Covering how your community prevents falls, promotes safety for older adults
By Liz Seegert
Every 15 seconds, an older adult falls. According to the American College of Sports Medicine, falls are the leading cause of injury-related death among adults age 65 and over. Additionally, the ACSM says that one in every three older adults takes a serious fall each year – resulting in more than 20,000 fatalities.
In 2012, 2.4 million nonfatal falls among older adults were treated in emergency departments, with some 722,000 of these patients hospitalized, according to statistics from the CDC. These falls resulted in direct medical costs of more than $30 billion, and those costs are expected to skyrocket to between $44 and $54 billion by 2020 as the population ages.
Falls mean serious consequences for seniors
- According to this CDC fact sheet, falls have significant impact on quality of life, ability to live independently and increase the risk of early death.
- Additionally, falls are a leading cause of traumatic brain injury in adults over 65. CDC data shows falls cause more than 81 percent of traumatic brain injury in this population.
- Fear of falling may cause seniors to limit their activities, leading to reduced mobility and loss of physical fitness; this, in turn, increases their actual risk of falling.
- People age 75 and older who fall are four to five times more likely than those age 65 to 74 to be admitted to a long-term care facility for a year or longer.
- Elderly people who survive a fall experience significant morbidity — the American Academy of Family Practitioners points out that hospital stays are almost twice as long in elderly patients who are hospitalized after a fall than in elderly patients who are admitted for another reason.
- Elderly who fall experience greater functional decline in activities of daily living and in physical and social activities, and are at greater risk for subsequent institutionalization compared with their counterparts who do not experience a fall.
However, the National Council on Aging says falls are not an inevitable part of aging. Strength and balance exercises, medication management, regular vision checkups, and “fall proofing” the living environment are all steps older adults can take to reduce their risk of falls.
Medicare pays for a health risk assessment as part of an annual wellness visit for beneficiaries under the Affordable Care Act. The assessment helps identify chronic diseases, injury risks, modifiable risk factors and urgent health needs of an individual and can be performed by a health care professional or as part of a community-based prevention program. Home safety is part of the behavioral risk assessment. The Physician Quality Reporting Initiative also incentivizes certain providers to assess fall risk and to create a fall prevention plan if a risk is identified.
The risk of falls is an ongoing concern for older adults. The American Occupational Therapy Association says “there is a need to educate Medicare practitioners about fall prevention and evidence-based interventions that should be provided as part of routine and ongoing care.” And, there is a need for education among Medicare beneficiaries about the importance of addressing falls through the Medicare and other systems.
Risk factors for falls
- Muscle weakness
- Previous falls
- Gait or balance impairment
- Use of medications
- Visual impairment
- Home safety hazards
- Arthritis, diabetes, vestibular dysfunction, osteoporosis, Parkinson's disease, cardiovascular conditions, cognitive impairment.
- The Merck Manual has several tables highlighting specific disorders and drugs that may contribute to increased risk of falling.
Falls are often caused by a loss of balance or the inability to maintain the body’s center of gravity (COG) over its base of support (BOS). The ASCM provides detailed explanations of the different types of balance and the systems that can affect them.
Exercise programs that target the physiological systems in balance control, specifically the visual, vestibular, somatosensory and muscular systems, can improve balance and reduce the risk for falls.
Medications and their side effects - especially when combined with other physical issues, can seriously impact balance, stability, strength, and depth perception. The American Geriatrics Society has a list of 10 medications older adults should use with caution or avoid all together. Herbal remedies and OTC drugs can also interfere with prescription medications — causing dizziness, poor balance, clumsiness, or lightheadedness. Regular medication reviews can help avoid potential interactions.
The interior and exterior of the home presents many potential fall hazards. Common concerns include falls in the bathroom or the stairs but tripping hazards, such as scatter rugs, uneven floors, clutter, lamp wires or extension cords can also cause a fall in a matter of seconds. Banisters, poor lighting, loose carpeting, and rocky ladders or step stools are also common causes of home falls according to the CDC.
Making changes can help a person can feel safer and less at risk of falling. For example, the bathroom can be modified by installing grab bars and a place to sit in the shower or tub and having non-slip surfaces. Handrails, adequate lighting, and visual contrast can make steps safer. Some communities have programs to help seniors take care of chores requiring a ladder, such as cleaning out gutters.
More quick facts about falls:
Would like some attribution for these – would help journalists using this tip sheet so they can cite sources in their reporting.
- According to the American Foundation for the Blind, people with vision loss are almost twice as likely to experience multiple falls as those with normal vision.
- The American Geriatrics Society estimates that one-third of those over 65 experience a fall at home, and nearly half of elderly nursing home residents fall each year. The National Safety Council says that any of these falls could be prevented through simple home modifications.
- The AGS notes that walking aids are very important in helping many older adults maintain or improve their mobility. They should be properly fit by a physical therapist along with instructions on safe use.
- Staying at home or limiting activity won’t help to prevent falls. Physical activity actually promotes independence, since strength and range of motion benefit from use. Social activities are also good for your overall health, according to NCOA.
Many state and local organizations have fall prevention programs – exercise, home modifications, education, and checklists which boost seniors’ knowledge of their fall risk factors and provide appropriate strategies to reduce their fall risk. The STEAD! Program (Stopping Elderly Accidents, Deaths, and Injuries), is a fall prevention tool kit that contains an array of health care provider resources for assessing and addressing fall risk in clinical settings.
- Profile community or government falls prevention programs — exercise, awareness, patient/provider education.
- Examine volunteer programs to retrofit older homes with grab bars, simple repairs to flooring, stairs, carpeting.
- Highlight volunteer (or for-profit) home fall risk assessments.
- Talk to caregivers, older adults who have experienced falls, and those who are doing what they can to prevent them.
- Check local emergency department, nursing home stats on falls related admissions - how do they compare across facilities or communities? What about falls in local assisted-living communities? Are those reported anywhere? What is being done to address hazards in institutional settings on individual and facility-wide basis.
- Check with the local or state medical association, physical or occupational therapy associations about whether there are provider education programs like this multiple stakeholder initiative in Ontario, Canada.
- What other community or government resources exist, what are policymakers doing to help?
Resources for reporters:
- Agency for Healthcare Research and Quality guidelines on implementing organizational falls prevention programs
- American Geriatrics Society Practitioner Falls Toolkit
- CDC Home Falls Prevention Checklist
- Grantmakers in Aging overview of several falls prevention programs
- National Council on Aging Falls Prevention
- National Safety Council Older Adults & Falls
- National Council of State Legislatures Map of Fall Death Rates among Adults 65 and older
- American Physical Therapy Association
Erin Wendel, senior media relations specialist, public & media relations (703-706-3397; firstname.lastname@example.org
Katie Riley, media relations manager (301-652-6611, ext. 2963; email@example.com)
- America’s Health Rankings Data on Falls in Older Adults
Institute for Aging Research, Hebrew SeniorLife, (an affiliate of Harvard Medical School):
Marian T. Hannan, D.Sc., co-director of Musculoskeletal Research Center; Senior Scientist (617-971-5366; firstname.lastname@example.org)
Lisa VanderWerf-Hourigan, director, Injury Prevention Program, Florida Department of Health (850-245-4440 ext. 2776; Lisa.VanderWerf-Hourigan@flhealth.gov)
Peggy Haynes, M.P.A., director elder care services, Partnership for Healthy Aging, MaineHealth (207-661-7120; email@example.com)