01. Introduction

  • Annually, 1 of every 3 older adults (age 65+) fall.
  • Falls are a major threat to the independence and quality of life of older adults.
  • Fall-related injuries are responsible for:
    • Significant disability.
    • Reduced physical function.
    • Loss of independence.
    elderly-woman-stairs.jpg (Centers for Disease Control and Prevention, 2011)

02. Falls

Fall: an event which results in a person coming to rest inadvertently on the ground, floor or other lower level from an abrupt dissipation of mechanical energy.


  • Prominent among the external causes of intentional injury. (WHO, 2007)

  • Common types of falls are coded as:

      - E880-E888 in International Classification of Disease-9 (ICD-9).
      - W00-W19 in International Classification of Disease-10 (ICD-10).

03. Type of Falls

The most common type of fall resulting in hospitalization among older adults (age 65+) occurred from falls on same level from slipping, tripping, and stumbling.

Types of Falls2.jpg

04. Location of Falls

The most common location of falls resulting in hospitalization among older adults (age 65 +) occurred in the home.

Location of falls.jpg

  • 1 in every 3 older adults fall annually and the likelihood of falling increases proportionally with age (CDC, 2007).
  • Among older adults, falls are the leading cause of:
    • Injury
    • Hospitalization due to injury
    • Death due to injury
      • The death rates from falls among older adults have risen sharply over the past decade.
        • In 2005, 15,802 older adults died as a result of fall injuries (CDC, 2007).
        • In 2009, 2.2 million nonfatal fall injuries among older adults were treated in emergency departments and more than 581,000 of these patients were hospitalized (CDC, 2007).

06. Aging Population

Fall-related injury is an emerging and largely unrecognized public health problem that is anticipated to grow as the population ages.


  • Currently, 13% of the U.S. population is age 65 or older. (Berger, 2011)

  • This number is expected to almost double by 2050.

population projection.jpg

07. Trends and rates

  • During 2003-2007, there were 79,386 falls fatalities (rate: 40.77 per 100,000 population) reported among the U.S. elderly; it rose from 13,800 to 18,000 between 2003 and 2007.
  • The annual mortality rate varied from a low of 36.76 per 100,000 in 2003 to a high of 44.89 per 100,000 in 2007.
  • Falls mortality rate increased by 22.14 per 100, 000 population from 2003 to 2007.

trends:rates.jpg

08. Risk Factors

risk factors.jpg

09. Consequences

Fractures


  • Includes: hip, spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.

  • One year mortality rate of 20-30%


Traumatic brain injury

  • 20% of serious head injuries lead to mental decline.

Fear of Falling

  • Self imposed restrictions on activity and mobility



  • Can contribute to future falls and the risk of more serious injuries


Loss of independence

  • Related to decreased mobility and functional abilities



  • Increased rates of admittance to nursing homes or long-term care facilities.


Prolonged hospitalization
Loss of self-esteem
Death

10. Costs

The cost of fatal fall injuries totaled $349 million:


  • $160 million for men



  • $189 million for women.


Costs were similar for men and women until age 85, when the costs for women ($105 million) exceeded those of men ($62 million).

Costs.jpg

11. Prevention Strategies

Older adults can remain independent and reduce their chances of falling by:


  • Exercise regularly. It is important that the exercises focus on increasing leg strength and improving balance, and that they get more challenging over time. Tai Chi programs are especially good.



  • Ask their doctor or pharmacist to review their medicines--both prescription and over-the counter--to identify medicines that may cause side effects or interactions such as dizziness or drowsiness.



  • Have their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision. Consider getting a pair with single vision distance lenses for some activities such as walking outside.



  • Make their homes safer by reducing tripping hazards, adding grab bars inside and outside the tub or shower and next to the toilet, adding stair railings and improving the lighting in their homes. (CDC, 2012)

12. Factors Limiting Progress

Defining falls


  • There are many different interpretations of falls. Older people tend to describe a fall as a loss of balance, whereas healthcare professionals generally refer to events leading to injuries and ill health. (WHO, 2007)


Aging population

  • Falls exponentially increase with age-related biological change, therefore a pronounced number of persons over the age of 80 years will trigger substantial increase of falls and fall injury at an alarming rate. (WHO, 2007)


Current lack of education and awareness about this issue

  • Falls cost the American government $19 billion a year, but only $1 million a year is spent on falls research and prevention. (National Safety Council, 2007)


Unknown interactions with medications

Health factors


  • Heart disease, stroke, cancer, diabetes, or vision problems have higher fall rates. (National Safety Council, 2007)

