"I've fallen, and I can't get up!"

How big is the problem? >1/3 of adults 65 and older fall each year in the United States (Hornbrook et al. 1994; Hausdorff et al. 2001). >1/3 of adults 65 and older fall each year in the United States (Hornbrook et al. 1994; Hausdorff et al. 2001). Every 18 seconds, an older adult is treated in an emergency room for a fall Every 18 seconds, an older adult is treated in an emergency room for a fall 2 million ED visits in 2006 for nonfatal injuries2 million ED visits in 2006 for nonfatal injuries 500,000 hospitalized 19 billion each year for injuries500,000 hospitalized 19 billion each year for injuries Average hospitalization $17,500 Average hospitalization $17,500 $54.9 billion (in 2007 dollars) projected for 2020$54.9 billion (in 2007 dollars) projected for 2020

How big is the problem? 20% to 30% of people who fall suffer moderate to severe injuries (Alexander et al. 1992; Sterling et al. 2001) 20% to 30% of people who fall suffer moderate to severe injuries (Alexander et al. 1992; Sterling et al. 2001) Mortality 5X higher than young with similar injuries (Trauma) Mortality 5X higher than young with similar injuries (Trauma)

Epidemiology

Deaths and Mortality (Data are for the U.S.) Number of deaths: 2,426,264 Death rate: deaths per 100,000 population Life expectancy: 77.7years Infant Mortality rate: 6.69 deaths per 1,000 live births Number of deaths for leading causes of death: Heart disease: 631,636 Cancer: 559,888 Stroke (cerebrovascular diseases): 137,119 Chronic lower respiratory diseases: 124,583 Accidents (unintentional injuries): 121,599 Diabetes: 72,449 Alzheimer's disease: 72,432 Influenza and Pneumonia: 56,326 Nephritis, nephrotic syndrome, and nephrosis: 45,344 Septicemia: 34,234 CDC Website “FastStats” 2006 data

National Vital Statistics Report 2006 Type How many in a year Average frequency Hospital90,000 One American dies in a hospital from a medical error or a lethal infection every 6 minutes Transport43,443 One American killed by a traffic accident every 12 minutes Poisoning19,457 One American accidentally poisoned to death every 27 minutes At home 18,048 One American killed in an accident at home every 29 minutes Falls17,227 One American killed in a fall every 31 minutes Drunk driving 16,885 One American killed by a drunk driver every 31 minutes Homicide16,137 One American murdered every 32 minutes Drowning3,306 One American drowned every 159 minutes Scope of the Problem

Risk Factors - Fear of Falling Can be as life altering as any physical limitation! Can be as life altering as any physical limitation! May start vicious cycle of inactivity May start vicious cycle of inactivity May occur when a person has not fallen May occur when a person has not fallen

Intervention Programs Comprehensive fall historyComprehensive fall history Medication review +/- pharmacist consultMedication review +/- pharmacist consult Physical exam by physicianPhysical exam by physician Physical therapist evaluationPhysical therapist evaluation Occupational therapist evaluationOccupational therapist evaluation Home safety assessmentHome safety assessment Evidence Based Health PromotionsEvidence Based Health Promotions

Home Safety Assessment Furniture that is too high Furniture that is too high Electrical cords on floor Electrical cords on floor Clutter on floor Clutter on floor Lighting Lighting Phone Phone Low furniture Low furniture Throw rugs Throw rugs

Bed and Bath Bedside phone Bedside phone Bedside lamp Bedside lamp Night light Night light Non- slip surface Non- slip surface Grab bars Grab bars Shower seat Shower seat Raised toilet seat Raised toilet seat

What Works for Prevention? Cochrane Review 2009 “Interventions for preventing falls in older people living in the community” Cochrane Review 2009 “Interventions for preventing falls in older people living in the community” Exercise interventions reduce risk and rate of falls.Exercise interventions reduce risk and rate of falls. Research is needed to confirm the contexts in which multifactorial assessment and intervention, home safety interventions, vitamin D supplementation, and other interventions are effective.Research is needed to confirm the contexts in which multifactorial assessment and intervention, home safety interventions, vitamin D supplementation, and other interventions are effective.

Summary Falls are not an inevitable part of aging Falls are not an inevitable part of aging Intervention before a fall is ideal Intervention before a fall is ideal Prevention is the keyPrevention is the key Intervention after a fall is essential Intervention after a fall is essential Request a PT/OT consult after the fallRequest a PT/OT consult after the fall Outpatient Therapy In The HomeOutpatient Therapy In The Home

Collaborative Partnerships