Update on Falls
Marc Hochberg, MD, MPH, MACP, President, USBJI
Falls are the leading cause of injury-related morbidity and mortality among older adults in the United States. Approximately one-quarter of older adults (aged 65 and above) report having one or more falls each year resulting in approximately 3 million visits to emergency rooms per year. Burns and Kakara from the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, recently published an analysis of deaths from falls among older adults in the U.S. from 2007 to 2016 (1). They noted an annual increase in both the number of falls as well as age-adjusted death rates from falls; the rate of deaths from falls increased by an average of 3.0 percent per year reaching a rate of over 60 per 100,000 persons aged 65 and above in 2016 (see Figure). When examined by age group, persons aged 85 and above (often classified as the “oldest old”), had the highest death rate: over 250 per 100,000 or more than 1 in 400 persons. Interestingly, death rates from falls were higher in men than women and in whites compared to non-whites.
Falls are the major modifiable risk factor for fractures; indeed, over 90 percent of osteoporotic fractures result from a fall from standing height. There are many factors that have been identified to increase the risk of falls; the most important are advanced age, having a history of prior falls and any medical condition associated with an impairment in gait, balance, physical function, vision or mobility.
The U.S. Preventive Services Task Force recently published evidence-based recommendations on the prevention of falls in community-dwelling older adults aged 65 and above who are not known to have osteoporosis or vitamin D deficiency. The Task Force recommends exercise interventions to prevent falls; the types of exercise considered include supervised individual and group exercise classes, physical therapy, gait and balance training, resistance training, flexibility and endurance training as well as tai chi. In addition, a “multifactorial intervention” that includes an assessment of modifiable risk factors for falls with customized interventions for each patient also was recommended. The initial “multifactorial” assessment could include a comprehensive geriatric assessment or an assessment using a combination of various components, such as balance, gait, vision, postural blood pressure, medication usage, home environment, cognition, and psychological health. This type of multi-disciplinary assessment is consistent with recommendations from the American Geriatric Society (AGS) and should be combined with a comprehensive management strategy directed at all identified modifiable risk factors. The AGS also recommends adaptation of the home environment, minimization or withdrawal of psychoactive medications, management of postural hypotension, and use of appropriate footwear.
The USBJI has revised the curriculum in its public education program “Fit to a T” to place greater emphasis on fall prevention in an effort to align with the Center for Medical Technology Policy’s “Strategic Roadmap to Prevent Secondary Fractures” that has been endorsed by the American Society for Bone and Mineral Research and the USBJI. In addition, persons should download health information on preventing falls from the websites of the Centers for Disease Control and Prevention and the National Institute on Aging.
(1) Burns E, Kakara R: Deaths from fall among persons aged > 65 years - United States, 2007-2016. MMWR Morb Mortal Wkly Rep 2018;67:509-14.
Related articles in this Newsletter ASBMR Pushes for Progress with the Secondary Fracture Prevention Initiative; Why Bone Health Management Matters.