How can we slow the number of deaths from falls in older adults?
Tuesday, July 07, 2015
In May, the National Center for Health Statistics published a data brief called "Death from Unintentional Injury Among Older Adults Aged 65 and Over: United States, 2000-2013." One of the key findings of the study was that the age-adjusted fall-injury death rate among older adults has nearly doubled from 2000 to 2013 — from 29.6 per 100,000 to 56.7 per 100,000.
This sharp increase, combined with the fact that the generation of baby boomers has entered the 65-and-over age group, creates an urgent need for private healthcare providers and healthcare institutions to increase their awareness of this public health issue and integrate best practices for fall prevention in older adults into their clinical setting.
The American Geriatrics Society and British Geriatrics Society recommend for all older adults to be asked by a healthcare provider, at least once a year, if they have fallen or if they have problems with walking and balancing.
A fall-risk screen is recommended for any older adult who has fallen or is reporting difficulty with walking and balancing. A multifactorial fall-risk assessment is recommended for older adults who perform poorly on the fall-risk screen, present for medical care due to a fall, have experienced multiple falls or demonstrate difficulty with walking and balancing.
In San Diego County, the Fall Prevention Task Force has created resources for providers on geriatric fall prevention at SanDiegoFallPrevention.org. The task force also produced the seven-minute evidence-based YouTube video below for healthcare providers that summarizes the geriatric best-practice recommendations for preventing falls in older adults.
The American Academy of Otolaryngology recommends for all adults over 65 to be screened for benign paroxysmal positional vertigo (BPPV), which is the most common vestibular disorder. Screening for BPPV is especially recommended for older adults with unexplained, repeated falls.
Some older adults with BPPV may not complain of dizziness or vertigo at all but may still present for care with unexplained, repeated falls and difficulties with walking and balancing. BPPV can be fixed in one treatment about 85-90 percent of the time and can have a huge impact on reducing difficulties with walking and balancing in older adults.
In a study published in the Journal of Sports Physical Therapy in May, researchers in Taiwan demonstrated that people with BPPV have a higher incidence of fracture, especially those over 65. Therefore, following the best-practice recommendation to screen all adults over 65 for BPPV may reduce the number of fractures in the aging population.
The Journal of the American Medical Association published an article June 9 that analyzed data on patients with acute spinal cord injury in the United States, from the Nationwide Inpatient Sample Database. During the study period from 1993-2012, the proportion of total spinal cord injury cases among adults age 65 and over increased from 28 percent in 1997-2000 to 66 percent in 2010-2012. Much of this increase was due to falls.
The high incidence of BPPV in older adults may be due to normal aging of the vestibular system, so there is an urgent need for all geriatric healthcare providers to learn how to screen for BPPV and other vestibular disorders, at the minimum. The fabric of our healthcare system in America must weave in the best practices for reducing falls in older adults, especially by performing fall risk screens, multifactorial fall risk assessments and vestibular assessments, as recommended by our expert physician groups.
The results of our collective efforts may relieve the Medicare burden by reducing healthcare costs related to fractures, brain injuries and spinal cord injuries in older adults, as well as increasing the quality of life for all the families and communities in our entire nation.
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