Grant Baldwin, PhD
Director, Division of Unintentional Injury Prevention
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention
Do you know an older adult who has fallen recently? Chances are that you do, since every second of every day, an older American falls, as highlighted in the Centers for Disease Prevention and Control’s (CDC’s) recent Morbidity and Mortality Weekly Report (MMWR), Falls and Fall Injuries Among Adults Aged 65 Years and Over — United States, 2014. Falls are very common among older Americans. Research shows that individuals in certain groups are more likely to fall, such as women and American Indians/Alaskan Natives. Another striking finding was that in one year, an estimated 7 million falls required medical treatment or caused restricted activity.
So, what can healthcare providers do to reduce falls? CDC developed the Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative that gives all members of the healthcare team (e.g., physicians, nurses, pharmacists, physical therapists, and caregivers) guidance on how to make fall prevention part of their routine care for older adults.
The CDC STEADI initiative is based on the American and British Geriatrics Societies’ guidelines on fall risk assessment and follow-up. STEADI includes information for providers on how to screen for fall risk, assess fall risk factors, and provide or make referrals to evidence-based interventions that can reduce patient risk.
STEADI can be integrated into routine clinical practice beginning with three initial steps:
- Screen for fall risk. Ask your patients: Have you fallen in the past year? Do you feel unsteady when standing or walking? Do you worry about falling?
- Review and manage medications. Stop, switch, or reduce any medications that can increase the risk of falling (e.g., psychoactive medications, muscle relaxants, and medications affecting blood pressure).
- Recommend vitamin D to improve bone, muscle, and nerve health in older adults.
Falls can have serious lifelong outcomes. Every day in the U.S., approximately 74 older adults die from a fall. Falls cause more than 95% of hip fractures among older Americans, and women experience three-quarters of these injuries. Hip fractures are difficult to recover from, and many older adults lose their independence and are not able to live on their own afterwards.
Falls not only cause injuries and affect the independence of older adults—they also have a great impact on the health system. In 2015 alone, non-fatal fall injuries cost an estimated $31 billion in Medicare expenses, which is similar to the Medicare costs for cancer.
The good news is that older adult falls are preventable. Healthcare providers play a critical role in helping older Americans stay healthy, active, and independent longer. 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 evidence-based interventions as outlined in STEADI. The number of falls among this growing population will continue to increase unless effective interventions like STEADI are implemented nationwide.