Falls and Falls Related Injuries

1. Falls and Falls Related Injuries A Growing Public Health Issue Bonita Lynn Beattie, PT, MPT, MHA National Council on Aging Center for Healthy Aging February, 2007 www.healthyagingprograms.org

2. Why Falls, Why Now? Objectives: • You will gain an appreciation for the magnitude of the problem • You will be able to identify some common risk factors and evidence-based interventions that you can consider implementing or adapting to your communities • You will be able to access tools and resources that have been developed to help address this growing public health issue

3. Defining the Problem In 2003: • 13,700 died from falls • 1.8 million treated in Emergency Departments • 1.3 million treated & released • 460,000 hospitalized • Admission rates with age (39% of fall related admissions are 85+) How many non-reported falls?

4. 2000 State Profile:Unintentional Injury Deaths  *Per 100,000 population; age adjusted to the 2000 U.S. population

5. From 1994 to 2003, the unintentional fall death rates for both men and women increased significantly In 2003, the rate for men was 49% higher than for women.   * Per 100,000 population; age adjusted to the 2000 U.S. population.   Reference: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2005) [cited 2006 Aug 20]. Available from URL: www.cdc.gov/ncipc/wisqars.

6. Age-Adjusted Fall Death Rates Men & Women Age 65+, 1999-2004 Adjusted to the 2000 U.S. population, all races, both sexes

8. Hip Fractures • 95% of hip fractures caused by falls • 20% die within a year after hip fracture1 • 25% in a nursing home one year later2 • Rates higher for women (76% women) • 25% of community-dwelling older adults who have a hip fracture are in a nursing home for at least a year3 1. Nyberg, JAGS, 1996 2. NCHS, National Hospital Discharge Survey, 2001 3. Magaziner, et al., 2000

9. Quality of Life Impact • 20% - 30% fear falling1 • 35%-40% of people 65+ fall each year2 • Those who fall are 2-3 times more likely to fall again3 • 10%-20% of falls cause serious injuries4 1. Vellas BJ, Age & Aging, 1997; Friedman SM, JAGS, 2002 2. Hornbrook, Gerontologist, 1994; Hausdorff, Arch Phys Med & Rehab, 2001 3. Tinetti, New Eng J Med, 1988; Teno, JAGS,1990 4. Sterling, J Trauma-Inj Infection & Critical Care, 2001

10. Falls are not a normal consequence of aging Falls are not a normal consequence of aging Falls are not a normal consequence of aging

11. Identify Risk Factors • Intrinsic & extrinsic risk factors • Not modifiable • Older age • Female • White • Some chronic diseases • Modifiable • Muscle weakness • Poor balance • Impaired vision • Psychoactive medications • Environment

12. Effective Interventions What Works? • Comprehensive clinical assessment1 • Exercise for balance & strength2 • Medication management3 • Vision correction4 • Reducing home hazards5 • 1. American Geriatrics Society, JAGS, 2001 2. Lord SR, JAGS, 2001 3. Cumming RG, Drugs & Aging, 1998 4. Ray W, Topics in Geriatric R Rehab,1990 5. Day L, BMJ 2002; Gill TM, JAGS, 1999

13. Falls Free National Summit Preparation: Steering Committee, National Environmental Scan, Review Research Papers • 58 National organizations represented • Experts in their fields, representing diverse backgrounds • Two day summit grappling with the issues, developing strategies to activate what we know about falls prevention • Resulted in 36 actionable strategies and action steps largely doable in 18 months www.healthyagingprograms.org

14. National Action Plan Organized Around Risk Factor Management Physical Mobility Home Safety Medications Management Environmental Safety & Cross Cutting Issues

15. Recommendations from the Research • Include activities that specifically target balance and gait • Also target other associated risk factors (e.g., muscle weakness) • Exercise is performed at a moderate intensity or progresses from low to moderate intensity • Introduce progressively more challenging practice environments

18. Role of Medication Modification “ Numerous factors are associated with an increased risk of falling and fall-related injuries among older adults, but none is as potentially preventable or reversible as medication use.” Leipzig RM et al. Drugs and falls in older people: a systematic review and meta-analysis: I. psychotropic drugs. J Am Geriatr Soc 47ka

19. Medications Management • Goal A: All older adults will become aware that falling is a common adverse effect of some prescription and nonprescription medications and discuss these effects with their health care provider. • Goal B: Health care providers will be aware that falling is a common adverse effect of some prescription and nonprescription medications, and therefore will adopt a standard of care that balances the benefits and harms of older adult medication use.

20. Home Safety

21. Source: National Health Interview Survey, 1997-1998 (Kochera, 2002) Kochera, 2002) Where People Fall

24. Home Modification Interventions

25. Problems in the Community Abound

26. Multifactorial Nature of Falls Demands a Coordinated Effort For any of these evidence-based interventions to be effective, they must be included as part of a program that addresses multiple risk factors for falls as most falls can be attributed to multiple causes…and is tailored to meet individual needs

27. Long-term involvement = Long-term benefits Part of the Solution: Community Programs

28. Translate & Disseminate Evidence-Based Programs • Translation • Matter of Balance www.mmc.org/mh_body.cfm?id=432 • Community Tai Chi Program • Compendium of Effective Interventions: A Best Practices Guide for the Prevention of Falls Among Seniors Living in the Community www.phac-aspc.gc.ca/seniors-aines/pubs/best_practices/intro_e.htm

29. Translate & Disseminate Evidence-Based Programs • Dissemination • National Resource Center for Safe Aging www.safeaging.org • Fall prevention education materials www.cdc.gov/ncipc/duip/fallsmaterial.htm

30. How to Get Started Locally • Know the real issue, know your local data • Research the evidence-based solutions • Conduct a local resource scan – find partners, include older adults themselves

31. How to Make a Local Difference • Above all else set reasonable target goals, monitor results, network with communities struggling with the same issues • Keep communications open, share successes, problem solve issues

32. Resources • Center for Healthy Aging www.healthyagingprograms.org Falls Free Electronic News • Center of Excellence for Fall Prevention www.stopfalls.org • National Resource Center on Supportive Housing and Home Modification www.homemods.org

33. Resources • A Tool Kit to Prevent Senior Falls: Falls in Nursing Homes: CDC www.cdc.gov/ncipc/factsheets/nursing.htm • Patient Safety and Quality Healthcarewww.psqh.com/mayjun06/falls.html • National Center for Patient Safety Falls Toolkitwww.va.gov/ncps/SafetyTopics/fallstoolkit/index.html

34. Additional Resources • National Guideline Clearinghouse www.guideline.gov (Search under fall prevention programs) • Home Safety Council: State of Home Safety Facts about safety in the home homesafetycouncil.org/state_of_home_safety/sohs_2004_p017.pdf • American Society on Aging Web Cast: Reducing the Risk of Falling www.asaging.org/webseminars

35. And Even More Resources • National Safety Council www.nsc.org/issues/fallstop.htm • British Columbia Injury Research and Prevention Unit http://www.injuryresearch.bc.ca/index.aspx • National Institute on Aging, AgePage: Preventing Falls and Fractures www.niapublications.org/agepages/PDFs/preventing_Falls_and_Fractures.pdf • First Nations Remembering When www.nfpa.org