Every second of every day in the United States an older adult falls. Every 11 seconds an older adult is treated in an emergency room for a fall. Every 19 minutes an older adult dies from a fall.
“How many times have you fallen in the past 12 months?”
That’s the first thing physical therapist Laura Wazen asks patients when they walk through the doors of her practice to undergo a balance assessment. And if statistics are any indication, it’s a question of growing importance. Deadly falls are on the rise.
Not every person who ends up at Equinox Physical Therapy thinks they have a balance problem – many are there because of pressure from either their family or doctor. She once had a patient deny they had a balance issue because they “only fell once or twice a day.”
An in-home exercise program reduced subsequent falls in high-risk seniors by 36 per cent, according the results of a 12-month clinical trial published today in the Journal of the American Medical Association.
The study, conducted by UBC faculty of medicine researchers in partnership with the clinical team at the Falls Prevention Clinic at Vancouver General Hospital, found a reduction in fall rate and a small improvement in cognitive function in seniors who received strength and balance training through the clinical trial.
Falls increase risk of injury and loss of independence for older adults. Exercise is a widely recommended fall prevention strategy, but whether it can reduce subsequent falls in those who have previously fallen is not well established.
Falls are not just a problem of advanced age, according to researchers in Trinity College Dublin, who have identified a sharp increase in falls after the age of 40, particularly in women.
The research, which drew on data from TILDA (the Irish Longitudinal Study on Ageing) as well as data from similar studies in Australia, Great Britain and the Netherlands, found that for women the prevalence of falls increases from the age of 40 on — 9% in 40-44 year olds, 19% in 45-49 year olds, 21% in 50-54 year olds, 27% in 55-59 year olds and 30% in 60-64 year olds.
The findings indicate that middle-age may be a critical life stage for interventions designed to prevent falls, according to the authors. The study incorporated the data from 19,207 men and women aged between 40 and 64 years. It has been recently published in the international journal PLOS ONE.
Falls are the leading cause of illness and death among Americans aged 65 and older. In 2014, some 2.8 million older adults visited the emergency department (ED) for a fall-related injury. And over time, the ED visit rate for falls among older adults has grown to 68.8 per 1,000 older adults (as of 2010).
Older adults who visit the ED for a fall are at high risk for both revisiting the ED and dying. In fact, some estimates show that 25 percent of older adults visiting the ED for a fall returned for at least one additional fall-related visit. Fifteen percent of those older adults died within the following year.
Because so many older adults visit an ED due to falls, many experts see an opportunity for EDs to play a role in reducing future falls among older adults who are at high risk.
One of the biggest health threats facing Americans age 65 and older is also one many of them don’t like to talk about: falling.
At least half of senior Americans who fall don’t tell anyone, according to a report from the Centers for Disease Control and Prevention. Whether it’s a spouse declining to tell a partner, or an elderly parent hiding it from the children, many seniors keep quiet because they are embarrassed and fear losing their independence.
By remaining silent, however, many of these patients become more afraid and more sedentary, medical experts say. That increases their risk for additional falls and injuries, which can lead to fatal complications such as intracranial bleeding, flail chest and respiratory failure. Indeed, falls are the leading cause of injuries and death from injuries in older Americans, according to the CDC.
Falls are a leading cause of death and disability in the elderly, and also contribute to rising healthcare costs. In 2012, a research team from Duke-NUS Medical School (Duke-NUS) in Singapore teamed up with the Singapore General Hospital (SGH), Changi General Hospital (CGH) and Agency for Integrated Care, to study the effectiveness of tailored physical therapy programmes for the elderly to prevent falls, also known as the Steps to Avoid Falls in Elderly (SAFE) study. The results of that study are now in.
The team, led by Professor David Matchar, Director of the Health Services and Systems Research Programme at Duke-NUS, recruited into the SAFE study 354 elderly patients who previously sought medical attention at emergency departments for a fall or fall-related injuries. All recruited patients were older than 65 years of age. Of these, half were randomly assigned to the intervention group, to receive tailored and intensive physical therapy. The other half were in the control group, and received no structured physical therapy beyond usual services. All participants were followed over a period of nine months.
When the management team of one hospital’s pediatric rehabilitation unit sought to decrease the number of falls among its patients, they found little in the way of guidance. So they got to work: after scouring the research, they developed a unique falls prevention program called “Red Light, Green Light” that resulted in greatly reduced falls among these patients. The program is described in detail in an article e-published ahead of print in Physical Therapy (PTJ), the scientific journal of APTA.
Most falls prevention programs are centered around older adults. But according to authors, 61% of falls among children are “anticipated physiologic falls”—in short, falls that could have been predicted using a falls risk assessment tool. Of those pediatric falls that caused injuries, most were due to “family inattentiveness” or “environmental/equipment factors.” So, the interdisciplinary team designed the program to educate both staff and family members who are present when the child is transferring or ambulating.
Falls among people 65 and older make up a significant portion of the 911 calls to emergency medical services (EMS) providers—but the likelihood of the event resulting in transport to a trauma facility can depend on the location of the fall, sex of the injured individual, and even geographic setting, according to an analysis of events recorded in 2012.
In an article published in the American Journal of Preventive Medicine, researchers looked at data from 903,588 calls made to EMS providers related to falls by individuals 65 and older, including age and location of the victim, as well as the initial clinical impressions of the EMS provider and final dispensation of the call.
The rate of deaths from fall injury among Americans 65 and older nearly doubled between 2000 and 2013, and falls now represent over half of the total deaths from unintentional injury among that group, according to a new report from the US Centers for Disease Control and Prevention (CDC).
In a data brief issued on May 7, the CDC reported that from 2000 to 2013, the age-adjusted fall injury death rate rose from 29.6 per 100,000 Americans 65 and older to 56.7 per 100,000. Falls-related deaths now represent 55% of all unintentional injury deaths for that group, 1 of only 2 unintentional injury categories that actually rose during the study period (unintentional poisoning was the other category that showed an increase, but the uptick was slight, and at 4% represents the next-to-smallest cause).
The prevalence of self-reported falls among adults 65 and older is on the rise, and it’s not just because of an aging American population, according to researchers who analyzed data collected from 1998 to 2010.
Researchers anticipated that if increases in falls prevalence were found, they would be largely due to “changes in age structure of the population”—that is, more and more people getting older and older. What they found surprised them: while prevalence did increase across the board for adults 65 and older from 1998 to 2010, from 28.2% to 36.3%, the largest jumps in prevalence occurred in the lower age brackets.