Fall Risk and Prevention Among the Older Population
Written by Marty Watts, PT, VP of Population Health
My wife's grandmother was an active, independent 95-year-old who lived alone, drove around town to appointments, shopped for groceries, attended social events, and went to the YMCA weekly to exercise until she fell. How many of us have also had an older relative or neighbor who suffered a fall?
Every second, an older adult has a fall in America, accounting for 3 million trips to the ER, 950,000 hospitalizations, and 32,000 deaths. According to the CDC, falls are among the top 3 causes of unintentional injuries in the US, resulting in $50 billion in annual medical costs. The average hospital cost is $30,000. With the aging population in America, this number is only expected to rise. Of individuals 65 years old and older, 30-40% have had a fall, and 50% of those over 80 have had a fall. 50% of fallers will have two or more a year. 14% of home care patients fall within the first month after hospitalization. 95% of hip fractures are the result of falls, and falls are also the most common cause of traumatic brain injury. The mortality rate following a fall is 9.6% within 30 days of the fall and 33% after one year.
Among older adults who fall, less than half will inform their doctor of the fall. My experience as a therapist is that they also rarely notify their family. Many factors may play into this, but the primary issue is a fear of losing their independence or the perception that they may no longer be allowed to live independently in their home.
The first thing we can do as family members or healthcare workers is to begin the conversation. If I ask, "Have you had a fall"? they will often deny having had a fall. However, if I instead say, "Tell me about the last time you had a fall," they usually will discuss a fall with me more openly as their therapist. Simple rephrasing seems to lower their defenses and encourage them to be more open to discussion.
The next thing that can help prevent falls is completing a therapy assessment. Therapists assess several factors known as modifiable risk factors, which consist of biological, environmental, and behavioral factors.
Biological—The therapist will assess factors like patient’s strength, mobility, balance deficits, and vision. All of these play a factor in the risk for falls and can be assessed with standardized tests performed by the therapist.
Environmental- this category consists of risk factors in and around the home. 55% of older adults fall in the home, and 23% occur outside but near the home. A therapist will begin with a home assessment as the home environment is implicated in 35-40% of falls. Things typically assessed are the entrance to the home, identifying which entrance is safest, steps with sturdy handrails, adequate lighting with automatic sensors, and a chair to sit in if they get too tired and need to rest. Are there tripping hazards in the home, such as throw rugs, loose flooring, clutter on the floors, or extension cords? A home assessment can reduce the risk of falls by 36%.
Behavioral- Are they taking psychoactive meds? Are they taking four or more medications, as this increases the likelihood of falls? Do they have risky or impulsive behaviors? For example, a 90 year old woman broke her hip because she wanted to change her drapes by standing on her chair. Also, older adults with cognitive deficits are twice as likely to suffer a fall. Occupational therapists and Speech Pathologists can provide interventions to assist patients and their caregivers with cognitive deficits.
For my wife's grandmother, this was her first fall, and she ended up in the hospital then rehab; and it started a downhill trend with her health over the next several years and cost her independence and quality of life. If you have an older family member or loved one, don't wait; begin the conversation with them today and then discuss with their physician the possibility of a therapy referral to prevent another fall, or better yet, intervene before they have that first fall.