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CDC UPDATE: NEWEST INFORMATION ON PREVENTING FALLSMay 6, 2004 CDC Initiative Aims to Prevent Falls Among Older Americans Costing $20 Billion a Year In Devastating Injuries and Deaths One of every three older Americans — about 12 million seniors — fall each year. Though most only fall from a standing position rather than from a height, the impact of that fall can be devastating. Of the approximately 13,000 Americans who die from falls every year, more than 11,600 are age 65 or older. Another 338,000 adults, mainly those older than 65, fall and fracture their hip. Only half of the older adults who were living independently before their hip fracture were able to live on their own a year later. “A fall is a potentially life-changing event for an older person. Older adults can’t bounce back from an injury like a younger person can,” says Dr. Christine Branche, Director of the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (the Injury Center). Located in Atlanta, the Injury Center is part of the U.S. Centers for Disease Control and Prevention (CDC). CDC’s Injury Center is heading efforts to address older adults’ risk for injuries, especially falls, which are the leading cause of injury-related death among the older population. The agency takes a comprehensive approach to tackling this public-health issue by funding research on the causes and prevention of falls and fall-related injuries, educational efforts, and state and local projects to develop and evaluate community interventions. “Falls can happen to anyone, even the rich and famous,” explains Injury Center health educator Sarah Olson. For example, Katherine Graham, former president of The Washington Post Co., and Dr. Robert Atkins, developer of the popular Atkins diet, were both still very active in their lives when they died following a sudden fall. “It only takes one fall, one moment of losing your balance or inattention or tripping over something to result in a fall that causes a serious injury, such as a hip fracture, that starts a downward spiral of loss of independence and a lower quality of life,” Olson said. Hip fractures are one of the most serious consequences of falling, according to CDC. Half of older adults can no longer care for themselves after a hip fracture, and a quarter will die within a year of the injury. “A lot of people don’t ever recover from a hip fracture. It’s slow to heal and takes a lot of work to regain independence,” says Dr. Judy Stevens, Ph.D., an epidemiologist at CDC’s Injury Center. A broken hip also carries a high price tag: $16,300 to $18,700 during the first year after injury. The estimated cost is even higher for Medicare patients. Medicare payments just for the six months after a hip fracture average $23,500 — $3,800 of which is for treatment in a skilled nursing facility. Medicare spent an estimated $2.9 billion on hip fractures in 1991. Every year, falls among older people cost the nation more than $20.2 billion. By 2020, the total annual cost of these injuries is expected to reach $32.4 billion. HIP FRACTURES AND WOMEN Older adults with osteoporosis are at particular risk of a hip fracture, according to Stevens. Osteoporosis is a disease characterized by low bone mass and deteriorating bone tissue. Women are more prone to osteoporosis because their bones are less dense than those of men. Consequently, hospitalization rates from hip fractures are three times higher for older women than for older men. Younger women can protect against osteoporosis with calcium and weight-bearing exercise. However, bone density is difficult to recover once a sizable amount has been lost. The Medicare Osteoporosis Measurement Act of 2001 expanded coverage of bone mass measurements to all Medicare patients at clinical risk for osteoporosis. This law enables people at high risk to be screened and treated for low bone density before their increasing bone fragility results in a fracture. PREVENTION IS MULTIFACETED Although it may be too late for an older person to build up bone mass, there are many ways to help prevent falls at any age. “Falls usually involve many factors, so the most effective approach to preventing them is multifaceted,” Stevens said. Especially important are educating long-term care staff about fall risk factors, monitoring medication use, and making environmental changes such as clearing pathways and lowering beds. Falls in the home can also be prevented, helping older adults to remain independent. Simple changes to an older adult’s home, such as removing throw rugs and adding grab bars to bathrooms, can quickly and easily reduce the risk of falling. Vision problems can increase a person’s risk for falls by as much as 60 percent. Improving vision and improving lighting in the home are therefore both effective strategies for preventing falls. Exercise that improves balance and increases the muscle strength in legs has been proven to be especially important. Tai Chi, for example, has been shown to reduce seniors’ risk of falling by 50 percent, according to research by Steven L. Wolf, Ph.D. with Emory University published in the May 1996 Journal of