One of every three older Americans falls every year. Among those 75 and older, the number of falls-related deaths tripled to more than 25,000 from 2000 to 2016. Even after adjusting for age, the mortality rate for falls roughly doubled over that period. Of every 100,000 people age 75 and older, 122 will die from a fall.
Falls not only are killing more older adults, they are costing the nation billions of dollars. According to one study, the US spent $50 billion in 2015 on falls. Overall, hospital and post-acute costs for traumatic injury (frequently falls) was more than costs for strokes and heart attacks combined.
Many of these data are from four articles in the current issue of the Journal of the American Medical Assn (JAMA). And that itself is important, because the influential journal is sending a message to physicians: Pay attention to your patients’ risk of falling.
Falls are preventable
That is critical because many falls among older adults living at home are preventable. Simple exercise programs and more careful use of medications can significantly reduce falls among older adults. So may modest home modifications and other relatively low-cost interventions.
One new study in Vancouver, British Columbia found that older adults using a balance, strength, and walking regime called the Otago Exercise Program reported one-third fewer falls than a similar group that didn’t participate.
The Center for Disease Control (CDC) has published a list of prescription drugs that increase the risk of falls. In her blog Better Health While Aging, Dr. Leslie Kernisan described those meds, with advice on what patients can do to reduce the risks.
The value of modest changes
Another cause of falls: a dangerous home environment. Loose area rugs, bathrooms without grab bars, steps without railings, or hard to reach light switches all can lead to falls. And any one can be catastrophic.
For a relatively few dollars, families—or even health systems—can lower these risks. Imagine the net savings if we could reduce that $50 billion in costs by just 10 percent. You can buy a lot of grab bars for $5 billion.
But surveys find that many people are simply unaware that falls are preventable with modest changes in behavior, or simply are not motivated to follow a regular exercise program.
It starts with docs…
That’s where physicians come in, and why the JAMA focus on falls is so important. Docs are enormously influential when it comes to changing the behavior of their patients, if they are willing to try. The CDC has developed an initiative called Stopping Elderly Accidents, Deaths, and Injuries (STEADI) that doctors can use to screen for their patients’ fall risks.
It starts with docs asking their older patients three quick and simple questions:
- Have you fallen in the past year?
- Do you feel unsteady when standing or walking?
- Do you worry about falling?
If patients answer yes to any of them, physicians must take the next step and help their patients’ protect themselves by, say, prescribing an exercise class, reviewing their meds, or referring them to a contractor who specializes in home renovations for older adults.
Similarly, hospitals can do more. Many are rightly obsessed with reducing falls while patients are in their facilities, in part because since their Medicare payments are partly tied to those events. But too many ignore their patients’ fall risks after they have been discharged. And those falls can lead to readmissions and more financial penalties. For the sake of their bottom lines and, more important, their patient’s overall well-being, hospitals ought to guide patients and their families to fall prevention interventions before they are discharged.
Hospitals will say patients are only in the hospital for an average of only about four days, and time to properly plan their discharges is limited. It is true. But it is no excuse.
Similarly, health plans need to increase their focus on fall prevention. Medicare Advantage plans, at risk for their members’ medical costs, should be especially aware. But so should traditional plans.
Finally, the federal government has a falls prevention program as part of the Older Americans Act. It is authorized to spend $5 million annually—a pittance relative to the federal budget (and the cost of falls). The Trump Administration has proposed eliminating the program.
All this said, it is important to find a balance between risk and safety. Many older adults want to remain active and, like the rest of us, sometimes overdo it. They have the right to take some risk in their lives and, sometimes, that may result in a fall.
But with some simple interventions, many falls can be prevented. Yet, according to the new JAMA article the number of falls among older adults is increasing. That is inexcusable.