Falls in the older adult – Just not sexy enough?

treppe-stair-escaleras-mobius-traveller_40

Two weeks ago, a $1 Million prize was announced in San Francisco Bay area: The Palo Alto Longevity Prize. Palo Alto Investors and guru Yoon Jun will award the money in batches to those researchers able to restore to youthful parameters certain physical functions in elderly animals. The group ultimately hopes to unlock the key to immortality.

Wow! After that first wow, all I could think about was why there are no prizes for:

  • Figuring Out How to Age Comfortably, Gracefully and with As Much Quality of Life as Possible;
  • Emphasizing the Improvement Over Quality, Not Quantity, of Life; or
  • Tackling the Awful Problem of Falls in Our Elderly.

The Elderly Falling….hmmmm….that just doesn’t quite have quite the “sizzle” of immortality, does it? Nonetheless,It Is A Big Deal!

Note: For purposes of this discussion “Elderly” includes the “young old” over age 65, the “middle older” over age 75, and the “oldest old” age 85+

Here are some staggering statistics about falls and the elderly:

  • 1/3 of older Americans falls each year = 1.4 Million falls ===> $30 Billion/year (Direct and indirect costs). This dollar number is expected to increase by 2020 to @$60 Billion/year
  • Elderly falls account for 95% of hip fractures
  • Falls are the leading cause of accidental deaths in persons over the age of 65. In 2010, over 21,700 older adults died of injuries sustained in a fall
  • Falls are the 6th leading cause of death in the elderly
  • Of those who fall 20% will requirement placement in a long-term care facility. Those over 75 years of age are 4-5 times more likely that a 65-74 year old to spend a year or more in a long-term facility after falling. The cost to these individuals is equally staggering, a year in a nursing home averages $80K – $90K per year. There is no government support for this type of care except for those that qualify for Medicaid
  • 20% of the elderly who suffer a hip fracture as a result of the fall will die within a year and the increased prevalence of osteoporosis in aging populations increases the risk that even a relatively minor fall will result in one or more fractures
  • Bathrooms are one of the most dangerous and common areas where falls occur

When Nancy Reagan fell in 2012 and suffered multiple rib fractures many were shocked. But at 90 yrs old, she was right in line with her peers and had, in fact, fallen before. It is notable that she was so frail that, despite being escorted on one arm, still suffered rib fractures. Perhaps the break in her fall spared her the much more serious hip fracture.

So why to the elderly fall so much? Here are some reasons:

  1. Impaired balance
  2. Decreased strength and coordination which when marked, is often called “frailty” (Note frailty can occur at any age)
  3. Decreased vision (day and night)
  4. Hazards in their environment
  5. Increased dizziness or vertigo (due to heart conditions, inner ear issues or other)
  6. Decreased proprioception, sensation (diabetic and other peripheral neuropathies)
  7. Medications which can cause dizziness or decrease alertnes

In recognition of the magnitude of the problem of Falls in Elderly and the myriad causes for these untoward events, the US National Council on Aging declared an annual “Falls Prevention Awareness Day” in 2008. The 6th year annual celebration last year on September 22, 2013 was the largest yet, with 47 states and D.C. participating. In 2013, the US Senate passed a resolution designating September 22,2013 as “National Falls Prevention Awareness Day”.

BK

 

Helpful Tips for Falls Prevention

For individuals

  • Exercise and strength training classes
  • Balance exercises.
  • Daily walking (indoors-malls or outdoors-track)
  • Use walking sticks if balance not perfect
  • Walk, as exercise, using a walker mobility aid if balance is poor.
  • Unusual new strategies: Tripping seniors on treadmill to build subconscious learning to prevent falls in future.
  • Consider wearables for falls detection (after the fact) and falls prevention (wearables with sensors which may alert increased risk, potentially preventing falls)

For homes- in general 

  • Single floor designs
  • No rugs
  • Adequate lighting
  • Banisters on both sides of stairs
  • Wider hallways and doors to accommodate walkers and wheelchairs

For bathrooms – specifically

  • Increase friction underfoot
  • Multiple grab bars
  • Disability toilets and showers
  • Empty/remove the counter top to allow wheelchair access

For the community

  • Wider sidewalks
  • Longer crossing times at busy intersections
  • Banisters on both sides of stairs within reaching distance of a single individual

Resources

National Council on Aging http://www.ncoa.org

North Carolina Falls Prevention Coalition http://www.ncfallsprevention.org

“The Methuselah Prize”, Muriel R.Gillick MD, Life in the End Zone Blog, September 14 2014,http://blog.drmurielgillick.com/2014/09/the-methuselah-prize.html?m=1, accessed September 19 2014

“Nonfatal Bathroom Injuries Among Persons 15 and Older”, Centers for Disease Control and Prevention, June 10 2011, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6022a1.htm, accessed September 19 2014

“Why the rise in fatal falls?” Barbara Peters Smith, Sarasota Herald Tribune, January 1 2014,http://www.heraldtribune.com/article/20140101/ARTICLE/140109981/2416/NEWS?p=1&tc=pg#gsc.tab=0, accessed September 19 2014

“Infographic: A Guide to Nursing Home Costs”, Kimberly Leonard, US News and World Report, February 26 2014, http://health.usnews.com/health-news/best-nursing-homes/articles/2014/02/26/infographic-a-guide-to-nursing-home-costs, accessed September 19 2014

“The Danger of Falling Down”, Kimball B Forbes MCD, Moapa Valley Progress, June 11 2014,http://mvprogress.com/2014/06/11/the-danger-of-falling-down/, accessed September 19 2014

“Diabetes increased risk for major osteoporotic hip fracture”, William Leslie MD,   Healio Endocrine Today, September 17 2014, http://www.healio.com/endocrinology/bone-mineral-metabolism/news/online/%7B2e9f2ddb-2688-4cf6-aeee-b0449e6ca728%7D/diabetes-increased-risk-for-major-osteoporotic-hip-fracture, accessed September 19 2014

“Nancy Reagan Falls and Breaks Ribs: Why Aging Naturally Brings More Falls”, Caregiver List, May 28 2012, http://www.caregiverlist.com/blog/?tag=/preventingfalls, accessed September 19 2014

“Inclusive Design is more than just nice architecture”. Marcio Dupont, Product Design Hub, October 3 2010, http://productdesignhub.com/2010/10/inclusive-design-is-more-than-just-nice-architecture/, accessed September 19 2014

“Visiting the Bathroom Is Risky Business”, Karen D Austin, The Generation Above Me Blog, July 2 2013,http://thegenerationaboveme.blogspot.com/2013/07/visiting-bathroom-is-risky-business.html, accessed September 19 2014

“Tripping seniors could help prevent future falls”, CBS News, August 28 2014,http://www.cbsnews.com/news/tripping-seniors-could-help-prevent-future-falls/, accessed September 19 2014

“Med-Tech start up creates wearable device to prevent falls among elderly”, John Kennedy, Silicon Republic, August 29 2014, http://www.siliconrepublic.com/start-ups/item/38131-med-tech-start-up-creates-w, accessed September 19 2014

Image Credit

Treppe – Stair – Escaleras – Mobius Link

One thought on “Falls in the older adult – Just not sexy enough?

  1. Pingback: Will the real _ _ _ _ _ _ _ _ _ _ please stand up! | Bernadette Keefe MD

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