EPIDEMIOLOGY OF FALLS
age or older are a result of falls (Cameron, Schneider, Childress, & Gilchrist, 2015). Fractures are, in general, the most common injury resulting from falls in older adults. Common fracture sites include the hip, wrist, humerus, and pelvis and result from a combination of the fall, osteoporosis, and other health factors that make older adults susceptible to injury. In 2013, more than 25,000 older adults died as a result of injuries from unintentional falls. An average hospital stay for a fall injury costs $35,000 (Cameron et al., 2015). What cannot be quantified in dollar amounts is the fear of falling that develops in many older adults, despite the type or degree of injury. A fear of falling can result in limited physical activity, poorer physical fitness, and less socialization. This can lead to a cycle of falling, fear of falling, limited activity, and thus an increased risk for falling (Hornyak et al., 2013; Mane et al., 2014; Young & Williams, 2015). Finally, this sobering statistic should draw attention to this health emergency: “Every 13 seconds an older adult is seen in an emergency department for a fall” (Cameron et al., 2015).
Falling down does not sound so serious in the large landscape of healthcare issues in the United States. After all, people fall down all the time and get back up and continue their day. Falls would probably not be considered the same degree of health threat that cancer, diabetes, or heart disease are to our quality of life and mortality. The definition of a fall, “an unintended non-medical event resulting in a person finding themselves on a lower supporting surface” (Renfro et al., 2016), doesn’t sound threatening either. But falls are an emergency for an older adult who, because of a fall, might sustain a fracture, lose independence, or even die. With an annual cost of $30 billion spent on direct and indirect costs resulting from falls, older adults who fall may see this as a health emergency. Of adults 65 years or older, one of every three will fall at least once per year, and 30% of fallers will sustain an estimated 13 million injuries requiring medical treatment each year. Of those who fall, 20% will experience a serious injury that requires emergency room treatment, such as lacerations, hip fractures, and head trauma (Tinetti, Han, & Lee, 2014). More than two-thirds (81%) of traumatic brain injuries in adults 65 years of
RISK FACTORS FOR FALLING
This section will describe the myriad of influences on fall risk in older adults. Some influences are a result of typical aging, some are due to pathologic changes that occur with aging, and Population subsets at risk for falls Falls in older adults are the negative result of multiple risk factors; the greater the number of risk factors, the higher the chances of falling. Although many of the average community- dwelling older adults are at risk for falls, there are subsets of older adults who have higher than average risk. Research shows that a history of an injurious fall in community-dwelling older adults older than 75 years of age can be one of the best predictors of future falls (Pohl, Nordin, Lundquist, Bergstrom, & Lundin-Olsson, 2014). The risk for falls increases if the older Intrinsic and extrinsic fall risk factors If therapists can identify the existing risk factors for falls then interventions can be designed to modify or eliminate those risk factors that are susceptible to change. However, some factors are not modifiable, like age. There are several ways in which to categorize risk factors for falls, including, but not limited to, ability to predict future falls, factors that are modifiable versus
some are environmental. Emphasis will be placed on factors that should be assessed in a fall risk evaluation.
adult lives with multiple chronic conditions and diseases (Renfro et al., 2016), such as Alzheimer’s disease and related dementias, intellectual or developmental disabilities, multiple sclerosis, or Parkinson’s disease. Additional conditions include arthritis, cancer, chronic obstructive pulmonary disease, diabetes, depression, heart disease, myocardial infarction, hypertension, and stroke (Sibley, Voth, Munce, Straus, & Jaglal, 2014). Women fall more frequently than men (Pohl et al., 2014).
unmodifiable, and factors that are intrinsic or inherent to the person versus extrinsic factors such as environmental hazards. The type and number of fall risk factors help to determine what components of a fall risk assessment require a more detailed evaluation (Table 1 lists intrinsic and extrinsic fall risk factors).
Table 1: Risk Factors for Falls Intrinsic
• Low vitamin D. • Orthostatic hypotension. • Dizziness. • Medication issues/errors. • Cognitive decline. • Ethnicity. • Impaired sensation in feet. • Gender/age. • Chronic disease.
• Muscle weakness, especially in lower extremities. • Physical inactivity. • History of falls.
• Gait abnormalities. • Improper AD use. • Poor balance. • Poor vision care. • Fear of falling. • Depression. • Poor self-efficacy.
Extrinsic
• Loose carpet/rugs. • Lack of bathroom safety equipment. • Improper handholds. • Furniture/clutter. • Cabinets or storage inaccessible to user. • Narrow doorways/paths limited AD. • Polypharmacy.
• Improper footwear. • Poor lighting. • Low chairs/toilets/sofas. • Trip hazards. • Stairs. • Uneven surfaces. • Wet surfaces.
AD = Assistive device. Note . From Western Schools, 2019.
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