Older adults more likely to fall, suffer debilitating injuries, but it doesn’t have to be that way

Older adults are at higher risk for falls and more likely to suffer from debilitating injuries, especially hip fractures, as a result. Yet, falls aren't simply “accidents” or an inevitable part of aging, says Anne Shumway-Cook, Ph.D., of the department of rehabilitation medicine at the University of Washington.

Safe at Home

“You can to a great extent identify people who are prone to fall, modify their risks and substantially reduce the number of falls,” Shumway-Cook says. One key is making community and home environments safer.

Too many Americans live in “Peter Pan houses,” designed for people who never grow old, says Jon Pynoos, Ph.D., co-director of the Fall Prevention Center of Excellence. He says that homebuilders and consumers need to think about designing homes that are safe, functional and accessible.

The Fair Housing Amendments Act of 1988 has helped older people at risk, but it “doesn't require excellent lighting, handrails or grab bars that help people get in and out of bathtubs,” Pynoos says.

Design Issues

In Europe, bathrooms have walk-in showers without a lip. Pynoos says that Scandinavian countries, in particular, “have thought ahead and pay more attention to design issues of this type.”

Many older U.S. homes he sees have front stairs leading outdoors with a single railing, or no railings, making them a danger to older adults.

“All of us are aging," Pynoos says, "and we want to stay in the homes that we have and want them to work for us as we get older.”

This is the first of three special briefings on aging well.
Visit www.cfah.org/programs/aging.cfm

The Facts:

• The direct medical costs of all fall-related injuries totaled $20 billion in 2000, with the costs of hip fracture representing the single largest expense, according to a report by the Centers for Medicare & Medicaid Services.¹

• Falls are the leading cause of injury and injury deaths among older adults, with more than 12,800 dying each year from fall-related injuries, according to the 2000 National Vital Statistics Report and a 2005 paper from the National Council on the Aging.^{2 3}

• A Baltimore study found that 25 percent of community-dwelling older adults remain institutionalized for at least a year after suffering a hip fracture.⁴

• In a 2004 study from the British Medical Journal, 80 percent of women over age 75 compare living in a nursing home following a hip fracture unfavorably to death.⁵

• The risk of falls and fractures among older adults can be reduced by removing trip hazards in the home, using nonslip mats in the bath or shower floors, installing grab bars next to the toilet and in the tub, having handrails on both sides of stairways and improving lighting.⁶

• Dietary problems are associated with the development of osteoporosis, which is the major cause of bone fractures in older people -- fractures that are often precipitated by falls.⁷

• Physical activity that involves balance, mobility and gait training reduces the risk of falls. For example, a Journal of the American Geriatrics Society study of people age 70 and older found that a 15-week tai chi program reduced the fear of falling and cut the risk of multiple falls in half.⁸

• The most effective fall-prevention programs reach those at greatest risk of falling and include a variety of strategies such as exercise, medication reviews or modifications and education that targets these individuals' multiple risk factors, according to a landmark 1994 study in the New England Journal of Medicine.⁹

• Because several chronic conditions (such as Parkinson's disease and stroke) have been shown to be key risk factors for falls, regular provider visits for these conditions may also reduce the risk of falls. Annual eye exams may be particularly important, the CDC suggests.⁶

• A meta-analysis by the RAND Corporation found that fall-prevention programs can reduce both the number of adults who fall by an average of 11 percent and the monthly rate of falling per person by an average of 23 percent.¹⁰

Movement to Prevent Falls

Lower extremity weakness, impaired balance and walking problems are the three major physical risk factors for falling for older adults, according to Anne Shumway-Cook, Ph.D., “and all can be improved by exercise.”

“My first goal is to improve balance and mobility so people can be safe and independent - my second goal is to reduce falls” says Shumway-Cook, a physical therapist and associate professor at the University of Washington.

“Most of my patients have learned to avoid falls by sitting on the couch and reducing their activity. It’s a strategy that may work in the short run but leads to a whole host of problems, including worsening of balance and walking problems,” Shumway-Cook says.

Although a continuum of fall-prevention resources exists, getting people to use them is a challenge. For example, Group Health offers a “Silver Sneakers” program that will pay for seniors’ gym memberships, yet people are still reluctant to take advantage, according to Shumway-Cook.

In 2005, the Center for Healthy Aging of the National Council on the Aging spearheaded the Falls Free Coalition, a group of national organizations committed to reducing falls and fall-related injuries among older adults.

Lynn Beattie, director of health promotion programs at the Center for Healthy Aging, says the Falls Free National Action Plan came about with the awareness that falls were an increasing public health issue.

The good news, says Beattie, is that research shows a number of effective strategies exist for preventing falls in older adults.

Taking multiple medications or taking any single psychotropic medications are key fall risk factors for older people, and medical management is an important component of fall prevention.

In the past, Beattie says, Medicare had inconsistently reimbursed health professionals for a falls-risk interventions, particularly for physical and occupational therapy for those at high risk but who have not yet suffered a fracture. Now, a specific code exists to make reimbursement more likely.

“Because falls are a complex, growing public health problem it’s going to take collaboration at the national, state and local level to effect meaningful changes,” Beattie says. “Everyone in the community has a role to play.”

She sees signs of progress, such as the latest clinical guidelines from the American Geriatric Society for reducing falls. The guidelines were, for the first time, based on input from other professional associations, including those representing physical therapists, occupational therapists, pharmacists and hospice.

The Advocacy Workgroup - part of the Falls Free Coalition - is pushing for the approval of the Falls Act of 2005, which was introduced into the Senate last year and will soon be introduced into the House. For $75 million, the bill addresses public education strategies, health-care provider awareness and the promotion of community-based interventions.¹¹