Falls are a leading cause of morbidity and mortality among older people, but many are preventable. The dearth of fall screening by physicians and lack of awareness among the older population about their risk, has been recognized as a public health problem. The American Public Health Association recently adopted a new policy on fall prevention calling for increased use of an Evidence-Based Falls Prevention Algorithm, and for all health care stakeholders to be more proactive in screening for and addressing fall risk in older people.
The announcement of this new policy presents a great opportunity for journalists to investigate if and how local providers are helping to mitigate fall risk among their older patients. Reporters can also highlight local programs that may help improve balance, gait, and mobility by providing free or low-cost vision screenings or even low- or no-cost home repair and maintenance services.
More about fall risk and interventions
While we may not automatically think of falls as a public health issue, they are the leading cause of injury for people ages 65 and older. Over 14 million (one in four) older adults report falling every year, CDC data show. Serious falls can result in head injuries, broken bones, loss of independence or even death. Yet the risk is often unrecognized or unaddressed by physicians or families. Fall interventions can save the health system hundreds of millions of dollars, according to the APHA policy brief. Performing home hazard evaluations alone could save an estimated $442 million.
“It’s not only a public health issue, but it’s actually a national public health crisis and one of the biggest health risks that patients have,” said Andrea Thau, O.D., policy chair and governing councilor of the vision care section of the American Public Health Association and author of this initiative. “And often, it’s unrecognized by people, but falling can lead to really serious sequelae. It’s really horrific.”
Simple fall interventions, like those detailed in the CDC’s STEADI fall prevention program, can make a huge difference in health costs. For example, addressing vision problems can save as much as $423 million by mitigating falls in the at-risk population. Addressing mobility and balance issues could save upwards of $315 million, according to Thau.
Why it matters
While Medicare’s “Welcome to Medicare” visit includes a fall risk assessment, not all providers actually conduct them. Subsequent preventive screenings often do not include questions about fall risk either. However, including other members of the health team in performing appropriate fall risk screenings and assessments and using evidence-based algorithms to prevent falls may save millions of dollars in health costs and improve quality of life of older people, minimize preventable hospitalizations and lower morbidity and mortality, the APHA concludes.
Fall risk factors vary of course, but common concerns include:
- Medications that can affect balance, mobility, cognition or alertness.
- Physical inactivity, which can lead to injury, sarcopenia, mobility, flexibility, gait and stability.
- Vision problems — even small changes in vision can increase fall risk.
- Previous falls within the last 36 months.
- Cognitive impairment — the prevalence of falls among people with dementia is 50% to 80% within a 12-month period.
- Complications of metabolic syndrome such as neuropathy, amputation, vision impairment.
- Gait and balance disorders.
- Built environment — poor lighting, stairs, throw rugs, lack of grab bars and grips in bathrooms, cracks or holes in outdoor walkways, sidewalks, or driveways; poorly cleared ice and snow; and poorly maintained lawns.
The APHA strongly recommends all providers get trained on and connect patients with the STEDI initiative, which can significantly reduce risk of falls among those 65 and older. The program offers training for physicians, pharmacists, and other health providers, along with an algorithmic-based toolkit to help them screen, assess, and intervene among their older patients. Multiple resources are also available for patients and caregivers, including printed materials and videos.
“We’re trying to encourage the use of this screening model that’s out there to try to encourage not just primary care physicians, but all medical personnel that interact with patients, to really think about it and talk about it,” Thau said in a phone interview. “So many older people who are independent and live alone, don’t really have anybody to even help them know what they need to do to make their own space safe.”
Many of us know neighbors, friends and family members who have suffered the devastating consequences of a serious fall. My 89-year-old grandmother was functioning adequately on her own until she tripped on the corner of a too-long bedspread and broke her hip. She somehow managed to get to the phone and call for help. When the ambulance took her away, I’m sure she had no idea that was the last time she’d see the apartment she had lived in for more than 60 years. She spent the next two years in a nursing home in progressively declining health, and passed away just shy of her 92nd birthday. Much of her decline stemmed from what was a preventable accident. STEADI did not exist at the time, but I wish it had.
As the APHA notes, “Widespread implementation of a multifactorial falls prevention algorithm such as STEADI could serve as a major step toward reducing poor outcomes following injury by preventing the initial injury from occurring in at-risk groups.”
Resources
- CDC STEADI program.
- Fall risk in older adults data, from National Safety Council.
- Falls and Fall Prevention in Older Adults, continuing education, from the National Library of Medicine.
- Federal Programs Provide Support for Preventing Falls, but Program Reach is Limited, a 2022 report from the Government Accountability Office.
- Global prevalence of falls in the older adults, from the Journal of Orthopaedic Surgery and Research.
