Falls in the Elderly

Identify scope of the problem

Describe contributing factors for falls

Learning Objectives

How serious is the problem of falls?

Incidence rates of Falls in U.S.

One of every three adults over 65 years fall in every year

One of every two adults over age 80 fall annually

For people 65 years old or older…..

Where are people likely to fall?

Nursing Home 10%

Home 60%Public Places 30%

• Falls are the leading cause of injury among people over 65 years

• Of those who fall, 20-30% suffer severe injuries that make it hard for them to get around or live independently

Older adults are hospitalized for fall related injuries 5 times more often then they are for injuries from other causes

How big is the problem?

Mortality

Morbidity Fractures Soft tissue injuries Head trauma/TBI Joint distortions and dislocations Loss of confidence - fear of falling Restricted activity

Consequences of Falls

In 2000, estimated fall-related injury cost was $19.2 billion

Medicare costs per fall averages between $9,000 and $13, 500

Cost of fall injuries increase with age Cost of fall injuries are higher for women

than men

Costs

Unintentional Fall Death Rates by Gender, Age 65 +, U.S. 1996

Source: National Center for Health Statistics, Vital Statistics

0

20

40

60

80

100

120

140

Per

100

,000

65-74 75-84 85+

MenWomen

0

5

10

15

20

25

30

35

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

Unintentional Fall Age-Adjusted Death Rates, Age 65 +, gender and race U.S.

White, Men

Black, Men

White, Women

Black, Women

Source: National Center for Health Statistics, Vital Statistics

3% of all falls cause fractures. Approx. 95% of hip fractures in older people

aged over 65 years are the result of a fall People who have a hip facture are 5 ~20%

more likely to die in the first year following the injury than any other reason in the same age groups

Fractures

Loss of self confidence Decrease of physical activity level and quality

of life Fear of not being able to get up after a fall

Fear of Falling

Aged (over 65 years) Female Poor mobility or fragility – lower extremity

weakness, and poor grip strength Functional impairments - limited Activities of

Daily living (ADL) Poor gait and balance Low body weight

Intrinsic (Personal) risk factors for Falls

Risk Factors

Cognitive impairment or dementia Chronic illness

- Parkinson disease, visual difficulties, stroke, hypertension, or urinary incontinence

Psychoactive medications

- tranquilizers or antidepressants Previous falls Heavy drinking

Intrinsic (Personal) risk factors for Falls continued…

4,4

2,9 2,92,3

1,82,2 2,4 2,5

3,02,6

1,7

0,00,51,01,52,02,53,03,54,04,55,0

Mea

n R

R o

r OR

Relative risk ratio (RR) or Odd Ratio (OR) of Fall

J Am Geriatr Soc. 2001

Polypharmacy – four or more prescription medications combination

Home hazards Clutter, or loose rugs Poor lighting on stairs and hallways Lack of bathroom safety, e.g. grab bars in

bathtub Footwear Busy street or elevated walkways

Extrinsic or Environmental Factors

Exercise/physical activityespecially geared to gait and balance

and flexibilityMedicines reviewedVision checkedImproving home safety

Personal Prevention

Hip pads Mobility aids

Cane Walkers Wheelchairs

Bathroom aids - Raised toilet seats- Grab bars

Assistant Devices

CDC’s National Center for Injury Prevention and Control

National Resource Center on Aging and Injury

WHO –Ageing and Life Course National Fire Protection Association National Women’s Health Information Center Elder Web Additional Reading List

Resources