Falls are a major health problem in the elderly community. It has been estimated that approximately 25% to 35% of community living older adults experience one or more falls each year. The definition of a fall is "an unintentional event that results in the older adult coming to rest on the ground or on another lower level."
Among older adults, falls are the leading cause of accidental deaths and the most common cause of non-fatal injuries and hospital admissions for trauma. Most falls (44%) occur at ground level; 16% occur on the stairs, while 4% occur in the bathroom. About 75% of home-based falls occur during the performance of routine daily activities, 44% of falls occur in the presence of one or more environmental hazards; 2-5% of falls occur during the performance of hazardous activities such as climbing onto ladders, and 23% occur outside.
In 2001, more than 1.6 million seniors were treated in emergency departments for fall-related injuries and nearly 388,000 were hospitalized. An older adult is 4 times more likely to be hospitalized for a fall than for any other injury. Each year, approximately 6,000 people die from a fall and approximately 75% of them are over the age of 65 years.
There are many causes of falls in older adults and generally there are multiple factors contributing to the fall. Sometimes it is difficult to determine the cause of the fall because an older adult may not report a fall or has poor recall about the fall. Or, the older adult may state that they did not fall, only tripped or slipped. Many older adults may not report a fall because of fear of losing independence.
Rubinstein and Josephson outlined the causes of falls in older adults. Most falls are classified as accidental or environmental. For example, tripping over an obstacle, falling due to an uneven surface.
| Causes of Falls * |
% |
| Accidental/environmental |
31 |
| Gait/balance instability |
17 |
| Dizziness/vertigo |
13 |
| Drop Attack |
10 |
| Confusion/Cognitive impairment |
4 |
| Postural hypotension |
3 |
| Visual impairment |
3 |
| Unspecified or unknown |
18 |
(*Rubinstein & Josephson, 2002)
Risk Factors associated with falls in older persons are often categorized as intrinsic, extrinsic or environmental. Intrinsic factors are within the individual, for example, balance problems, on the other hand, extrinsic factors are imposed upon the individual, for example, multiple medications. Environmental hazards include factors such as stairs, without railings or loose rugs, lack of railings in bathrooms or poor lighting; these hazards become especially important when the individual also has either intrinsic or extrinsic risk factors.
Fear of falling in older adults is associated with increased risk of falls, restrictions of activities, gait deficits and decreased functional mobility. Not surprisingly, risk of falling and fear of falling interact whereby both factors reinforce each other. Restriction of activities in response to this fear result in weakness and poor balance; on the other hand, fear of falling may be a realistic response to reduced capacities.
Several agencies including the American Geriatric Society in accordance with their Guidelines for the Prevention of Falls in Older Adults and the Centers for Medicare and Medicaid Services (CMS) in accordance with the Physician Quality Reporting Initiative (PQRI) Measure #4 Screening for Future Fall Risk have identified the need for providers across diverse setting to screen individuals for fall risk.
Research has shown that the simple act of screening for fall risk in a community setting may provide a catalyst for falls risk reduction. Researcher Ness, et al., determined that people "identified as and informed that they were at high risk for falls" were more likely to make changes to prevent falls than those not identified as and informed that they were at high risk for falls.
Clinton Physical Therapy Center and the Take Charge Fitness Program are teaming up with their new program "got balance?" to provide FREE Screenings for Future Fall Risk for older adults on the second Thursday of each month from noon to 1 PM. The purpose of the program and ultimate goal is to identify who is likely to fall or fall again. Participants will be asked to fill out a short questionnaire and will be provided with a copy of the results of their screening to share with their physician. Participants will also be provided with information for In-Home Safety Checks, Environmental Safety Checks, a basic Fall Prevention Exercise Program and other resources to reduce the risk of falling. Please call 457-8237 for an appointment for your free screening on the next schedule date on May 8th from noon to 1 PM.
Please note that fall risk screens cannot provide a "diagnosis" or accurately predict future falls by 100%. Rather they are used to screen an individual and to serve as a mechanism for the older adult to have these risk factors assessed by his/her physician. All older adults should be reminded to visit their primary physician on a regular basis.
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Joyce Klee is a Physical Therapist and Co-owner of Clinton Physical Therapy Center
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