Addressing Falls Prevention Among Older Adults, Part I: Understanding Why Falls Happen

Overview

This is the first of two staff development trainings offered by Hospital for Special Surgery’s VOICES 60+ Senior Advocacy Program to health professionals on the importance of addressing falls in older adults.

The goal of this training is to frame the importance of this concern as a public health issue while offering strategies to open discussion and assessing falls risk related to older adults. Nimali Jayasinghe, PhD, Assistant Professor of Psychology in Psychiatry at Weill Cornell Medical College and an expert on falls prevention, presented this topic to an interdisciplinary team of social workers, nurses, program associates, and volunteers.

Dr. Jayasinghe outlined learning objectives for the presentation:

• Review basic information about falls
• Learn the importance of asking patients about their falls history
• Discuss falling risk factors and causes
• Notice the effects of falling
• Debunk the myths about falls
• Discuss educating, motivating, and supporting patients around the topic of falls prevention

Falls: Definition and Statistics

Dr. Jayasinghe began her presentation by defining a fall as an “unintended movement to the ground or lower level that is not the result of an overwhelming external force, seizure, or excessive alcohol intake.”

Dr. Jayasinghe explained that several important facts must be considered when addressing falls:

• Falling is very common: 1 in 3 older Americans over the age of 65 – approximately 12 million - will fall in any given year
  • Half of those people (6 million) will fall at least one more time and possibly repeatedly that year.
• The likelihood of falling increases steadily across a person’s lifespan starting from the age of 40 and progressing through the ages of 50, 60, 70 and 80.
• 60% of falls occur in the home
• 30% fall in a public setting
• 10% fall in a health care center

Risk Factors

She asked members of the audience to name some of the risk factors or reasons why patients fall, and several members offered answers, including “bone density loss, illnesses such as osteoporosis, muscle weakness or loss in muscle strength, and eyesight and hearing changes.”

Dr. Jayasinghe also added that some medications such as sleep aids, antidepressants, and cardiac medications have side effects that may put people at risk for falling.

It’s very important to think about intrinsic factors that could cause a fall or put people at risk of falling. Do they have a medical condition that puts them at risk? For example, a patient with a medical condition such as diabetes might not have the same foot sensation as an individual without the illness, and that patient would need to take additional precautions when walking.

Extrinsic factors - external risks such as tripping hazards - must likewise be considered.

Causes

There are numerous reasons why a person might fall. One of the most common is an everyday accident caused by a hazard in the environment, such as a slippery surface, an unsecured rug, clutter in the home, poor lighting, and rushing to the bathroom at night.

Some major risk factors for falling are health related, including arthritis, gait problems, muscle weakness and others. If you are speaking to somebody who have these risk factors, they are more likely to fall -- and it is essential to talk about falls prevention.
Additional risk factors equal greater likelihood for falls in the future.

Falls are the fifth leading cause of death and the leading cause of accidental death in adults over the age of 65. About 20% to 30% of people who fall will have some kind of serious injury such as bruising, spine injury, and some kind of fracture.

According to the Centers for Disease Control (CDC), in the year 2000 about $19 billion was spent in treating people for the injuries resulting from a non-fatal fall. It’s expected that by the year 2020, about $55 billion will be spent treating people that suffer a non-fatal fall.[1]

The Effects of Falling

After suffering a fall, people often stop doing everyday activities such as cooking or going out for a walk. This can affect mood and cause them to become socially isolated. After a fall, people may become less able to care for themselves, which may mean that they will need more care or move to a nursing home. In fact, falls are the leading cause of nursing home admissions. Falls have emotional consequences. People, especially older adults, can become very fearful of falling and suffer depression or even symptoms of post-traumatic stress disorder (PTSD).

Dr. Jayasinghe asked the group to describe whether they’ve had to initiate a conversation about falling with a patient. Several participants shared their encounters and experiences.

Most older adults know somebody who has had a serious fall or might even have died from a fall. When older people are surveyed, there is a high degree of concern about falling. In fact, they say that they are more concerned about falling than they are about being a victim of a crime. However, most people don’t initiate conversations about falling with social workers, nurses, or doctors because they feel embarrassed to talk about it.

Dr. Jayasinghe stated that it may be better to ask a patient about safety, rather than falling. It’s important to be able to assess his/her risk without making the patient feel uncomfortable. Simply ask questions such as, “Do you worry about your safety? Do you think about your safety?”

If the patient is receptive to these initial questions, followup questions regarding their concerns about their falls history could include the following:

• Have you fallen in the last five months?
• What were the circumstances?
• Did you get injured?
• Did you get support?
• Are you worried about falling again?

The key is to ask questions!

This topic is covered in greater detail in Part II of this presentation, Approaching Your Patient About Falls Prevention.

Debunking Myths about Falls

Falling happens to other people, NOT to me.
There are people who will say, “It won’t happen to me.” This presents an opportunity to decrease patients’ anxiety and actual risk by responding, “Well it could be you, but it can possibly be avoided if you do these things.”

Falling is a normal part of aging.
Some people will say falling is part of aging. The truth is, it’s not part of aging. It’s controllable, and there are things that can be done to reduce the likelihood of falling, or at least to reduce the likelihood of having a serious fall.

Falling is inevitable…nothing I do will help.
Many people are wary about falls prevention. We are all responsible for informing others that there are several things that they can do to reduce their likelihood of falling.

Being inactive is the best way to stop myself from falling.
Some people believe that the best way to prevent falls is to stay in bed or in their chair. It’s important to understand that performing physical activities will actually help them feel more in power and in control, as their strength and range of motion benefit from remaining active.

A patient might be at any one of the following readiness stages:

Precontemplation: “I don’t see a problem.”
Contemplation: “I wish I could change.”
Preparation: “I want to change. I can change. I will change.”
Action: “I am taking steps to change. I am changing.”
Maintenance: “I made changes and will continue to work on them.”

According to Dr. Jayasinghe, “To make changes people need to feel in power and that they know what to do. It’s helpful to set small goals.”

Read the second part of this presentation, focusing on Approaching Your Patient About Falls Prevention.

Additional Resources

Dr. Jayasinghe ended the presentation by sharing online resources available to the public.

National Institute on Aging

Center for Disease Control and Prevention

About VOICES 60+

The mission of VOICES 60+ is to enhance the medical care experience of patients 60 and over by helping them to navigate and access the care, community resources, and education they need. These training sessions seek to address staff development needs which advance the Prevention Agenda for Public Health of our hospital’s Community Service Plan.

VOICES 60+ has expanded its existing program priorities to:

• Goal 1: Educate and raise awareness of ethnically diverse older adults on issues related to communication with their health care providers about arthritis and related needs with a specific focus on falls prevention
• Goal 2: Increase patient safety and support at home and in the social environment by linking older adults with community partners that provide language and culturally appropriate services

References

1. Falls Among Older Adults: An Overview. Centers for Disease Control and Prevention. www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

Posted: 3/29/2011

Summary by Jacqueline Sandoval, Program Associate, VOICES 60+ and Juliette Kleinman, LCSW, ACSW, Manager, VOICES 60+

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