the American Geriatrics Society. CDC also participated in the development of the National Blueprint on Physical Activity among Adults Age 50 and Older to promote physical activity in this group. Fear of falling itself is a risk factor. People who limit their activities because they fear falling do not get essential exercise they need to help prevent falls, often resulting in isolation and depression — all risk factors for falls, Olson said. MEDICATION REVIEWS Medication reviews are another important method of reducing an older person’s risk of falling, according to Stevens. Because of their higher rates of chronic health problems, older adults often take multiple medications whose potential side effects — such as drowsiness and dizziness — can lead to a fall, particularly when the drugs are combined. Research has clearly shown the link between falls and psychotropic drugs like tranquilizers and sedatives, according to Stevens. Taking four or more drugs puts older people at increased risk for falls. Physicians can help minimize the number of drugs an older person takes by thoroughly reviewing the patient’s current medications before prescribing other drugs. Older people, whose metabolism is generally slower than that of younger adults, are also sometimes prescribed inappropriate dosages. Many fall- prevention programs encourage older people to have their physicians review on a regular basis all the medicines that they take. DEMONSTRATION PROJECTS CDC’s Injury Center is sponsoring a number of demonstration projects to develop effective ways to prevent or minimize falls and injuries. One such project is with the California State Health Department, which has been funded to study the effectiveness of “No More Falls!” — a community-based fall prevention program for independently living older adults in the community. The overall goal of this study is to demonstrate the value of integrating fall prevention into existing community-based public health programs for older adults. The intervention includes four elements: education about fall risk factors, exercise to increase strength and balance, medication review, and home assessment and modification. The goal of the intervention is to reduce incidence of falls requiring hospitalization by 10 percent. Results of the study, which are expected to be completed by October 2004, will help guide future efforts to develop multifaceted fall prevention programs. In October 2002, the Injury Center funded the Wisconsin Department of Health, in collaboration with the University of Wisconsin, to conduct a randomized controlled trial to assess the effectiveness of a comprehensive approach to preventing falls among adults ages 65 and older at high risk for falls. This project involves two components: a comprehensive at-home assessment followed by risk reductions (through changes in medical condition, vision, medications, behavior, physical functioning, home environment, and social support) and a broad-based program to engage and educate service agencies and health providers. The study is expected to be completed in August 2005. The CDC Injury Center also supports academic innovations, such as a fall prevention program in nursing homes developed by Wayne Ray at Vanderbilt University, in Nashville, and being tested at facilities in Tennessee. Nationwide, half of all nursing home residents — roughly 750,000 — fall at least once a year. The high rate of falls in nursing homes is generally attributed to the frailness of their residents. The Tennessee Fall Prevention Program teaches staff how to reduce obstacles and other hazards in residents’ daily environment, monitor medication use, and increase the safety and fit of wheelchairs so that residents do not fall forward or tip over. Ray and his co- researchers found that residents were 20 percent less likely to fall after the program was implemented. FALL-PREVENTION RESOURCES In another effort to spread the word about the risk of falls, CDC’s Injury Center has compiled a Tool Kit to Prevent Senior Falls, a collection of research findings and educational and assessment materials for use by professional service providers. The tool kit, available in English and Spanish, has been distributed to more than 6,000 organizations, such as local agencies on aging and state and local health departments, since it was released in 2000. Information is available on the CDC website (see Resources for Reporters at the end of this document). CDC’s Injury Center also has a book highlighting 18 local fall prevention programs across the United States, U.S. Fall Prevention Programs for Seniors. It is available on the CDC Injury Center website (see Resources). This publication describes programs that offer comprehensive education about fall prevention, home assessments, and access to home repair services. For example, a program of the Visiting Nurse Association in South Central Connecticut in New Haven educates staff about certain illnesses like Parkinson’s disease that put seniors at risk for falls. The association also facilitates exercise classes and visits older adults in their homes to identify environmental hazards, educate them about injury