September 23, 2014, is both the first day of autumn and the seventh annual Falls Prevention Awareness Day. Sponsored by the National Council on Aging (NCOA), this year’s theme —Strong Today, Falls Free Tomorrow — focuses on raising “awareness about how to prevent fall-related injuries among older adults.”
The sixth Annual Falls Prevention Awareness Day, themed Preventing Falls: One Step at a Time, was held September 22, 2013, and it achieved a great deal. For example, on that same day, the US Senate passed a resolution making the day official. In addition, more than 17,000 elderly adults were physically screened, a half-million others were reached through evidence-based programs, and another 1.5 million “were reached through advocacy events and education and awareness campaigns.” With 2 million participants in 47 states, the event was the largest thus far. The NCOA’s goal is to make 2014 an even greater success.
Every year, according to the Centers for Disease Control and Prevention (CDC), a third of adults aged 65 and older fall unintentionally. Nearly 22 thousand people died in 2010 (the CDC’s most recent data) as the result of an unintended fall, while the nation’s emergency departments treated another 2.3 million nonfatal fall injuries. Even though women are more likely to fall, men have a 40 percent higher chance of dying from fall injuries.
The majority of falls occur inside homes, but a third take place outdoors. When an older adult is outside and exposed to extreme weather, they may suffer from hypothermia, frostbite, and/or dehydration. Whether indoors or outside, falls are the leading cause of both fatal and nonfatal injuries among seniors. Because the population 65 and older is expected to double by 2030, fall prevention is rapidly becoming a national imperative.
Compounding matters are the equally explosive growth rates expected among older adults with such chronic diseases as diabetes, heart disease, dementia, and COPD. Fall rates are higher among people who have these diseases and their associated complications. Along with ailments and medications that inhibit a person’s ability to see, hear, or touch properly, injuries from falls are likely to dramatically increase.
Why Seniors Fall
As people age, their bodies undergo age-related changes. Reflexive speeds slow, stamina decreases, and bones may weaken, especially at the joints. While these changes do increase the risk of falls, diseases and other pathologies can play major roles. Sensory deprivation resulting from eye diseases such as macular degeneration, hearing loss, and balance disturbance, as well as a loss of tactile sensation in the feet, can threaten an aging adult’s safe independence.
Medical problems, especially chronic diseases, are major contributors to seniors’ risk of falling. Diabetes can damage the eyes and render feet unresponsive to the ground. Cardiovascular diseases and COPD can slow or even paralyze ambulation, while dementia can rob individuals of the memories essential to going outside safely. Medications for these and many other issues can cause dizziness, interfere with gait, and exacerbate glare — among other issues.
Consequences of Falling
Depending on a fall’s severity, its impact can have profound effects on a senior’s physical and psychological well-being. Physical injury is the most direct and visible effect. According to the National Institute on Aging, nonfatal injuries from falls range from minor lacerations and abrasions to fractured hips and traumatic brain injuries (TBIs). Falls are in fact the most common cause of TBIs, according to the CDC, and account for 95 percent of hip fractures. Of the 258,000 hip fractures in 2010, women suffered twice the injury rate as their male counterparts. Other fractures typical after falls include the hand, forearm, upper arm, ankle, leg, pelvis, and spine.
Beyond physical damages, a fall can lead to serious psychological problems. The fear of falling itself is among the most common, even among older adults who have never fallen. Their terror can intensify and initiate a vicious cycle: Out of fear, a person may withdraw from all activities except the most essential. Social isolation ensues, and withdrawn older adults are more likely to be malnourished, skip or forget to take medications as prescribed, and become more susceptible to illness — all of which could make them more likely to fall.
Beyond their impacts on seniors and caregivers, fall-related injuries add a tremendous burden to a strapped healthcare system. The CDC estimates the medical costs of these injuries in 2010 to be more than $30 billion and estimates that by 2020, this number will more than double to $67 billion. Medicare payments averaged between $13,797 and $20,450 per fall in 2010. Sixty-five percent of “community-dwelling older adults” treated for fall-related injuries were admitted for inpatient hospitalizations. Medicare reimbursed 78 percent of the various medical costs. Given the dramatic increase in the number of fall-prone older Americans over the next 20 years, the consequences of falls could be at crisis levels, challenging policy makers to find solutions.
