By Amy Hester, Ph.D., R.N., Chairwoman and CEO, HD Nursing

It’s easy for healthcare practitioners and industry executives alike to marvel at the lightning-fast pace of advancement in medical technology and evidence-based tools that feature targeted interventions tailored to individuals. One such area involves assessing and preventing fall risks in vulnerable populations across the U.S.

There are some wearables, smartphone applications, medical alert systems and programs that come with connections to medical practitioners, health coaches and case managers. While the technology is impressive, it must be blended with a human touch to achieve the best possible outcome. That’s exactly what a fall-risk assessment tool, such as the HD Nursing Falls Prevention Program, accomplishes. Validated in multiple forms, including electronically, it serves to prevent falls that may result in injury or even death, promotes a safer environment and reduces cost.  

Several groups are prone to falling, including, of course, the elderly, but also military veterans who are aging or disabled, as well as subcategories of the latter that include traumatic brain injuries (TBIs) and amputees. With Veterans Day on November 11, it behooves all of us to be more mindful not only of their service to our country, but also the struggles they continue to endure away from the battlefield.

It’s important to note that these segments of the population may not be adept at, or comfortable, using technology, which further supports the need to blend tech and human touches. They also are more prone to loneliness and depression, both of which are known to increase a person's risk of falling and were exacerbated during the pandemic. This is another reason why a human touch is so critically important for helping combat troubling mindsets and preventing injuries.

The issue hits close to home. For example, there were as many as 970 deaths related to falls in Tennessee in 2020, with about 84%, or 812, occurring among individuals who age 65 year and older. The percentage of older adults who fell in Tennessee in 2020, the latest year for which the Centers for Disease Control and Prevention has data on this topic, was 31.2% -- accounting for 321,104 individuals. Tennessee landed in the second-highest category among states reporting age-adjusted fall percentages. The falls death rate per 100,000 people was 85.9 with 862 deaths in Tennessee in 2021, the latest year for which the CDC has published that data point. The percentage was slightly higher than average relative to other states.

For anyone who is 65 and older, the most common cause of trauma is a fall. It’s also the No. 1 reason senior citizens lose their independence and move into assisted living or some sort of institutionalized setting.

As for the veteran population, there were nearly 414,000 TBIs among U.S. service members worldwide between 2000 and late 2019, with more than 185,000 veterans who use Veterans Administration for their healthcare having been diagnosed with at least one TBI. Just like the elderly or disabled vets, they face a higher risk of falling. Veterans traditionally possess many social determinants of health. They cannot always afford wearable devices, for instance, nor might they be all that enthusiastic about being monitored or watched.

Another point worth noting is that when people are hospitalized and may be in a particularly frail state, the risk of falling is much greater. Consider, for example that between 700,000 and 1 million people in the U.S. fall in the hospital every year. The resulting fractures, lacerations or internal bleeding lead to increased healthcare utilization. About three million seniors who have injured themselves in falls are treated in emergency departments each year, with as many as 800,000 requiring hospitalization.

Anything that can be done to assess and prevent the risk for falling in the hospital could go a long way toward improving outcomes and lowering expenses. The cost of falls totaled more than $50 billion in 2015, with Medicare and Medicaid shouldering 75% of the bill. Providers can play a big part in cutting costs. They have a real incentive to pursue fall-prevention care, which can be reimbursable by the Centers for Medicare & Medicaid Services depending on the setting of care.

For instance, in outpatient clinics, fall-risk screening starts with guideline questions posed by the American Geriatric Society to determine who is at risk. While many providers simply acknowledge that some of their patients are at risk for falling, what they need to be doing is conducting a comprehensive assessment of why individual are at risk in the first place. Some screening questions can be done by registration personnel before a patient arrives at the clinic, setting the stage for meaningful conversations during their office visit. Within the EHR, multiple members of the team can be involved to collect that information so that the provider can make the most of what little time is spent with patients and improve care decisions.

Other helpful strategies include doing exercises such as Tai Chi to strengthen the legs and improve balance, encouraging regular checkups with an eye doctor and making homes safer by eliminating items that people could trip over, adding grab bars by a tub, shower and toilet, or installing railings on both sides of stairs.

When blended with advanced technology, human touches that are routinely incorporated into patient care will go a long way toward mitigating the risk of falling, providing more efficient treatment and lowering costs.

Dr. Amy Hester, PhD, RN, BC, FAAN, Chairwoman and CEO, HD Nursing.

Amy has 25 years of nursing experience including over a decade of med/surge and neuro nursing followed by unit management and hospital administration. In 2015, she earned a Doctor of Philosophy in Nursing Science and has since published and spoken extensively on the subject of falls and injury prediction and prevention. She retired from UAMS in 2018 after 26 years of service to dedicate her time fully to HD Nursing. She is adjunct faculty at UAMS College of Nursing. As an entrepreneur, she mentors others to help them with their own endeavors. Amy also serves as the Chair of the HD Nursing Board of Directors.