* among Missouri seniors 65+ years, by county, 2004-2005
The total direct cost of all fall injuries for people 65 and older in 2000 was slightly more than $19 billion.17 By 2020, the annual direct and indirect cost of fall injuries for people 65 and older is expected to reach $43.8 billion (in current dollars). The costs of fall injuries tend to increase with age and tend to be higher for women.18
What can older adults do to decrease the risk of falling?
Falls are not necessarily an inevitable part of the aging process, but are often highly preventable.
Most experts agree that an approach that addresses multiple modifiable risk factors is the most effective. Older adults should consider increasing their ability to remain independent by decreasing their risk of falling in the following ways:
Participating in a fall risk assessment. Consult your physician or a physical therapist for advice on such an assessment.
Managing your health, including chronic and acute conditions and medications. Ask your physician or pharmacist to review your medications with you on a regular basis for adverse interactions or any medications that can be reduced or eliminated.
Assuring your home and community environments are free of environmental hazards. You may find a home safety checklist is useful, a resource for a home safety checklist is noted later in this article.
Participating in an appropriate physical activity routine to increase strength, balance and gait. Request a referral for physical therapy, or with your physician’s approval, participate in a home exercise program or a physical activity program at your local senior or community center.
Assuring optimal vision, including adequate and uniform lighting in the home and regular eye exams with recommended corrections. Consider light bulbs throughout your house with sufficient wattage to allow you to see clearly in each room including stairwells, hallways and bathrooms. Schedule eye examinations regularly.
In customizing your personal plan to decrease your or your loved one’s risk of falling, you may find these resources of use:
What can communities do to decrease risk of falling amongst older adults?
Community leaders, as well as senior-serving organizations and associations, may wish to join the Show Me Falls Free Missouri State Coalition. The State Coalition is led by a multi-agency leadership team including: AARP-Missouri Chapter; Missouri Association of Area Agencies on Aging; Missouri Pharmacy Association; Missouri Physical Therapy Association; Missouri Department of Health and Senior Services; and OASIS.
The Show Me Falls Free Missouri State Coalition is a voluntary coalition of diverse entities interested in decreasing falls and fall-related injuries amongst Missouri’s older adults while maximizing their independence and quality of life and decreasing healthcare costs and deaths.
The Show Me Falls Free Missouri State Coalition has developed a state plan to guide this work which is available at http://www.dhss.mo.gov/showmefallsfreemissouri/ , including information about resources which may be useful to older adults and communities. This site also provides information about how to contact the state coalition and join this important work.
Communities are increasingly planning intentionally to optimize their older adults’ opportunity to remain independent which includes decreasing their fall risks. Additional resources which your community may find useful to support these efforts include:
References 1. Rubenstein, LZ, Josephson KR, Robbins AS. Falls in the nursing home. Annals of Internal Medicine 1994; 121(6):442-51. 2. Tinetti ME, Doucette J, Claus E, Marottoli R. Risk factors for serious injury during falls by older persons in the community. Journal of the American Geriatrics Society 1995; 43(11):1214-21. 3. Tinetti ME, Williams TF, Mayewski R. Fall risk index for elderly patients based on number of chronic disabilities. American Journal of Medicine 1986:80(3):429-34. 4. Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Archives of Physical and Medical Rehabilitation 2001; 82(8):1050-6. 5. Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (2006). Available from: http://www.cdc.gov/ncipc/wisqars/ 6. Missouri Department of Health and Senior Services (DHSS). MICA (Missouri Information for Community Assessment) Injury. (cited 2005 August); Available from: http://www.dhss.mo.gov/InjuryMICA/ 7. Stevens, JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006; 12:290-5. 8. Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall-related injuries in older adults. American Journal of Public Health 1992;82(7):1020-3. 9. Sterling DA, O’Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. Journal of Trauma-Injury, Infection and Critical Care 2001; 50(1):116-9. 10. Bell AJ, Talbot-Stern JK, Hennessy A. Characteristics and outcomes of older patients presenting to the emergency department after a fall: a retrospective analysis. Medical Journal of Australia 2000;173(4):176-7.
11. Jager TE, Weiss HB, Coben JH, Pepe PE. Traumatic brain injuries evaluated in U.S. emergency departments, 1992-1994. Academic Emergency Medicine 2000;7(2):134-40. 12. Scott V, Dukeshire S., Gallagher EM, Scanlan A. An inventory of Canadian Programs for the Prevention of Falls Among Seniors Living in the Community. Ottawa: Health Canada; 2001. Report No.:Cat. No.:H39-594/2001E.
13. Bezon J, Echevarria KH, Smith GB. Nursing outcome indicator: preventing falls for elderly people. Outcomes Managed Nursing Practice 1999;3(3):112-6;quiz 116-7. 14. Cummings, RG. Intervention strategies and risk factor modification for falls prevention. A review of recent intervention studies. Clinical Geriatric Medicine, 2002;18(2):175-89. 15. Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age and Ageing 1997;26:189-193. 16. Missouri Department of Health and Senior Services (DHSS). MICA (Missouri Information for Community Assessment) Injury. (cited 2005 August); Available from: http://www.dhss.mo.gov/InjuryMICA/ 17. Stevens JA, Corso, PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006; 12:290-5. 18. Englander F, Hodson TJ, Terregrossa RA. Economic dimensions of slip and fall injuries. Journal of Forensic Science 1996:41(5):733-46.
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