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

How big is the problem?How big is the problem?

>1/3 of adults 65 and older fall each year >1/3 of adults 65 and older fall each year in the United States in the United States (Hornbrook et al. 1994; Hausdorff et al. 2001).(Hornbrook et al. 1994; Hausdorff et al. 2001).

Every 18 seconds, an older adult is treated Every 18 seconds, an older adult is treated in an emergency room for a fallin an emergency room for a fall• 2 million ED visits in 2006 for nonfatal injuries 2 million ED visits in 2006 for nonfatal injuries • 500,000 hospitalized500,000 hospitalized19 billion each year for 19 billion each year for

injuriesinjuries Average hospitalization $17,500Average hospitalization $17,500

• $54.9 billion (in 2007 dollars) projected $54.9 billion (in 2007 dollars) projected for 2020for 2020

How big is the problem?How big is the problem?

20% to 30% of people who 20% to 30% of people who fall suffer moderate to severe fall suffer moderate to severe injuries injuries (Alexander et al. 1992; Sterling et al. 2001)(Alexander et al. 1992; Sterling et al. 2001)

Mortality 5X higher than Mortality 5X higher than young with similar injuriesyoung with similar injuries (Trauma)(Trauma)

EpidemiologyEpidemiology

Deaths and Mortality(Data are for the U.S.)

 Number of deaths: 2,426,264

Death rate: 810.4 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 2006National Vital Statistics Report 2006

Type Type How many How many

in a in a year year

Average frequency Average frequency

Hospital Hospital 90,00090,000 One American dies in a hospital from a medical One American dies in a hospital from a medical error or a lethal infection every 6 minuteserror or a lethal infection every 6 minutes

Transport Transport 43,44343,443 One American killed by a traffic accident every 12 One American killed by a traffic accident every 12 minutesminutes

PoisoningPoisoning 19,45719,457 One American accidentally poisoned to death One American accidentally poisoned to death every 27 minutesevery 27 minutes

At homeAt home 18,04818,048 One American killed in an accident at home every One American killed in an accident at home every 29 minutes29 minutes

FallsFalls 17,22717,227 One American killed in a fall every 31 minutesOne American killed in a fall every 31 minutes

Drunk Drunk drivingdriving 16,88516,885 One American killed by a drunk driver every 31 One American killed by a drunk driver every 31

minutesminutes

HomicideHomicide 16,13716,137 One American murdered every 32 minutesOne American murdered every 32 minutes

DrowningDrowning 3,3063,306 One American drowned every 159 minutesOne American drowned every 159 minutes

Scope of the ProblemScope of the Problem

Risk Factors - Fear of FallingRisk Factors - Fear of Falling Can be as life altering as any Can be as life altering as any

physical limitation!physical limitation!

May start vicious cycle of inactivityMay start vicious cycle of inactivity

May occur when a person has not May occur when a person has not fallenfallen

Intervention ProgramsIntervention Programs

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

Home Safety AssessmentHome Safety Assessment Furniture that is too highFurniture that is too high Electrical cords on floorElectrical cords on floor Clutter on floorClutter on floor LightingLighting PhonePhone Low furnitureLow furniture Throw rugsThrow rugs

Bed and BathBed and Bath

Bedside phoneBedside phone Bedside lampBedside lamp Night lightNight light Non- slip surface Non- slip surface Grab bars Grab bars Shower seatShower seat Raised toilet seatRaised toilet seat

What Works for Prevention?What Works for Prevention? Cochrane Review 2009 “Cochrane Review 2009 “Interventions Interventions

for preventing falls in older people for preventing falls in older people living in the community”living in the community”• Exercise interventions reduce risk and rate of Exercise interventions reduce risk and rate of

falls.falls.• Research is needed to confirm the contexts in Research is needed to confirm the contexts in

which multifactorial assessment and which multifactorial assessment and intervention, home safety interventions, intervention, home safety interventions, vitamin D supplementation, and other vitamin D supplementation, and other interventions are effective.interventions are effective.

SummarySummary Falls are not an inevitable part of agingFalls are not an inevitable part of aging Intervention before a fall is idealIntervention before a fall is ideal

• Prevention is the keyPrevention is the key Intervention after a fall is essentialIntervention 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 PartnershipsCollaborative Partnerships