prevention, and give out bath mats, night lights, medication boxes, and other safety supplies. Other programs send “handy people” into elders’ homes to install grab bars, stair lifts, and other assistive devices. OTHER TYPES OF INJURIES Although the Injury Center’s injury-related work with older adults focuses primarily on preventing falls, seniors are also at increased risk of injury from fires, car crashes, and other life-threatening events. The following information looks at two other injury-related CDC projects that may interest reporters. * Older people are at least twice as likely to die from falls and fires as younger adults. To educate elders about these risks in tandem, CDC’s Injury Center and the National Fire Protection Association created a model prevention program called Remembering When. The program, centered around 16 safety messages about fire and fall hazards, was designed to be taught to elders in private homes, senior centers, or other settings. The program’s activities and lesson plans weave in trivia about old music, events and personalities to make the presentations fun and memorable for elders. Remembering When is now being implemented in five states: Arkansas, Maryland, Minnesota, North Carolina and Virginia. CDC is currently evaluating this program to determine its effectiveness in motivating seniors to make behavior changes. * More than 7,500 older adults die in car crashes every year, a 10 percent increase in the past decade. Contrary to popular perceptions of older drivers as dangerous to others, older people are less likely than drivers age 16 to 34 to be involved in crashes that kill other people. However, if older people are in a car crash, they are more vulnerable to injury and death. Because more than 40 million older adults are expected to be licensed drivers by 2020, older driver safety has become an increasingly important issue. A new CDC Injury Center research project is examining the characteristics of older drivers who die in car crashes to better understand the risk factors among this age group. For example, older men are twice as likely as older women to suffer motor vehicle- related injuries. This media background paper was written by April Thompson and updated by Nancy Aldrich. The lead editor was Bill Benson. STORY IDEAS FOR JOURNALISTS 1) Are there fall-prevention programs in your area? Check with your local area agency on aging and senior centers. 2) Check with local colleges and universities to see if they have ongoing research on falls. # # # RESOURCES FOR REPORTERS CDC’s Injury Center: www.cdc.gov/ncipc/, (770) 488-4902, fax: (770) 488-1667, email: OHCINFO@cdc.gov Publications: Check for Safety: A Home Fall Prevention Checklist for Older Adults, www.cdc.gov/ncipc/pub- res/toolkit/cksafety.pdf Costs of Fall Injuries among Older Adults, www.cdc.gov/ncipc/factsheets/fallcost.htm Falls among Older Adults, http://www.cdc.gov/ncipc/olderadults.htm#falls Falls and Hip Fractures among Older Adults, www.cdc.gov/ncipc/factsheets/falls.htm Older Adult Drivers, www.cdc.gov/ncipc/factsheets/older.htm Tool Kit to Prevent Senior Falls, www.cdc.gov/ncipc/pub- res/toolkit/toolkit.htm U.S. Fall Prevention Programs for Seniors, www.cdc.gov/ncipc/falls/default.htm California Chronic Disease and Injury Control Home Page, www.dhs.ca.gov/cdic/epic/, (916) 449-5700; fax: (916) 449- 5707. Epidemiology and Prevention for Injury Control Branch, www.dhs.ca.gov/epic/seniorinjuries/default.htm Guideline for the Prevention of Falls in Older Persons issued by the American Geriatrics Society, British Geriatrics Society and American Academy of Orthopaedic Surgeons in 2001, www.americangeriatrics.org/products/positionpapers/Falls.pdf Healthy People 2010 Objectives: Injury Prevention Chapter, www.safetypolicy.org/hp2010/hp2010.htm Injury Control and Emergency Health Services Section, American Public Health Association, www.icehs.org/ Injury Control Resources Information Network, University of Pittsburgh, www.injurycontrol.com/icrin/ Injury Prevention Web, San Diego State University, www.InjuryPreventionWeb.org/ National Association of Injury Control Research Centers, Colorado State University, www.naicrc.org/, (970) 491-2680 (ask for Julie Gibbs-Long, jalong@lamar.colostate.edu); fax: (970) 491-2940 National Blueprint: Increasing Physical Activity among Adults Age 50 and Older, www.cdc.gov/nccdphp/dnpa/press/archive/blueprint.htm, www.rwjf.org/publications/publicationsPdfs/Age50_Blueprint_s inglepages.pdf National Fire Protection Association, www.nfpa.org/Home/index.asp, (617) 770-3000; fax: (617) 770- 0700 National Resource Center on Aging and Injury, www.nrcai.org, (619) 594-0986; fax: (619) 594-2811, a partnership of San Diego State University Center on Aging and American Society on Aging with funding from CDC. National Resource Center on Safe Aging, www.safeaging.org/, an information database Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T. Journal of the American Geriatrics Society 1996; 44(5):489–97 State and Territorial Injury Prevention Directors’ Association, www.stipda.org/, (770) 690-9000; fax: (770) 690-8996
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