Population Health Effects Associated With Falls
The leading cause of injury in older adults is falling. According to Healthy People 2020 (2019), a person who has fallen is treated in emergency departments every 13 seconds, and falls claim the life of a victim every 20 minutes in the United States. About one-third of older adults fall every year (Healthy People 2020, 2019). Falls not only cause injuries and deaths, they are expensive injuries for patients and the U.S. healthcare system. The Center for Disease Control and Prevention (CDC) (2016) explains that over 800,000 people per year are hospitalized because of fall injuries; 300,000 of those hospitalizations are for hip fractures. In fact, 95% of all hip fractures are caused by falling. Falls are also the most common cause of traumatic brain injury (TBI). In 2015, falls cost Americans $50 billion, 75% of that was paid for by Medicare or Medicaid (CDC, 2016).
Falls happen everywhere in the United States, including the state of New Jersey. The New Jersey Department of Health, Office of Injury Surveillance and Prevention (2013) says that every 9 minutes in New Jersey, a person 60 years old or older is treated in an emergency room for a fall. The same demographic is indicated in 77% of hospital admissions for falls. The average cost for a hospital stay for falls in those 60 and older was just under $75,000, and New Jersey spent $1,715,733,716 in medical costs for falls in 2013 (NJ.gov, 2013). These statistics are staggering in terms of costs both in the lives and well-being of older adults in the New Jersey and the United States in general. However, there is good news: the number of falls can be reduced along with the costs of caring for them through evidence-based preventative measures and interventions.
Epidemiology of Falls
The incidence of falls among the elderly is high, but there are specific risk factors related to sex that increase the likelihood of falling. Gale, Cooper and Sayer (2016) of Age and Ageing explain that women have a higher likelihood of falling than men. This may be because women experience loss of bone mineral density more than men do because of menopause, but other risk factors may be in play also (Gale, Cooper, & Sayer, 2016, p. 789). Gale, Cooper and Sayer (2016) used data from the English Longitudinal Study of Ageing (ELSA) to investigate sex-specific associations between a wide range of potential risk factors and history of falls. They found that “higher levels of pain and the presence of chronic disorders were independently associated in multivariable analysis with an increased likelihood of having a history of falls in both men and women” (Gale, Cooper, & Sayer, 2016, p. 792). But other sex-specific factors were also discovered. For men “ high levels of depressive symptoms, older age and being unable to take the balance test” and for women “urinary incontinence and frailty” were associated with a higher likelihood of falling (Gale, Cooper, & Sayer, 2016, p. 792). These sex-specific fall risks are not directly addressed in the fall prevention literature.
Goal, Overview and Objectives of Healthy People 2020
The objectives of the Healthy People 2020 campaign regarding falls is to “reduce the rate of emergency department (ED) visits due to falls among older adults” (Healthy People 2020, 2019). The way to do this is through education and evidence-based fall prevention methods. Knowing how to prevent falls begins with knowing the risk factors for falls. Many of the risk factors related to falling can be addressed so that falls are prevented. The U.S. Preventative Services Task Force (USPSTF) (2018) recommends exercise and multifactorial interventions to prevent falls (USPSTF, 2018). While these 2 interventions are useful, other prevention measures are available too.
Population Focused Interventions
Several other fall prevention programs exist. These programs use evidence-based interventions and provide funding for programs that aim to reduce falls among the elderly. For example, the CDC has a program called STEADI (Stopping Elderly Accidents, Deaths, and Injuries). The STEADI program has developed an algorithm for healthcare providers that begins with screening for fall risks during yearly examinations, then assessing the patient’s modifiable risk factors and fall history by evaluating gait, strength and balance, identifying medications that increase fall risks, measuring orthostatic blood pressure, checking visual acuity, assessing feet and footwear, and identifying comorbidities. If a patient is assessed to be at-risk for falls, then interventions such as referral to physical therapy, exercise programs, ophthalmologist and/or podiatrist, and occupational therapy to address home fall hazards are undertaken. The last step is to follow up with patients and determine if the fall prevention program was successful (CDC, 2019). The issues of depression and incontinence are not directly addressed in the preventative measures.
The state of New Jersey also developed a fall prevention program in 2009 called the New Jersey Fall Prevention Workgroup. Its goals and objectives include developing a tool kit for fall prevention for fall prevention awareness week for 21 Area Agencies on Aging and other community-based organizations, a fall prevention campaign that identifies fall risks such as medications and poor vision, exercise for prevention and home safety education materials (NJ.gov, 2013). Part of this campaign involved distributing educational materials about fall prevention and raising awareness through local events aimed at the elderly population of New Jersey.
Conclusion
Falls can be prevented if evidence-based interventions to address and prevent are employed. However, more research on the causes of falls in elderly men and women should be done to prevent those sex-specific issues that cause them to be at-risk for falls. Nurses can contribute to the effort to prevent falls in the elderly in their home states and across the country.
References
CDC. (2016). Important Facts about Falls. Retrieved from Center for Disease Control and Prevention: https://www.cdc.gov/homeandrec...
CDC. (2019). Algorithm for Fall Risk Screening, Assessment, and Intervention . Retrieved from Center for Disease Control and Prevention: https://www.cdc.gov/steadi/pdf...
Gale, C., Cooper, C., & Sayer, A. (2016). Prevalence and risk factors for falls in older men and women: The English Longitudinal Study of Ageing. Age and Ageing, 45, 789-794. Retrieved from https://watermark.silverchair....
Healthy People 2020. (2019, October 6). Older Adults. Retrieved from Healthy People 2020: https://www.healthypeople.gov/...
NJ.gov. (2013). New Jersey Leadership: Making a Difference to Address Fall Prevention. Retrieved from NJ.gov: https://www.nj.gov/humanservic...
USPSTF. (2018, April). Falls Prevention in Community-Dwelling Older Adults: Interventions. Retrieved from U.S. Preventative Services Task Force: https://www.uspreventiveservic...
