By Mark Taylor

It was a combination of factors that made me think more about the cost and dangers of falling.

First, I’m in my early sixties and have cared for enough family and friends who have fallen to know that falls pose a huge risk not only to the “Greatest Generation,” but to mine as well.

I underwent ankle fusion surgery in September due to a fracture (misdiagnosed decades ago) that had made the ankle more unstable and increased my risk of falling. I also recently attended the Gerontological Society of America’s (GSA) annual conference and stumbled across a poster session illustrating the enormous cost of falls on our nation’s seniors, both physically and financially. The price tag for falling victims and their families and society was estimated to exceed $34 billion in 2013. Here are some more stats:

• Between one-quarter and one-third of seniors over 65 take a fall each year (about 29 million falls), causing more than 2.5 million injuries treated in emergency rooms. Falls are the leading cause of fatal and non-fatal injuries for older Americans, according to the National Council on Aging.
• Falls lead to more than 800,000 hospitalizations and more than 30,200 deaths annually, according to the U.S. Centers for Disease Prevention and Control (CDC).
• The annual cost of falls is expected to exceed $67 billion by 2030.
• The CDC predicts a quadrupling of annual deaths from falls by 2030 to exceed 100,000 if nothing is done to improve prevention.

We’ve all known a friend, neighbor or relative who has taken a fall and witnessed the sometimes tragic decline of people we love: going from the kitchen floor to an emergency room and hospital bed. That’s often followed by a move to a rehabilitation center or skilled nursing home, followed by loss of mobility and independence and a greater risk for depression and social isolation.

Amazingly – at least to me – I learned falls are not an expected, normal consequence of growing older and can be prevented.

State and national seniors’ organizations and government agencies are focusing significant efforts on falls. One comprehensive falls prevention program, “A Matter of Balance,” was found in this study to reduce the number and severity of falls and save nearly $1,000 per patient annually in medical costs.

Sally Fullman, 73, a former college professor, learned she had osteoporosis 12 years ago after an ankle sprain and minor fall. Fullman fell again six years ago, fracturing her tibia and suffering multiple hairline fractures.

“There was a lot of pain, and a whirlwind of depression swept over me,” she recalled “I couldn’t walk or exercise or go grocery shopping. I had to depend on others to shower or do my laundry. I was totally immobilized.”

Once well, Fullman volunteered to teach balance and fall prevention classes through the National Osteoporosis Foundation (NOF). “I’ve learned just how much a fall can completely change your life, so it’s really important to do what you can to prevent falls,” she said.

It’s not hard to find fall victims. Organizations like the NOF have outreach programs throughout the country. Universities from University of Southern California Davis to Johns Hopkins, University of Wisconsin, St. Louis University and Yale have research programs that study falls, their causes and the best prevention strategies. Balance and fall prevention programs are widely available in community settings, often through local agencies on aging, and instructors are grateful to connect journalists. (See the state falls prevention coalition list below.)

Jon Pynoos, a professor at the USC Davis School of Gerontology and co-director of the Fall Prevention Center of Excellence in Los Angeles, said recent research shows many falls are preventable.

Pynoos said that researchers have learned that there are exercise programs that can improve balance, including tai chi. He pointed out that homes are full of hazards that people don’t recognize, but can change.

“Throw rugs that are not secured are falls waiting to happen. Grab bars in bathrooms can keep someone from slipping. These are low-cost changes. There are simple things people can do in their own homes, which is where older people tend to spend most of their time.”

Pynoos recommended that seniors and their families do quick exams of their homes and look for hazards and fix them. He also said that pharmacists need to look for drug interactions and those that induce drowsiness and dizziness. State and local public health officials can also prioritize falls and prevention programs.”

Kathleen Cameron, senior director of the National Council on Aging’s National Falls Prevention Resource Center, said she now sees more resources and attention paid to falls. Cameron said the federal Administration for Community Living is funding programs and said public health agencies are implementing fall prevention programs.

“People are hearing more about it because of new money going to it,” she explained, citing last year’s White House Summit on Fall Prevention and the annual Falls Prevention Day. She said the CDC is promoting a program to encourage health care providers to initiate fall risk assessments and interventions. Forty states have fall prevention coalitions.

Cameron said Medicare pays nearly 80 percent of the costs of falls by seniors. “It’s a huge burden for taxpayers and older adults, with the potential for broken bones and traumatic brain injury, as well as the loss of independence and out-of-pocket costs,” she said.

She said many physicians do not screen patients for fall risks or ask if they have fallen recently. She said the most difficult obstacle is the widespread belief that falls are a normal part of aging and cannot be prevented.

“We cannot stop all falls,” Cameron conceded. “But we can greatly reduce the rate and severity of falls.”

The NCOA leads the Falls Free Initiative, a coalition of 70 organizations addressing the public health issues of falling.

Thomas Gill, M.D, a professor at the Yale School of Medicine, co-leads a clinical trial at 10 regional sites testing whether interventions can reduce the risk of fall injuries among high-risk older populations. “Falls are a complex geriatric condition that arises because of a confluence of different factors, ranging from visual impairment and balance disorders to medication use that may impair cognition or lower blood pressure,” Gill explained.

He said footwear choice and home environment, such as lighting, floor and bathroom surfaces, also contribute. In the study, a nurse fall care manager identifies home and lifestyle risk factors and prioritizes and addresses them.

“Helen Lach, a professor at the St. Louis University School of Nursing, said since the 1980s researchers have studied and explored the causes and risk factors of falling and have determined which interventions work.

“We know more about what to do, but we’re not implementing those practices as much as we need to,” Lach said.

She said more focus should be on educating insurance plans to pay for proven, evidence-backed programs. “There is a return on investment for providing some of these fall prevention programs.”

Here are some fall prevention tips from the National Council on Aging (NCOA):

1. Ask your doctor to perform a fall-risk assessment to identify potential medical causes for falls, such as foot pain, high blood pressure or poor balance.
2. Talk with your doctor or pharmacist to review medications and evaluate their fall risk.
3. Visit an optometrist or ophthalmologist to check and correct your vision.
4. Use fitted-assistive devices like canes and walkers.
5. Remove throw rugs from walkways and clear obstacles such as electrical cords, furniture and shoes. Install support bars in bathtubs and beside toilets and railings beside stairs. Repair cracks in sidewalks and driveways that could present trip hazards and install adequate indoor and outdoor lighting along walkways.
6. Take tai chi, yoga or other exercise classes to improve balance and build stronger muscles and bones.

Finally, learn how to prevent falls by exploring these online resources:

• The CDC’s Stopping Elderly Accident, Deaths & Injuries (STEADI) initiative offers a variety of resources for patients and healthcare providers.
• The National Council on Aging (NCOA) has these resources for reporters.
• NCOA’s list of evidence-based fall prevention programs.
• NCOA’s directory of state fall prevention coalition contacts.
• The Fall Prevention Center of Excellence’s Stop Falls website identifies best practices in fall prevention and provides resources for creating local fall prevention programs.

Mark Taylor is an independent health care journalist based near Chicago. Taylor was legal affairs reporter for Modern Healthcare magazine and writes for newspapers, as well as Medicare NewsGroup and Hospitals & Health Networks. He is a former Kaiser Media Fellow and a founding member of AHCJ.