« The Dual Agenda: February 19, 2015 Issue

Eldercare Voices

Catching Falls Before They Happen: A Proven Prevention Strategy

Audrey Chun, MD

As the population ages, working to promote and improve the health and wellness of older adults is a top priority. It is estimated that by 2030, 20 percent of the total U.S. population will be 65 years of age or older. With older adults living longer and the costs of health care continuing to rise, it is critical to take steps to prevent conditions that become increasingly common as people age. Preventing falls among older adults is one key health promotion strategy that warrants greater attention. Fortunately, there is a lot that can be done to recognize and prevent the risks of falling.

Every year, one-third of community-dwelling older adults will experience a fall, and this percentage is even higher for older adults in nursing homes. Falls can result in serious injury, particularly among older adults who may be frail. Falls increase the risk of fractures, hospital stays and infections, and may lead to time missed at work or at home with family. More serious falls may even result in brain injury or death.

Aside from the acute injuries that an individual may sustain in a fall, such an event can also be an indicator of new illness or advancing frailty. For those attempting to coordinate care and manage population health, like those participating in New York’s Fully Integrated Duals Advantage (FIDA) demonstration in my state, and other dual eligible demonstration projects, prompt recognition and evaluation of a new fall – even in the absence of immediately apparent injury – should be a priority. Primary care providers should be alerted to evaluate for infection, changes to medications, low blood pressure and new cardiac or neurologic conditions. Early identification of these conditions can help prevent unnecessary hospitalization and illness. A fall can also open opportunities to discuss home safety, goals of care and other preventative care.

Risk factors for falls include problems with vision or hearing, taking more than five medications, heavy drinking, and problems with frailty, strength or mobility. One of the most common, but often overlooked, signs of being at risk for a fall is one’s ability to get out of a chair or move around. If an individual has trouble balancing, walking without having to hold onto something, feels dizzy moving around, and/or has to grasp something to pull themselves up, then they are at greater risk for falling. Also problematic is that many individuals don’t realize they are at risk for a fall until they have one. Making older adults and those involved in their care aware of these fall risks before a fall occurs is of utmost importance and the key to prevention.

Not all falls can be prevented. Still, the risk and seriousness of falls can be significantly reduced with proper awareness, planning and treatment. Promoting conversations between physicians and older adults regarding fall concerns is a major aspect of reducing fall risk. If older adults are not talking about falls with their physicians, they need to be encouraged to do so for several reasons. First, physicians and other care workers can help identify and improve problems like difficulty with balance and vision trouble, as well as review current medications to ensure proper dosages. In addition, physicians may suggest physical therapy or balance and strength exercises that may help improve mobility. They may also recommend the use of mobility devices like canes and walkers when appropriate. Finally, physicians can help make older adults aware of tripping hazards in their homes, such as throw rugs, extension cords and raised floor surfaces and encourage the installation of grab bars and railings in the home. These are just some of the steps that can be taken when physicians and older adults work together to prevent falls and they highlight the importance of having the conversation about falls early on as an effective prevention strategy.

Older adults can also take measures on their own to reduce the risk of falling. Staying active both mentally and physically can help prevent diseases and disabilities related to falling. Oftentimes, even simple exercise regimens can be effective in promoting better health, balance and mobility. Being sure to be aware of oneself and one’s surroundings is critical to acting upon needed changes in one’s home and lifestyle to prevent falls. Having regular talks with one’s physician about falling concerns and current medications is crucial to getting the proper care, information and supervision required to reduce the risk of future falls.

Geriatric researchers have had several breakthroughs in fall prevention over the last few years. In one poignant example, a statewide initiative was launched in Connecticut to identify and educate people at risk of falls. Through targeted assessments and management strategies, the occurrence of falls was reduced by as much as 34 percent. These findings underscore the need for geriatric providers to be more proactive in identifying fall risks and utilizing prevention strategies with their older adult patients. Preventing falls before they occur goes a long way in improving the health of older adults and helping to reduce health care costs.   

Audrey Chun, MD, is Vice Chair for Clinical Services in the Brookdale Department of Geriatrics and Palliative Medicine, and Director of Coffey Geriatrics at the Martha Stewart Center for Living at the Mount Sinai Medical Center. As a recipient of a Health Professions Health Resources and Services Administration (HRSA) funded Geriatric Academic Career Award (GACA), she was able to pursue her clinical interests that include geriatric assessment, medical education, and delivery of care in the outpatient setting. Dr. Chun is a Geriatric Provider Advocate in New York, partnering with the coalition of advocacy groups working to shape the state’s dual eligible demonstration project.         

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