Over the next few weeks, we will take a look at the subject of “Fall Prevention.” This should more accurately be described as “Fall Reduction”, or “Minimization of Fall Related Injury.” It is impossible to prevent falls entirely. Accidents happen. Nonetheless, falling in the elderly is a huge health care problem. So even if we don’t have the answer, it is worthwhile asking a few questions.
How huge a problem is it? And why should Audiologists get involved?
Patients with vestibular (inner ear) dysfunction are at higher risk for falling, particularly in situations where visual and tactile information is absent or unreliable (such as in the dark, or in a busy visual environment). Falls are one of the most serious and costly problems associated with aging. The statistics are startling. It is estimated that 40% of all people over 65 years of age fall at least once each year, leading to 1.6 million emergency room visits in 2000 (Fall Prevention Act of 2003; Rubenstein, 2006).
Falls are the leading cause of injury and injury deaths in older adults, and account for more than 300,000 hip fractures annually in the United States alone (FPA, 2003). Of those hospitalized for hip fracture, 50% will die within 12 months (Rubenstein, 2006). Another, 25% will never regain full mobility (Coogler, 1992). In essence, a fall leading to a hip fracture can forever change a patient’s life. From the perspective of the older patient, these statistics make it clear that developing effective fall prevention programs is important and worthwhile.
How much do falls cost the health care system?
Audiologists, as well as other health care practitioners, also need to recognize that, in addition to the obvious benefit to patients, fall prevention planning can significantly reduce health care costs. The costs of direct care alone for fall related injuries are estimated at $31 billion annually (estimated to be 6% of Medicare expenditures). Additionally, many of these patients are admitted to chronic care institutions. For additional statistics related to falling see the Fall Prevention Act of 2003, House Bill S. 1217 Link: http://www.govtrack.us/congress/billtext.xpd?bill=h108-3513
Numerous factors contribute to putting one at a higher risk for falling. A variety of medical conditions, including vestibular dysfunction, peripheral neuropathy, orthostatic hypotension, visual deficits and cerebral white matter changes may contribute to an increased risk for falling. Several authors from several different specialties have listed potential risk factors for falling. There is much overlap, but also some disagreement as to the factors most likely to trigger a fall. Next week we will explore some of the suspected risk factors
Coogler, C. (1992). Falls and Balance. Rehabil Manage, 53.
Fall Prevention Act of 2003. (2003, June 9). 108th Congress 1st Session. House Bill S. 1217.
Rubenstein, L. (2006). Falls in older people: epidemiology, risk factors and strategies for prevention. Age and Aging, 35(S2), 37-41.