13. Haddon's Matrix

14. Haddon's Ten Strategies

1. Prevent creation of the hazard.
Professionally delivered home safety evaluation to reduce environmental hazards and identify home modifications to maximize safety.
2. Reduce amount of the hazard.
Get your medications reviewed by doctor (especially if proprioception ability is affected by the prescribed medicine), walk on flat ground, and avoid traveling on irregular surfaces as much as possible. Modify home for safer and easier access.
3. Prevent release of hazard.
Apply soft material (e.g. carpet) to cover the floor, ensure common pathways are free from clutter, ensure outdoor walkways and stairs are free of leaves, ice, and snow, and secure rugs with tape.
4. Alter release of the hazard from its source.
Eliminate environmental hazards by installing non-slip flooring, placing rubber bathmats on the bathroom floor, keeping the nightlight on, and wearing non-slip footwear.
5. Separate person and hazard in time and space.
Make sure that spills are cleaned up and onstacles are removed as soon as possible. Use medication organisers for dispensing medications.
6. Place barrier between person and the hazard.
Wear proper personal protective equipment and assistive devices when reaching and walking. Install grab bars.
7. Modify basic qualities of the hazard.
Wear appropriate shoes, modify the home by Installing grab bars on tubs and by toilet. Apply contrast strips to all stairs, steps and changes in levels.
8. Strengthen resistance to the hazard.
Exercise regularly to keep muscles warm and to keep body mobile. Strength and balance exercises such as Tai Chi and walking can improve balance and strength. Increase calcium and vitamin D intake to reduce likelihood of a fracture.
9. Detect quickly
Provide first aid training to elder people. Use of personal alarms and a home safety checklist.the provision of efficient emergency services, use of a home safety checklist.
10. Repair the damage.
Exercise and strength training to make the bones more resistant to a second fall/injury. Movement rehabilitation through physical activity to get the individual walking or using the injury body part again.

Prevent creation of the hazard through professionally delivered home safety evaluation to reduce environmental hazards and identify home modifications to maximize safety.


  • Research has shown the cause of falls to be multi-factorial in nature, influenced by conditions within the individual, within the environment, and as a result of the interaction between the two. The most successfully proven falls prevention initiatives are those that use a multi-faceted approach.



  • Identifying environmental factors that contribute to falls and implementing the recommendations to remove these elements can improve safety, reduce health care costs, and enhance the independence and participation of older adults.



  • Recommendations often include a combination of interventions that target improving physical abilities to safely perform daily tasks, modifying the home, and changing activity patterns and behaviors. (AOTA, 2012)

16. References

  • Alamgir, H., Muazzam, S., & Muazzam, N. (2011). Unintentional falls mortality among elderly in the United States: Time for action. Retrieved from: http://dx.doi.org/10.1016/j.injury.2011.12.001.
  • AOTA (2012). Occupational Therapy and prevention of falls. Retrieved from: http://www.aota.org.ezp2.lib.umn.edu/Consumers/Professionals/WhatIsOT/PA/Facts/39478.aspx.
  • Berger, K.S. (2011). The developing person through the life span (8th ed.). New York, NY: Worth Publishers.
  • Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (2007). Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed March 30, 2012.
  • Centers for Disease Control and Prevention (2011). Falls among older adults: an overview. Retrieved from: http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html
  • Hausdorff JM, Rios DA, Edelber HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Archives of Physical Medicine and Rehabilitation 2001;82(8):1050-6.
  • Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. Preventing falls among community-dwelling older persons: results from a randomized trial. The Gerontologist 1994:34(1):16-23.
  • Stevens JA. Fatalities and injuries from falls among older adults - United States, 1993-2003 and 2001-2005. MMWR 2006a;55(45).
  • Trotter, M., Stephenson, S., Simpson, J. & Casey, D. (2005). Fact sheet: Hospitalized falls. Retieved from: https://docs.google.com/viewer?a=v&q=cache:i_ew1bf63c4J:ipru3.otago.ac.nz/ipru/FactSheets/FactSheet35.pdf+intertnational+classification+of+disease-10+for+falls+W00-W19&hl=en&gl=us&pid=bl&srcid=ADGEESgTRPNQxB4Q4xlMnogNapCz4fVSLqHDUSOsT3bvyRWE2CpnVIVAyuF-c18EeCUOMAoNQru3vAAHW2JIriNvPUTQwwEEXEii6O89y_ishrrxoro0jbqwwtEllx12haiwGy88wsWB&sig=AHIEtbSJGDIwckOV9Jjrg-oNKfqnNBusFg.
  • U.S. Census Bureau (2010). Population estimates and projections. Retrieved from: http://www.agingstats.gov/Main_Site/Data/2008_Documents/Population.aspx.
  • VHA (2004). NCPS toolkit. Retrieved from: http://www.patientsafety.gov/SafetyTopics/fallstoolkit/notebook/03_background.pdf.
  • World Health Oranization (2007). WHO global report on falls prevention in older age. Retrieved from: http://www.who.int/ageing/publications/Falls_prevention7March.pdf.