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Falls and fall-related injuries impose an enormous burden on individuals, society and the nation’s health care systems. As the population of the United States ages, the negative impact of falls continues to increase.
According to the Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control:
- More than one-third of adults’ age 65 years and older fall each year.
- Among older adults, falls are the leading cause of injury deaths and the most common cause of injuries and hospital admissions for trauma.
- Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes.
- Of those who fall, 20 to 30 percent suffer moderate to severe injuries that reduce mobility and independence, and increase the risk of premature death.
Statistics of Unintentional Falls Among Seniors
The Chronic Disease Prevention and Health Promotion (CDPHP) Injury Prevention staff looked at 2005 national data obtained through the CDC concerning deaths and injuries to people 65 years and older.
In 2005, 15,800 persons 65 years and older died from an unintentional fall and 1.8 million seniors were treated in U.S. hospital emergency rooms for non-fatal falls. Or put another way, every hour 1.8 seniors died and every hour 205 were treated in emergency rooms for fall-related injuries.
The financial impact of fall-related injuries is significant. The CDC reports that $19.2 billion annually is spent on treating the elderly for the adverse effects of falls: $12 billion for hospitalization, $4 billion for emergency department visits and $3 billion for outpatient care. Most of these expenses are paid for through Medicare. It is projected that direct treatment costs will reach $43.8 billion annually in 2020, at which time the cost to Medicare would be $32.4 billion.
The national 2005 death rate (per 100,000 population) from unintentional falls for seniors 65 and over was 42.96. Available data for Nevada from 2005 shows the unintentional fall death rate (per 100,000 population) for seniors 65 and over was 37.90, just slightly under the national rate.
Additional information obtained from the Center for Health Data and Research at the Nevada State Health Division showed that there were 132 deaths as a result of unintentional falls in Nevada for the year 2004. Of the 132 deaths, 93 or 70 percent occurred in Clark County. Eighty-four or 64 percent of those deaths in Nevada were seniors 65 and older.
Hospital Discharge data collected by the Center for Health Data and Research for the years 2003 through 2005 showed that 10,035 people were admitted to Nevada hospitals as a result of an unintentional fall. This was 45 percent of all hospital admissions for accidental injuries during that three year period.
Many falls and fall-related injuries can be prevented with existing knowledge and technology. The risk of falling can be reduced by following these steps:
- Exercise regularly
- Exercise is one of the most important ways to reduce your chances of falling. It makes you stronger and helps you feel better.
- Exercises that improve balance and coordination (like Tai Chi) are the most helpful.
- Ask your doctor or health care worker about the best type of exercise program for you.
- Visit the Physical Activity web page for more tips and resources on beginning an exercise routine.
- Make your home safer
- Half of all falls happen at home. To make your home safer:
- Remove items from stairs and walkways to prevent tripping.
- Remove throw rugs or use double-sided tape to keep rugs from slipping.
- Keep items you use often within easy reach. Avoid using step stools.
- Install grab bars in next to your toilet, tub and shower.
- Use non-slip mats in the bathtub and shower.
- Improve the lighting. As you get older, brighter lights are needed to see well. Lamp shades or frosted bulbs can reduce glare.
- Install handrails and lights on staircases.
- Wear shoes with good support and non-slip soles. Avoid wearing slippers and athletic shoes with deep treads.
- Ask your health care provider review your medicines
- Ask your doctor or pharmacist to review the medicines you take (include over the counter medicine).
- Some medicines or combinations of medicines, cause drowsiness or light-headedness, which can lead to a fall.
- Get your vision checked
- Get your eyes checked by an eye doctor.
- You may be wearing the wrong glasses or have a condition such as glaucoma or cataracts that limits your vision.
- Poor vision can increase your chances of falling.
Development of Clark County Senior Fall Prevention Task Force
The CDPHP Injury Prevention staff surveyed 52 community organizations in Clark County who are involved with senior populations to see if senior fall prevention education was being conducted. Of the 22 organizations who responded, none of them were aware of the recently published CDC Tool Kit to educate seniors on fall prevention. Only three organizations briefly addressed fall prevention in their programs. Many of the responding organizations expressed interest in meeting to address the problem of unintentional falls in the Clark County senior population.
The CDPHP Injury Prevention staff organized and facilitated the first meeting of the Clark County Senior Fall Prevention Task Force in 2005. Current organizations participating in the task force include:
- Southern Nevada Health District – Office of Chronic Disease Prevention and Health Promotion
- Clark County Department of Parks & Community Services
- Clark County Social Services
- Nevada Division of Aging
- Helping Hands of Henderson
- Nevada Injury Prevention
- Visiting Angels
- UNLV Gerontology Program
- University of Nevada Cooperative Extension – Seniors Can
- Nevada Disability Advocacy & Loss Center
- Nevada AARP
The Task Force looked at data and program information from around the country including "Falls Free: Promoting a National Falls Prevention Action Plan" issued by the National Council on the Aging and the Home Safety Council.
