- By Rita Rubin
Unintentional falls are a leading cause of injury and death in older Americans, and the problem is getting worse.
It is an expensive issue: The Centers for Disease Control and Prevention (CDC) predicts that by 2020, indirect and direct costs related to falls will reach around $67.7 billion a year.
Most falls happen in the home, where simple aids and relatively inexpensive fixes can make a big difference — if you can convince aging family and friends of their value.
Few Sign Up For Fall Prevention Programs
New programs to prevent falls are also proving effective. But typically, only about 10 percent of those who are eligible sign up for fall prevention programs, says Dr. Judy Stevens, senior epidemiologist in the Division of Unintentional Injury Prevention at the CDC’s Injury Center.
“People are anxious,” Stevens says. “They don’t want to talk about falls. If they’re falling, they see that the next step is a nursing home.”
Indeed, nearly half of nursing home admissions are due to falls. Yet, Stevens says, people are reluctant to take steps that can prevent falls, such as using a cane or installing grab bars in their bathroom, because they don’t want to look or feel old, she says.
Perhaps a better way to frame fall prevention is as maintenance of independence, Stevens says. As she and her co-authors wrote in a study published in Injury Epidemiology, “For older adults, falls and associated injuries threaten their health, independence and quality of life.”
Deaths From Falls Rising
And falls threaten life itself. While the U.S. 65-plus population increased 17 percent from 1999 to 2010, the number of deaths related to falls in that age group more than doubled.
Stevens has co-authored a new study that investigated the rising numbers.
The research, published in the Journal of the American Geriatrics Association, came up with two possible reasons: better reporting on death certificates and an increase in chronic diseases that could lead to falls.
“People who have heart conditions are at a higher risk of falling,” Stevens says. And, she says, the medications people take for chronic conditions can lead to falls. For example, diuretics affect blood pressure. Because of a sudden drop in blood pressure, some patients taking diuretics black out if they stand up too quickly.
Taking Steps to Reduce Falls
Stevens’s research has also looked at measures to reduce falls.
The best thing reasonably healthy people can do to reduce their risk is exercise to improve balance and strengthen legs, Stevens says. Tai chi, a low-impact exercise, is a winner here, she says, with research suggesting it can reduce falls by about 45 percent.
Stepping On, a program developed in Australia, is catching on in the U.S., Stevens says. It’s aimed at people who have fallen or at risk for or afraid of falling. The fear alone can lead to isolation and inactivity. Research has shown that the program reduces falls by about 30 percent.
“People really like it. It’s very effective, and it’s social. It’s a little less strenuous than tai chi,” Stevens says.
Participants meet for two hours a week for seven weeks. They learn simple strength and balance exercises that they practice at home. They listen to guest speakers, such as pharmacists who talk about how drug interactions can increase the risk of falls.
A Pennsylvania Program
Even a half-day program can be helpful, Steven Albert, chair of the Department of Behavioral and Community Health Sciences at the University of Pittsburgh Graduate School of Public Health, has found.
Healthy Steps for Older Adults, a voluntary statewide program offered by Pennsylvania’s Department of Aging, reduced falls by 17 percent, Albert and his co-authors reported last month in the American Journal of Public Health. The walk-in program, a free half-day workshop offered at senior centers, screens participants for their risk of falls and provides education about how to prevent them.
Participants receive a booklet about balance and strengthening exercises and observe demonstrations of them. People identified as having a high risk for falls are referred to primary care doctors.
In his study, Albert found that three out of four Healthy Steps participants conducted home safety assessments, and a third reduced home hazards.
“Simply informing older adults of their high-risk status and heightening their sensitivity to situations involving a risk of falling may lead to reductions in falls,” Albert and his co-authors write.
But only about one in five of the participants found to be at high risk of falling followed up with a doctor.
Doctors, themselves, aren’t trained to evaluate older patients’ risk of falls, unless they’re geriatricians with a particular interest in mobility, Albert says. “We need to change primary care a little bit.”
It’s not that difficult, he says. Simple assessments, such as testing vision and reflexes, can be done in a doctor’s office, as can referrals for physical therapy to strengthen the legs.
While Healthy Steps might not be as effective as more individually tailored programs, it is inexpensive — the state aging department reimburses senior centers $70 per person — and can be offered to large numbers of older adults, Albert says.
It’s a worthy investment, Albert says. “When you fall and you’re elderly, all of a sudden your world changes.”
Some Stats on Falls
- One in three adults 65 and older fall each year, and about a quarter of them suffer moderate to severe injuries, according to the CDC.
- The direct medical costs of falls in 2010, adjusted for inflation, totaled $30 billion, according to the CDC.
- Compared to men and people younger than 85, women and people 85 and older were twice as likely to suffer an injury when they fell, Stevens's study published in Injury Epidemiology shows.
- Falling backward and landing flat was the most likely position to result in an injury. Falling sideways came in second, her report found.
- Of the 783 falls that occurred inside the home, those that occurred in the bathroom were about 2 ½ times more likely to result in an injury than falls in the living room, pointing out the need for grab bars both inside and outside the tub.
Rita Rubin is a former USA Today medical writer who now writes about health and science for publications including Next Avenue, U.S. News, WebMD and NBCNews.com.