“I’ve Fallen and I Can’t Get Up”: Preventing Falls in the Elderly Living at Home
May 5, 2014
The purpose of this paper is to explore fall prevention in the elderly.
The definition of a fall in the Veterans Health Administration (VHA) is "loss of upright position that results in landing on the floor, ground or an object or furniture or a sudden, uncontrolled, unintentional, non-purposeful, downward displacement of the body to the floor/ground or hitting another object like a chair or stair" (OJIN, May 2007) Most falls are involuntary and can be caused by many factors, such as: poor vision and/or hearing, medications, inadequate lighting, home hazards, improper footwear, physical illness, and lack of activity. Most “baby boomers” like me have experienced the consequences of an elder parent who have been injured by a fall. Each year, one in every three adults age 65 and older falls. Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. Fortunately, falls are a public health problem that is largely preventable. (CDC, 2013) In order for the elderly to maintain their independence, falls must be minimized. Since most falls are preventable, individualized plans should be developed and incorporated into the standard routine physical by the primary care physician of every elderly person at risk of falling. These plans should involve implementation from doctors, family members, caregivers, and anyone designated as health care proxy.
THE COST FACTOR
Falls among older adults (people aged ≥65 years) are the leading cause of both injury deaths and emergency department visits for trauma (Centers for Disease Control and Prevention [CDC], 2012). Falls can have devastating and long-term consequences including reduced mobility, loss of independence, and premature death (Sterling, O’Connor, & Bonadies, 2001). Each year, falls are responsible for more than 20,000 deaths and 2.3 million emergency department visits nationwide (CDC, 2012) and incur more than $30 billion (in 2010 dollars) in direct medical costs (Stevens, Corso, Finkelstein, & Miller, 2006).
THE PRIMARY CARE PHYSICIAN’S ROLE
The physician’s role is crucial in laying out the fall prevention care plan for the elderly patient. Medication adjustments, behavioral modification, and regimented exercise programs have been shown prospectively successful to reduce falls in this population, thus significantly reducing health care cost for relatively little outlay (Siracuse, et al, 2008). One of the programs that Siracuse is referring to originated from a study done by Mary E. Tinetti, et al. They studied 301 men and women living in the community who were at least 70 years of age and who had at least one of the following risk factors for falling: postural hypotension; use of sedatives; use of at least four prescription medications; and impairment in arm or leg strength or range of motion, balance, ability to move safely from bed to chair or to the bathtub or toilet (transfer skills), or gait. These subjects were given either a combination of adjustment in their medications, behavioral instructions, and exercise programs aimed at modifying their risk factors (intervention group, 153 subjects) or usual health care plus social visits (control group, 148 subjects). During one year of follow-up, 35 percent of the intervention group fell, as compared with 47 percent of the control group (P = 0.04). The adjusted incidence-rate ratio for falling in the intervention group as compared with the control group was 0.69 (95 percent confidence interval, 0.52 to 0.90). Among the subjects who had a particular risk factor at base line, a smaller percentage of those in the intervention group...
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VHA. Long Term Services and Supports Team, VA Puget Sound
Monday, July 29, 2013
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