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Public health: Fall prevention for older adults



By Erin A. Bills, MPH, Contributor

People 65 and older are at an increased risk of falls and injury associated with falls. Fall prevention is often overlooked, but reducing the number of falls could save billions in healthcare dollars and enable many older people to live happier, healthier and more independent lives.

Fall-related injuries are costly to treat. Direct medical costs of falls in 2000 totaled more than $19 billion dollars, according to the Centers for Disease Control and Prevention. $179 million was spent treating fatal fall injuries and $19 billion for nonfatal injury treatment. In 2010 dollars, this equates to approximately $28.2 billion.

Falls in the older adult population carry a significant risk of injury and commonly result in lacerations, hip fractures or traumatic brain injuries. The CDC reports more than 90 percent of all hip fractures result from falls. These injuries can result in hospitalization or surgical treatment, increasing the risk of morbidity and mortality in these patients.

In 2009, 2.2 million nonfatal fall injuries were treated in the emergency room. Of these patients, more than 581,000 were hospitalized. Men are more likely to die from a fall, while women suffer a twofold risk of a fall-related fracture.

The risk of serious injury increases with age. Those over the age of 75 are four times more likely to be admitted to a long-term care facility after sustaining a fall.

A comprehensive fall prevention program is an important component of geriatric preventive medicine. The following five basic fall prevention steps suggested by the CDC and the American Academy of Family Physicians lowers the risk of falling and fall-related injuries while helping to maintain independence.

1. Talk to your doctor. Many older adults don’t talk to their healthcare provider about past falls or about the risk of falling. Patient education in the clinical healthcare setting is dependent upon a productive doctor-patient relationship and is important for the aging patient population.

Many older adult patients receive treatment for multiple chronic conditions requiring numerous prescriptions and over-the-counter medications. Studies conclude that the use of four or more medications significantly increases the risk of falls in the elderly. It’s also imperative to participate in routine eye, ear and osteoporosis screenings to help ensure optimum vision, balance and bone health.

2. Stay active. Physical fitness reduces the risk of falls. Try walking, water aerobics or Tai Chi to help prevent falls by increasing strength and balance. Avoiding physical activity because of fear of falling only increases the risk. Talk with your doctor about a physical fitness program appropriate for you.

3. Improve home safety. Reduce tripping hazards, de-ice sidewalks and driveways, and use stability assistance devices in the bathroom. Make sure rugs are properly tacked to the floor, spills are cleaned immediately, surfaces are clutter-free, and walkways are clear of wires. Ensure proper lighting for all areas of your home.

4. Footwear. Wearing appropriate footwear is key. Choose sturdy shoes with nonskid soles that aren’t too thick. Make sure they fit properly by having your feet measured every time new shoes are purchased. Avoid wearing heels, flip flops or slippers that don’t have appropriate tread.

5. Assistance devices. Walking assistance devices such as a cane or walker can help keep you safe and stable. Handrails and grab bars in the shower and near the toilet also decrease risk.

Fall prevention should not be an afterthought. Components of an effective fall prevention program are relatively easy to adopt and will reduce the risk of falling among older adults.

Erin A. Bills, MPH, works with the Montana Office of Rural Health/Area Health Education Center at Montana State University. She lives in Big Sky and is dedicated to improving the health of Montana’s rural populations by developing effective preventive health policy. Follow her blog at

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