Keeping Seniors on Their Feet

CINDY SANDERS

Keeping Seniors on Their Feet
They happen to children all the time. Ice skaters and hockey players learn the proper way to execute them. And comedians use them to get a laugh … but there’s nothing funny about falling for millions of Americans over the age of 65.

"It’s a serious problem," said Lynn Beattie, MPT, MHA, vice president of injury prevention for the Center for Healthy Aging, which is part of the National Council on Aging (NCOA). She noted it has become such a serious problem that the CDC’s National Center for Injury Prevention and Control has named preventing falls in older adults one of its top three priorities.

By the Numbers


  • Nationally, more than one in three adults over the age of 65 fall each year, and 40 percent of those over age 80 fall annually.

  • Among older adults, unintentional falls are the leading cause of injury deaths (15,800 in 2005).

  • Falls are also the leading cause of nonfatal injuries (1.8 million ED treatments) and hospital admissions (433,000) for trauma among older adults, according to the CDC.

  • Every 18 seconds an older adult is treated in an Emergency Department for injuries sustained in an unintentional fall. Every 35 minutes, someone in this population dies as a result of those injuries.

  • Direct medical costs related to fatal falls accounted for $179 million in 2000. That same year, medical costs for nonfatal fall injuries totaled $19 billion.

  • From 1994 to 2003, age adjusted (to 2000 U.S. population) death rates from unintentional falls increased significantly for both men and women. In 1994, the death rate per 100,000 population aged 65 and older was 32.9 for men and 19.1 for women. By 2003, the rate had risen to 46.2 for men and 31.1 for women.

Sources: CDC Adult Falls Fact Sheet; MC Hornbrook et al. 1994; JM Hausdorff et al. 2001, JA Stevens et al. 2006; Vital Statistics of the United States; National Hospital Discharge Survey; Department of Health and Human Services; National Center for Health Statistics; Web-based Injury Statistics Query and Reporting System (WISQARS).

Injuries related to falls in those over 65 are costly in terms of direct dollars spent on medical care.

"Falls in older people are a $19 billion a year problem," pointed out Beattie. She added, however, the CDC must combat this problem with limited resources. "They get a million dollars a year to focus on it … it’s a little bit of a disconnect," she said wryly.

However, Beattie continued, the direct costs don’t compare to the enormous toll a fall takes in terms of lessened independence, increased fear and the adoption of a more sedentary lifestyle, which opens the door to a host of other healthcare issues. She said statistics show anywhere from 20 to 60 percent of community dwelling seniors have a fear of falling, "but it skyrockets to as high as 83 percent in older adults who have already begun to fall."

Beattie added, "We know if a person falls, they are two-to-three times more likely to fall again." Therefore, she said, the heightened fear among those who have taken a tumble in the past is justified but doesn’t have to be a barrier to living a full, active life if some simple, proven strategies are adopted to minimize future risk.

Building on a large body of evidence and a concern over increasing rates of serious injury and death as the result of falls, Beattie said 58 organizations, federal agencies and professional associations came together in December 2004 to map out a plan. The result of the National Falls Free Coalition was the National Action Plan, which includes 36 strategies the collective body of experts deemed important to affect change. To view the plan, please go online to the NCOA’s Center for Health Aging at www.healthyagingprograms.org and click on "Coalitions."

Beattie said that although counterintuitive to a person who has experienced a fall, the evidence clearly shows staying physically active is one of the best ways to avoid future falls. She urged healthcare providers to talk with patients about prevention strategies that include both medical and common sense steps.

Providers, she said, might need to refer older patients to a physical therapist to work on lower limb and extremity flexibility or to evaluate balance and gait. Appropriate medication management is also key. She said some medications or combination of prescriptions could cause a patient to feel dizzy or off balance.

Those in healthcare also have the opportunity to speak with seniors and their family members about non-medical interventions such as adding grab bars in bathrooms, making sure there are two handrails going up steps and adding nightlights to help older adults maneuver through their home at night. Beattie added seniors and caregivers might also need a gentle reminder that some chores … such as climbing a ladder to clean out gutters … might best be left to someone a little younger.

At Risk


Women are 67 percent more likely than men to have a nonfatal fall injury, and fall-related fractures are more than twice as high for older adult women than men. In 2003, approximately 72 percent of hospitalizations for hip fractures among older adults were for women.

However, men are more likely to die from their fall. The age-adjusted death rate for falls among older adults in 2004 was 49 percent higher for men than women.

In 2004, nearly 85 percent of deaths from unintentional falls were among people 75 and older. In that same group of 75 and over, people who fall are four-to-five times more likely to be admitted to a long-term care facility for a minimum of one year.

Sources: CDC 2005 & 2006; JA Stevens et al. 2005; IP Donald et al. 1999.

"We can’t stop all falls, but we can certainly reduce the risk," she said.

Beattie stressed the importance of working in collaboration. She said older adults really could not do a thorough risk assessment alone. To be most effective, providers, community agencies and planners, aging services, caregivers and family members all have to work together. The first step for the healthcare community is to simply ask the question – ‘Have you fallen?’– when seeing older patients.

"There are a lot of providers out there who aren’t aware of the issues," she noted. "It’s not something that is typically a part of their training unless they have a geriatrics focus."

The sense of growing urgency is directly tied to the nation’s aging population. Beattie pointed out that the Census count included 34 million seniors in 2000. That number has been projected to rise to 54 million by 2020 and 74 million in 2040.

"Many providers, as well as older adults, don’t really understand the magnitude of this problem," Beattie said. "With an aging population, this is a national problem."

Happily, there are a growing number of resources and increased attention directed at the problem. This past April, the Safety of Seniors Act was signed into law. Beattie said the new law’s provisions mirror the National Falls Free Coalition action plan and include an awareness campaign, provider education and assistance with funding community demonstration projects. Unfortunately, the law has not yet received its own funding. Still, Beattie noted, many interested stakeholders are building on the momentum and launching their own programs.

She said 19 states, including North Carolina and Florida in the Southeast, declared a Fall Prevention Awareness Day … fittingly on the first day of fall this year. She also pointed to a peer model demonstration project called "Matter of Balance" that was developed for the Partnership for Healthy Aging in Maine and has become a blueprint for other communities. The most effective programs, she said, recognize falls are a complex issue that take integrated measures to lessen risk.

"Within the community, we really need to have a collaborative approach to this," she concluded. "We’re all in this together."