Probably everyone reading this article is intimately aware of or knows someone that has fallen at home and suffered a serious injury. I have experienced this tragic issue first hand. My Mother was 82 years old when she passed away this year in March as a result of a fall she had 8 months prior. The statistics are staggering, 30-35% of people 65+ fall each year. Those who fall are 3 times more likely to fall again and 1 in 5 falls cause serious injury. My mother’s fall was a fractured hip that required an orthopedic surgery to stabilize the femur bone with screws. Falls in the elderly (65+) is the leading cause of deaths. In 2010 there were over 21,000 deaths from falls. Just 4 years later (2014) the number rose to 27,000 deaths. This number is 3 times greater than all other reasons for death (MVA’s, poisoning, fire/burns, drowning, suffocation, other). The trends in death rates are staggering as well. From 2000 to 2010 the rates for 100,000 deaths shows that men have increased 64% and women have increased 84%. The leading cause of nonfatal injuries among people 65+ show that falls outnumber all other reasons for deaths (2.3 million falls compared to less than 500,000 deaths for all other reasons). Lastly, the economic impact demonstrates the problem we are all up against. Annual Medicare costs for elderly falls have been estimated at $31.3 billion dollars and the elderly population is expected to increase 55% by 2030. Yikes!
What can we do about this? I have some great suggestions for you as our great community is so well equipped with great medical professionals to help cut down on these needless falls that lead to major complications and even death. Firstly you should visit the Centers for Disease Control and Prevention (CDC) website that has a fantastic series of brochures for people at risk of falling and healthcare providers to access great information to prevent falls in the elderly. There is an excellent checklist titled “Check for Safety” that can help you assess your home environment for safety. Check it out here.
The CDC put together this program many years ago as a result of this growing problem of falls in the elderly and trying to get all Primary Care Providers and other healthcare providers (PT, OT, Nurses, Optometrists, …) to be more proactive in managing this huge problem. The program is called, STEADI (Stopping Elderly Accidents, Deaths & Injuries). I encourage you to get into this website as it is full of easy and simple algorithms to follow. Once you have read the information and assessed your fall risk, you can begin with some great prevention strategies. If you see that you have a significant risk of falling consult your primary care physician for a referral to your favorite physical therapy clinic. With more than 8 private practices and our local hospital, Sierra Nevada Memorial Hospital, our community is well staffed to manage this problem.
Modifiable Risk Factors
There are three categories of risk factors that can be addressed to improve one’s balance, coordination and eliminate risk. The “Biological factors” include things like leg weakness, hip, knee, foot or ankle disorders, mobility problems, balance problems, poor vision and Vitamin D insufficiency. These are things that can be changed with great certainty. The “Behavioral factors” involve the medications you are taking, risky behaviors and inactivity. The “Environmental factors” are our homes. Is there too much clutter in the home with great risk of tripping, no stair railings or grab bars and poor lighting? I’m sure you’re thinking as you read these that this is easy to fix. And the answer is YES, it is easy but many times it requires a third person to recognize it, talk about it and then take action on it.
Prevention & Treatment
A physical therapist will perform a thorough evaluation of the following: history of falls, review of your medical conditions, discussions of medications taken and their effects, then perform a series of clinical tests to assess your gait, strength and balance, basic assessment of your vision and lastly check for postural hypotension (a sharp drop in blood pressure when you go from sitting to standing). We use evidence-based tests that are valid and reliable to track progress with repeated functional testing. These outcome measures are evidence based and can guide us in how to improve function. My clinic and many other PT practices have group fitness classes designed to improve balance, strength and prevent falls. Having a Doctor of Physical Therapy (DPT) working with you will likely improve function in a safe and cost effective manner. Medicare will pay for all treatments of PT with a referral from your physician.
Beyond PT, there are several types of community classes that have demonstrated effectiveness in preventing falls in the elderly. Tai Chi and Qi Gong are great forms of safe, slow purposeful and healing movement therapy’s that have shown to be effective in improving one’s balance, coordination health and wellbeing. I find it very rewarding to treat this patient population with risk of falls because there is so much we can do to make positive changes. When the patient is willing and able to perform the exercises we prescribe for home, they truly demonstrate improvement and independence returns. So I challenge every elderly person 65+ to go to the STEADI website and spend 5 minutes to access the “check for safety” and “Stay Independent” brochures to make sure you are safe at home and while ambulating in this wonderful community.