Fall prevention in the elderly population

The number of older people is growing rapidly worldwide. More than 580 million people are older than 60 years, and the number is projected to rise to 1000 million by 2020.(1) With the increase in life expectancy, the leading causes of death have shifted dramatically from infectious diseases to noncommunicable diseases. Falls, traffic crashes, suicide and related injuries among elderly people are major public health problems worldwide

Falls are a serious public health problem among older adults in Canada.(2) More than a third of adults aged 65 years or older fall each year.(3,4) In BC this means that an estimated 147, 000 British Columbians over age 65 are likely to fall in 2004.(5)

Falls are responsible for 70 percent of injury related days of hospital care for elderly people. In 2001 about 3,100 seniors over the age of 65 were hospitalized for a broken hip: about two thirds were females. A single hip fracture adds $24,400 to $ 28,000 direct health costs to the system. Injuries from falls account for 85 percent of all injuries to the elderly and in 1998 cost the province $ 180 million in direct health care csts.(5)

Direct costs include out-of-pocket expenses and charges paid by insurance companies for the treatment of fall-related injuries. These include costs and fees associated with hospital and nursing home care, physician and other professional services, rehabilitation, community-based services, the use of medical equipment, prescription drugs, local rehabilitation, home modifications, and insurance administration.(6) Direct costs do not account for the long-term consequences of these injuries, such as disability, decreased productivity, or reduced quality of life.

Setting a target in BC of a 20 percent reduction in falls as measured by current hospitalization rates for falls among elderly, would save $ 25 million a year in reduced health care costs.(5) Therefore it is necessary to implement aggressively the known cost effective and evidence based practices to prevent this multifaceted public health problem.

Alarming increase in the number and incidence of fall-related problems among elderly people, researchers have developed and tested various methods for the prevention of falls, including single-factor interventions (such as exercise or withdrawal of psychotropic medication) and their multifactorial counterparts (assessment and reduction of many predisposing and situational risk factors for falling). The newest and most clearly different approach has been the protection of the vulnerable site of the body when a fall occurs (with hip protectors).(7)

In addition over 60 randomized controlled trials of interventions to prevent falling have now been published. As many of the possible interventions are labour intensive and expensive, we need to target effective interventions at people who are most likely to benefit.(8)

REFERENCES:

(1). Population ageing: a public health challenge. WHO, Fact Sheet N 135. Revised September 1998.

(2) Weir, E., Culmer, L., fall prevention in the elderly population. CMAJ 2004; 171 (7).

(3). Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. Preventing falls among community-dwelling older persons: results from a randomized trial. The Gerontologist 1994; 34(1):16–23.

(4). Hausdorff JM, Rios DA, Edelber HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Archives of Physical Medicine and Rehabilitation 2001; 82(8):1050–6.

(5). Prevention of Falls and Injuries among the Elderly A special report from the office of the provincial health officer (2004) http://www.healthservices.gov.bc.ca/pho/pdf/falls.pdf (accessed on 1st Oct.2004)

(6). Englander F, Hodson TJ, Terregrossa RA. Economic dimensions of slip and fall injuries. Journal of Forensic Science 1996; 41(5):733–46.

(7).Kannus, P., Khan, K.M., Prevention of falls and subsequent injuries in elderly people: a long way to go in both research and practice. CMAJ. 2001; 4; 165(5):587-8.

(8). Gillespie, L., Preventing falls in elderly people. BMJ 2004;328: 653-654.

Conflict of Interest:

None declared