Thursday, September 22, 2016

Guest Post: Falls Prevention Awareness Day

- Stephen Hargarten, MD, MPH

Today is the 9th annual observation of Falls Prevention Awareness Day in the United States. Falls are the leading cause of both fatal and nonfatal injuries among older adults age 65 and over. The Centers for Disease Control and Prevention (CDC)’s latest Morbidity and Mortality Weekly Report (MMWR) article, Falls and Fall Injuries Among Adults Aged 65 Years and Over — ­­­United States, 2014 outlines the epidemiology of older adult falls, and how clinicians can use CDC’s evidence-based STEADI (Stopping Elderly Accidents, Deaths, & Injuries) initiative to help prevent them. STEADI provides tools for clinicians to use with older adult patients to screen for fall risk using three simple steps:

· Ask: Have you fallen in the past year? Do you feel unsteady when standing or walking? Do you worry about falling?

· Review/Reassess/Discontinue any medications or combinations that can increase the risk of falling.

· Recommend at least 800 mg IU of vitamin D to improve bone, muscle, and nerve health in older adults.

Every hour of every day, in communities across the United States, a patient who either just fell or is a fall risk, is being evaluated by a family physician or emergency care clinician. It is critically important that clinicians in urgent and primary care settings ask, review, and recommend fall prevention strategies for older adults.

The new CDC article highlights that in 2014, over 27,000 older adults died because of falls, and 2.8 million people were treated in emergency departments (EDs) for falls-related injuries. In the same year, CDC discovered that one in four older adults reported falling, totaling almost 29 million falls, and seven million fall injuries.

Falls not only cause injuries and affect the independence of older adults—they also have an impact on the economy. The annual medical costs associated with older adult falls are estimated to be $31 billion per year. The article estimates that the older adult population will increase 55% by 2030. The incidence of falls among this growing population will continue to increase unless effective interventions like STEADI are implemented nationwide.

Older adult falls are preventable. For patients in the ED or inpatient setting, care givers need to constantly evaluate and reevaluate for fall risk. Hospital bed side rails always should be in place to avoid an unintended fall from the bed.

Clinicians can play a critical role by following STEADI’s comprehensive approach of: 1) Asking older adult patients about falls, 2) assessing gait and balance, 3) reviewing medications, 4) prescribing interventions such as strength and balance exercises, 4) and recommending least 800 mg IU of vitamin D every day to prevent falls among older adults. Because many patients do not discuss the problem with their doctor, clinicians must be vigilant about asking patients about their falls, screening for fall risk, and implementing STEADI into practice.

As we acknowledge Falls Prevention Awareness Day, I encourage you all to take a stand against falls by integrating into your daily practice: Ask, Review, and Recommend for older adults. It’s good medicine!


Dr. Hargarten is Chair of the CDC's National Center for Injury Prevention and Control, Board of Scientific Counselors, and Professor and Chair of the Department of Emergency Medicine and Associate Dean for the Global Health Program at the Medical College of Wisconsin.