_____________________________________________________________________ Falls and Fall Prevention
According to the World Falls Guidelines Task Force, clinicians should routinely ask about falls in their interactions with older adults, as they often will not be spontaneously reported. (https://academic.oup.com/ageing/ article/51/9/afac205/6730755. Last accessed March 26, 2024.) Strength of Recommendation/Level of Evidence : 1A (Strong recommendation based on high-quality evidence) In 2020, emergency departments recorded 3 million visits for falls involving older adults; falls among adults older than 65 years of age caused more than 36,000 deaths, making it the leading cause of injury-related death in that age group [3]. Women are statistically more likely to report a fall injury compared with men of the same age. Most falls occur in the home (60%), followed by community public areas (30%) and healthcare settings (10%), such as hospitals and long-term care facilities [13]. Community-dwelling adults 65 years of age or older account for one-third of those who experience falls each year. Fall risk increases gradually with aging, associated with onset of chronic diseases and eventually with the aging process itself. The most robust correlation with fall risk is found among those with comorbidities of the central nervous system, heart disease, rheumatoid disease, osteoporosis, and chronic pain [5]. Obesity is observed to convey an increased risk of falls, related to sarcopenia and coinciding with a more sedentary lifestyle as one ages [6]. A systematic review and meta-analysis confirmed that obesity increases the risk of falls and multiple falls in people 60 years of age and older; however, there was insufficient evidence of an association with fall-related injuries or fractures [8]. In fact, data collated from the subset of cohort studies suggested that obese older persons are actually less likely to experience a fall injury or hip fracture. FALLS AMONG CHILDREN Among those 19 years of age or younger, falls are the most common cause of nonfatal injuries each year. Children younger than 6 years of age have the highest proportion of visits for falls, with 1.2 million emergency department visits per year [13]. Falls threaten the safety of children, and they are fourth among causes of unintentional death in children and adoles- cents. There is concern that childhood falls are under-reported events in health institutions [27].
TYPES OF FALLS Falls are defined by the World Health Organization as “events that result in a person coming to rest inadvertently on the ground, floor, or other lower level” [7]. Falls can be catego- rized into three types: physiological anticipated, physiological unanticipated, and accidental. It is important that the types of falls and risks of falling, whether living at home or residing in healthcare facilities, are well understood so appropriate fall prevention measures can be undertaken [9]. Fall preven- tion strategies designed for community-dwelling persons and healthcare facility inpatients and residents will be discussed later in this course. The category of physiologically anticipated falls includes indi- viduals who are at risk because of age and/or health status, as for example those with altered mental status, high-risk medication (e.g., sedative, epidural post-delivery), and frequent toileting needs (e.g., diarrhea, frequent urination) due to medications or intercurrent illness. Healthcare providers in the ambulatory setting as well as hospital and nursing home staff should be cognizant of individual risk and vigilant for the possibility of falls in this category. At-risk patients should be identified and closely monitored to address risk factors and ensure that preventive measures are in place [9]. Examples of anticipated falls include a patient with Parkinson disease fall- ing from a toilet, a patient with dementia who falls trying to get up from bed, or a patient with a large volume loss having a syncopal episode in the bathroom unattended. Unanticipated physiologic falls are fall events wherein the individual has no inherent (physiological) risk or reason for anticipating a fall under usual circumstances. In the inpatient/ in-residence setting with fall protocols in place, these patients should be documented as low risk for falling [9]. Examples of patients who might experience this category fall event would be a patient who develops stroke symptoms while sitting in a chair, or a patient who has a syncopal episode while straining for a bowel movement in the bathroom. Patients with new- onset seizures would also belong in this type of fall category. Accidental falls are those caused mainly by slips and trips, but other incidents could occur [9]. As an example, a hospital inpatient trips over the IV tubing or IV pump power cable, or another patient trips over the footrest of a wheelchair. These types of falls are accidental; whether or not they are predictable, thus preventable, depends on considerations of the environ- ment, age, strength, and clinical condition [9].
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