Fall Prevention Tips
Many falls are avoidable. The trick is for your patients to think ahead, become more aware of their body movements, and carefully adapt to their surroundings. Without overexerting herself, a senior patient can make outings safer and more efficient by combining chores into the same days. Thanks to the Internet, a growing number of community service organizations and merchandise vendors are available online — and a host of fall-related information and home safety tips is easy to access. Talk to your older adult patients and their families about placing orders and accept deliveries online, so they can continue to live at home. Here are a few additional tips that can help reduce patients’ risks of falling outdoors.
Before your patients go anywhere, instruct them to:
- Consult you or another healthcare provider about fall safety advice
- Stay in good physical condition, with a focus on weight-bearing exercises
- Get adequate amounts of vitamin D and calcium
- Have their eyes checked and wear proper prescription lenses
- Participate in regular osteoporosis screenings (and be extra vigilant if they test positive)
- Review their medications with their doctor or pharmacist, identifying those that put them at greatest risk for falls
- Take advantage of delivery services for medicines and food
Suggest that independent patients:
- Use community transportation resources — from buses and taxis to senior transport services
- Keep the entrances to their homes brightly lit, clean, and free of clutter
- Ensure all steps, stair rails, and porch flooring are in good repair
- Hire reliable help to clear their sidewalks and entry areas of snow and ice (and tell them to keep plenty of rock salt on hand)
- Consider where they’re going before leaving, picture obstacles and hazards they might encounter, and prepare for them
- Give themselves plenty of travel time
- Travel with friends or relatives
- Wear sunglasses in the daytime to prevent glare, which is a major cause of falls
- Wear proper non-rubber soled shoes, rather than flip-flops or high heels
- Use adaptive and protective equipment like walkers and hip pads
- Let friends, family members, or neighbors know where they’re going and what time they expect to return
- Carry cell phones and medical alert devices
When outside, patients should:
- Try to move more deliberately — paying attention to movements they make that might cause them to fall. Suggest that they take stairs slowly and think ahead.
- Slow down and look ahead, avoiding problem areas
- Avoid uneven or slippery terrain
- Use handrails whenever they are available
- Watch out for slippery flooring, especially polished surfaces
- Wear a shoulder bag or fanny pack so they can keep both hands free in the case of a slip
- Be mindful of invisible curbs with deceptive heights and angles
- Get motion-detector lighting installed to ensure they automatically have enough light when needed
- Have keyless entry locks installed on their doors or keep garage door remote controls handy
Talk to your patients about what they should do if they do fall. Tell them that before they jump back up, it’s wise to take a moment to assess the severity of their fall. If they’ve broken a bone, in most cases, pain will be sharp and immediate; however, not all fractures are as terribly painful. Fractures of the hip and spine may not present until later in the day, week, or even month. Tell patients and their families to check for blood in the case of a fall. If there are signs of heavy bleeding, urgent medical care is required.
More than half of the people who fall fail to mention it to their healthcare providers. Regardless of the injury’s severity, it’s important that patients talk to you or their doctors about their falls. Tell them to take specific notes detailing the fall and any subsequent pain.
How You Can Help
There are several ways you can be involved in preventing falls. Visit the Falls Prevention section of the NCOA’s website to find a wealth of useful tools and information. Whether at the neighborhood, city, county, state, or even federal level, you can help make a difference — and your timing couldn’t be more perfect. Among the tools provided are:
- An infographic, called Take Control of Your Health: Six Steps to Prevent a Fall
- A webinar detailing how you can participate in this year’s Falls Prevention Awareness Day
- A media tool kit comprising press releases, handouts, and fact sheets
- Examples of awareness activities
The list of NCOA sample activities is extensive. Here are just a few:
- Call on local and state elected officials to issue proclamations
- Send e-cards
- Put up posters
- Write articles
- Organize a falls prevention screening and health fair
- Instigate flash mobs
- Write letters to the editor
Healthcare professionals, legislators, older adults, and their family members alike can all play vital roles in preventing falls. Share your experiences with others, educate yourself and help teach others, advocate, and act. A wave of increases in fall-related injuries is likely, and the time step forward in the interest of preventing falls is now.