A Marr - Falls Prevention

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Older Adult Falls Prevention
Angela Marr, MPH
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Introduction

• 30-35 of people 65 fall each year1
• Those who fall are 2-3 times more likely to fall
  again2
• 10-20 of falls cause serious injuries3

__________ 1. Hornbrook, Gerontologist, 1994
Hausdorff, Arch Phys Med Rehab, 2001 2.
Tinetti, New Eng J Med, 1988 Teno, JAGS,1990 3.
Sterling, J Trauma-Inj Infection Critical Care,
2001
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Fall and Nonfatal Fall Injuries Among People
65--2006
14,903
Died
432,629
Hospitalized
1,309,722
Treated released
? Millions

• If an older adult falls, 2-3 times more likely to
  fall again

(Oliver, 2009), (Arias, 2008)
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Fall Death Rates by Sex Age, 2006
Men
Women
__________ NCHS, Vital Records, 2006
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Trends in Age-Adjusted Fall Death Rates Men
Women 65, 2000-2006
Men
35
Women
45
___________ NCHS, Vital Records, 2006
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Leading Causes of Nonfatal Unintentional Injuries
Among People 65, 2006
Total 3.1 million injuries
N1.84 million
__________ NEISS-AIP, 2006
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Nonfatal Fall Injury Rates by Sex Age, U.S.,
2007
Women
Men
__________ NEISS-AIP, 2007
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Trends in Age-Adjusted Nonfatal Fall Rates Men
Women 65, 2001-2007
Women
6
Men
8
_________ NEISS-AIP 2001-2007
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Where Do Falls Happen?

• At home, outside.......35
• At home, inside..23
• Away from home, in a
• familiar place..23
• Away from home, in an
• unfamiliar place..19

______ Berg WP, Age Ageing, 1997
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Why Do Falls Happen?

• Slipped or tripped..59
• Misplaced step...12
• Loss of balance.. 9
• Legs give way .... 4
• Other 16

______ Berg WP, Age Ageing, 1997
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Economic Impact

• In 2000, cost of fatal fall injuries among people
  65
• Total 19 billion
• Fatal falls 0.2 billion
• Nonfatal injuries 19 billion

• ___________
• Stevens JA, Inj Prev, 2006

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Quality of Life

• 20 - 36 fear falling1
• 20 die within a year after hip fracture2
• 25 in a nursing home one year later3

___________ 1. Vellas BJ, Age Aging, 1997
Friedman SM, JAGS, 2002 2. Lu-Yao GL, AJPH,
1994 3. Magaziner, J Gerontology Medical
Sciences, 2000
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Fall Risk Factors

• Biological Risk Factors
• Poor control and prevention of chronic health
  problems
• Mobility Problems due to muscle weakness or
  balance
• Vision changes or vision loss
• Behavioral Risk Factors
• Medication side effects and interactions
• Inactivity (physical, mental, social)
• Alcohol use
• Environmental Risk Factors
• Home and environmental hazards
• Poorly designed public spaces
• Incorrect use of assistive devices

Preventing Falls How to Develop Community-based
Fall Prevention Programs for Older Adults (CDC,
2008)
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Effective Fall Prevention Strategies

• Exercise for balance strength

• ___________
• Lord SR, JAGS, 2003
  

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Effective Fall Prevention Strategies

• Review manage medications

___________ Cumming RG, Drugs Aging, 1998 Ray
W, Topics in Geriatric Rehab, 1990
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Effective Fall Prevention Strategies

• Maximize vision

• ___________
• Lord SR, JAGS 2001

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Effective Fall Prevention Strategies

• Improve home safety

___________ Day L, BMJ 2002 Gill TM, APHA, 1999
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Older Adult Fall Prevention
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Fall Prevention Interventions
Intervention Duration Risk Factors Delivered Net Present Value
Tai Chi Moving for Better Balance -1 hour classes held three times a week -(26 weeks) -Biological -Behavioral -Tai Chi instructor with experience teaching older adults 354.1
Stepping On -7 classes -2 home visits -(25 weeks) -Biological -Behavioral -Environmental -Physical or occupational therapist, vision expert, pharmacist, nurse, nutritionist, podiatrist 155.9
Preventing Falls What Works A CDC Compendium of
Effective Community-based Interventions from
Around the World (CDC, 2008), (Carande-Kulis
et.al, 2010)
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Discussion Tai Chi Moving for Better Balance

• Exercise Based Intervention
• Addresses biological risk factors
• Promotes strengthening of muscles and improved
  balance
• Control chronic health conditions through
  exercise
• Addresses behavioral risk factors
• Promotes physical, mental and social activity

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Discussion Stepping On

• Multifaceted Intervention
• Addresses biological risk factors
• Strength and balance exercises
• Nutrition education
• Poor vision assessment
• Addresses behavioral risk factors
• Medication management
• Promotes physical, mental, and social activity
• Addresses environmental risk factors
• Assessment of hazards in and around the home
• Assist with home adaptations and modifications

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When It Comes ToInjury Prevention,Were
DoingMore Than JustCrossing Our Fingers.