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Falls Overview and Interventions

Dana Weisbrot

Chamberlain College of Nursing

NR503: Population Health Epidemiology and Statistical Principles

September 2019

Elderly falls constitute an important challenge for our older adult population as well as our healthcare system. Often times, after an older adult falls there are a number of issues that will follow that fall which will take a long time to resolve, sometimes with fatal outcome which affect not only the victim, but their family (CDC, 2014). This paper will present an overview of the problem of falls, data, goals and objective by Healthy People 2020, review mortality/morbidity risk, and explain population level interventions.

Overview, Background and Significance of the Problem 

As demonstrated by Ramsey, Hin, Prado, and Fernandez (2015) given the fact that adults 65 and older are becoming the largest of all age groups in the US, the number of falls and its injuries along with the financial costs are expected to increase as well”. In Florida, the elderly community ages 65 and older are the demographic mostly affected by falls. As reported by The Florida Department of Health (2019) 9,770 unintentional falls in Floridian older adults 65 years and older took place in Florida in 2018 alone. According to the Center for Disease Control (CDC) (2017) One out of five falls causes a serious injury such as head injuries and fractures. Three million elderly come into the emergency departments with fall related injuries. From those, over 800,000 are hospitalized often related to hip fracture. In 2015, the total medical costs for falls totaled more than $50 billion, from which 75% were billed to Medicare and Medicaid. At a state level, the incidence of falls among the elderly in Florida is high. Unintentional falls are the leading cause of fatal and non-fatal injuries among Florida residents ages 65 years and older. In Florida, in 2015, 2,603 older adults were fatally injured in a fall. Studies reporting higher rates of falling in elderly women than in elderly men (Chan & Do, 2015).

Epidemiological Analysis of the Problem

Forty one percent of all deaths resulting from injuries, and 70% of hospitalizations resulting from injuries among senior citizens are caused by falls. Furthermore, In 2015, 2,603 deaths of senior citizens in Florida were caused by falls, and in 2014, more than 208,564 senior citizens were brought to the emergency department for treatment from falls . Moreover, in 2016, 164,157 senior citizens are hospitalized from falls (Florida Department of Health, 2017). These issues directly impact on the health of senior citizens. Apart from deaths and hospitalization, the average cost of effectively treating senior citizens of 65 years and above in Florida is higher than what most families can afford. The economic impact of senior-citizen falls related to medical costs alone is about $2 billion in Florida (Florida Department of Health, 2017). In view of these reasons, it is necessary to form an intervention program that can help to reduce and prevent falls among senior citizens.

Healthy People 2020

Overview

The Healthy People 2020 aims at improving the quality of lives of senior citizens aged 65 years and older so that they live in the best possible way by preventing falls. The interventions are expected to significantly increase the life-span and quality of life of senior adults through community health approaches that will include family members of the senior citizens, healthcare stakeholders, and other members of the community (Center for Disease Control and Prevention, 2019). For this health program, falls among senior adults will be prevented and reduced by the application of research-based and evidence-based interventions among the elderly population.

Goals and Objectives

The goal of this program is to reduce the number of fatalities caused by falls among senior adults in Florida by at least 10% by the year 2020. Prevention of falls can increase the lifespan and quality of lives of senior citizens by reducing fatalities and fall-related injuries, which contributes to the fulfillment of HP2020 objectives (CDC, 2019). The short term objective is to increase mobility rates among senior citizens by applying approaches that can reduce the number of falls among senior citizens. The interventions will be applied at the community level to increase the levels of participation of Florida residents at the time of the program’s implementation and in the future.

Population Level Interventions

Physical Therapy

Physical therapy mainly involves conditioning the body to be resilient, strong, and adapted to varying degrees of physical activities. There are different forms of applying physical therapy senior citizens. It is inappropriate to engage senior citizens in highly energy-intensive exercises. Instead, there are a set of light exercises that the elderly can perform under the guidance of family members who will access the full instruction though brochures and in online platforms. Physical therapy activities will be tailored to the needs and abilities of each individual, and mainly involves training exercises that aid in balancing the body with more ease such as squatting with the arms stretched in front or sideways (Matchar et al., 2017). There are also strength and gait training each with different sets of exercises that need to be performed lightly but consistently for a period of at least three months (Matchar et al., 2017). The participants will be going for screening, vision check-ups, and polypharmacy assessment periodically through their physical therapy sessions. Healthcare experts will also be moving around to assess the nature of the environment that they live in to identify possible risk factors.

Falls-HIT Intervention

The Fall HIT intervention involves the visitation of healthcare workers and trained caregivers to places where the senior citizens live. The intervention mainly works by the experts’ assessment of the senior citizen’s demographics and health conditions, and provide advice and home modifications that can be used to minimize the chances of fall occurrence (Stevens & Burns, 2015). The experts give advice on the best ways to live, and offers tool kits that the family can use to safeguard the senior citizens from falls. It is also recommended that senior citizens go for frequent check-ups for assessment of possible mineral deficiencies such as lack of enough calcium and vitamin D so that appropriate interventions can be provided. For instance, family members are advised to feed senior citizens with diets rich in minerals and vitamin D to strengthen their bones. On some occasions, senior citizens may have to consistently take vitamin D supplements.

References

Center for Disease Control and Prevention. (2019). Healthy people 2020. Center for Disease Control and Prevention. https://www.cdc.gov/nchs/healthypeople/hp2020.htm

Centers for Disease Control and Prevention (2017). Important Facts About Falls. https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

Centers for Disease Control and Prevention (2014). Older Adult Fall Prevention, https://www.cdc.gov/media/dpk/healthy-living/injury-falls-older-adults/older-adult-falls.html

Chang, Vicky, Do, Minh (2015). Risk Factors for Falls Among Seniors: Implications of Gender, American Journal of Epidemiology, Volume 181, Issue 7, 1 April 2015, Pages 521–531, https://doi.org/10.1093/aje/kwu268

Florida Department of Health (2017). Florida Health Charts http://www.floridahealth.gov/statistics-and-data/florida-injury-surveillance-system/_documents/EDVisits-2016-chart.pdf http://www.floridahealth.gov/statistics-and-data/florida-injury-surveillance-system/index.html http://www.floridahealth.gov/statistics-and-data/florida-injury-surveillance-system/_documents/older-adult-falls-emphasis-report-2014.pdf

Matchar, D. B., Duncan, P. W., Lien, C. T., Ong, M. E. H., Lee, M., Gao, F., ... & Eom, K. (2017). Randomized controlled trial of screening, risk modification, and physical therapy to prevent falls among the elderly recently discharged from the emergency department to the community: the steps to avoid falls in the elderly study. Archives of physical medicine and rehabilitation, 98(6), 1086-1096.

Ramsey, R., Hin, A., Prado, C., & Fernandez, M. (2015). Understanding and Preventing Falls:

Perspectives of First Responders and Older Adults. Physical & Occupational Therapy In Geriatrics,

33(1), 17-33. doi:10.3109/02703181.2014.978432

Stevens, J. A., & Burns, E. (2015). A CDC compendium of effective fall interventions: What works for community-dwelling older adults (3rd ed.). Atlanta: CDC.

FALLS OVERVIEW AND INTERVENTIONS

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