The Task Force decided to get Clark County base data directly from the target population; seniors 55 and over by survey.
The survey measured responses from seniors who had, and had not, fallen in the past three years. The Cannon Survey Center at UNLV assisted in the creation and analyzed the completed surveys in January 2006.
The following community groups offered the survey:
- County and City Senior Centers
- The H2U program at Sunrise Hospital
- The Seniors Can Program at Cooperative Extension
- Central Christian Church Senior Groups
- The Clark County AARP Chapter meetings in January 2006
The survey was designed to get information such as:
- Home location where the fall took place
- Surrounding environment and conditions that may have contributed to those falls
- Information as to how falls affected the independent living status of seniors.
Demographic data and questions are included regarding the interest of those surveyed (both those who have had a fall and those who have not fallen) about receiving fall prevention education and home safety assessments.
Results and Indications
Results
The Southern Nevada Health District (SNHD) contracted with the Cannon Survey Center to assist with data entry and analysis. Surveys were completed with 388 individuals who were at least 55 years of age. The surveys were administered at a number of Clark County Department of Parks & Community Services Senior Centers, through the H2U Program at Sunrise Hospital, the Seniors Can Program at Nevada Cooperative Extension and three Clark County AARP chapter meetings. The total of 388 surveys came from seniors living in 46 different zip codes in Clark County.
Of this group, 267 individuals had not had a fall within the past three years and are thus categorized in the sub-group of non-fallers and 121 individual had fallen in the past three years and are thus categorized in the group of fallers.
Indications
When you look at the total of all the surveys taken (388), 42 percent of those seniors indicated interest in attending a presentation of information on how to prevent falls in and outside of the home. Only 22 percent of all the seniors surveyed showed interest in a free home safety assessment to assist in preventing falls. Of the seniors who had one or more fall in the past 3 years less than half (47 percent) were interested in a fall prevention safety presentation and only 29 percent were interested in a free home safety assessment.
While this survey is limited in numbers, the indications point to a lack of knowledge amongst the targeted senior population of the risks of experiencing a fall and the possible consequences that could affect independent living status of those having a serious injury as result of a fall. Educating the senior population concerning the risks and consequences of falls needs to be done in order to raise the interest in learning the steps that can be taken to prevent them. In order to develop an effective prevention program, a targeted public information campaign aimed at seniors and possibly the adult children of aging parents is needed to raise awareness concerning the risks and consequences of falls to seniors.
Grant Submitted
As a result of the indications staff submitted an independent living grant proposal to the Nevada Division of Aging to conduct a public information and awareness campaign to the Clark County senior population. The desired outcome of the campaign was to encourage seniors to exercise in structured supervised programs already available through Senior Centers throughout the county. During those classes seniors could also be educated about the risks of experiencing a fall and the consequences of having a serious injury as a result of a fall. Unfortunately the proposal was not funded.
Next Step
While researching fall prevention efforts through the national Council on Aging and the CDC, Health District staff found the "Stepping On" Program. "Stepping On" is a cognitive-behavioral, educational fall prevention program for seniors conducted in a small group environment. The program was developed at and researched by staff at the University of Sydney in Australia. The research, peer-reviewed and published in 2004, showed a 31 percent reduction in falls amongst seniors completing this program compared to a control group 14 months after finishing the program.
The Health District purchased a copy of the "Stepping On" program manual and is collaborating with the Graduate Occupational Therapy Program at Touro University and the Barbara Greenspun Women’s Care Center to conduct the program as a pilot project. The course involves 7 weekly 2 hour sessions with a follow up home visit conducted within the two weeks after the seventh class session. A booster session is offered at 3 months and a follow-up phone call is conducted at 6 months.
The Greenspun Center advertised the class in their Winter catalogue to begin on Monday, March 24, 2008 at 10 a.m. through Monday, May 5, 2008. The class filled up with the first 12 participants and is presently under way.
The University of Wisconsin received the single CDC research grant to study how to bring the Australian developed "Stepping On" program to local Wisconsin communities. Staff has been in contact with Jane Mahoney, MD, the lead of the Wisconsin research and they will collaborate with our program to assist with development in Clark County and Nevada.
A second "Stepping On" program has been scheduled to begin at the Greenspun Center on Monday, July 14, 2008.
Visit the Related Links webpage for additional Injury Prevention information.
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