Older adults worried about falling typically receive general advice: Take an exercise class. Get the vision checked. Quit taking medications for sleep. Install grab bars in the bathroom.
A new study suggests that kind of advice hasn't turned out to be extremely effective: Nearly three times more adults age 75 and older died from falls in 2021 than in 2000, based on a recent report in the Journal from the Ama.
In 2021, 25,189 people in this age bracket died from falls, compared with 8,613 in 2000. The rate of fatal falls for adults 75 and older a lot more than doubled during this time period, from 51.6 per 100,000 people in 2000 to 122.2 per 100,000 individuals 2021, the report found.
What's required to take a look alarming trend, experts suggest, is a more personalized method of preventing falls, more involvement by medical practitioners and better ways to motivate older adults to take action.
Elizabeth Burns, a co-author of the report and health scientist at the U.S. Centers for Disease Control and Prevention, said it's not yet clear why fatal falls are increasing. Older adults are most likely more susceptible since they are living longer with conditions such as diabetes and coronary disease and taking more brain-altering medications such as opioids, she noted.
By 2030, the CDC projects, 49 million older adults will fall every year, leading to 12 million injuries and most $100 billion in health-related spending.
The steep rise in fatal falls is “definitely upsetting,” especially given national, local and state efforts to prevent these accidents, said Kathleen Cameron, senior director of the Center for Health Aging in the National Council on Aging.
Since 2012, the CDC has attempted to turn the problem around by encouraging physicians to consider evidence-based fall prevention practices. But doctors are still not doing enough to help older patients, Burns said.
She cites evidence from two studies. In one, published in 2021, researchers found that less than 50 % of seniors who have been considered high risk – people who'd fallen repeatedly or sought medical attention for falls – received a comprehensive fall risk assessment, as recommended through the CDC and the American Geriatrics Society.
These assessments evaluate a person's gait, lower-body muscle strength, balance, medication use, issues with their feet, blood pressure level when rising from a sitting position, vision, vitamin D levels and home environment.
In another study, published this past year, Burns discovered that physicians and healthcare professionals routinely didn't review older adults' medications (about 40% didn't do so), recommend exercise (48% didn't) or refer people to an image specialist (about 62% didn't) when advising older patients about falls.
Physicians' involvement is essential because seniors have a tendency to place their doctors' advice seriously, said Emily Nabors, program manager from the Fall Prevention Center of Excellence at the University of Southern California.
Also, seniors tend to underestimate their chance of falling.
“It's very easy for people to check out a list of stuff that they should be worried about and think, 'That doesn't affect me. I walk all right. I don't have challenge with my balance,'” said Dorothy Baker, a research scientist at Yale Med school and executive director of the Connecticut Collaboration for Fall Prevention.
What's the choice to giving seniors a laundry listing of things to do and hope they give consideration? We asked experts around the country for suggestions:
Get a fall risk assessment. Doctors should ask older adults three questions about falls: Perhaps you have fallen in the past year? Do you feel unsteady when walking or standing? And therefore are you afraid of falling?
If the answer is yes to any of these questions, you're probably a good candidate for a comprehensive fall risk evaluation.
Dr. Muriel Gillick, a geriatrician at Harvard School of medicine, believes older patients and their families should “clamor” for these assessments. “Tell your doctor, 'We're really worried about falls. Can you do that type of evaluation?'” she said.
When you join Medicare, you become entitled to a “Welcome to Medicare” prevention visit, where doctors should evaluate your chance of falling. (This can be a brief screen, not a thorough examination.) Subsequently, seniors qualify every year for any Medicare annual wellness visit, that provides another chance for a health care provider to assess your fall risk.
If your physician doesn't offer these services, ask for a referral to another medical practice, said Leslie Allison, editor-in-chief of the Journal of Geriatric Physical Therapy. Physiotherapists can offer an in-depth review of walking, muscle strength and balance, she noted.
The CDC's “Stay Independent” brochure lists 12 fall-related considerations for those thinking about doing a self-assessment. Take notice of the 4g iphone, about depression, which alters attention, slows responses and is often overlooked in discussions about falls.
Get a personalized plan. An autumn assessment should identify risk factors that are specific for you as well as ways to address them.
“The goal is to develop personalized recommendations, which seniors are much more prone to occupy than generic non-tailored approaches,” said Elizabeth Phelan, a researcher of falls and associate professor of geriatric medicine at the University of Washington.
Take programs that address balance, for example. Some are equipped for older adults who're frail, some for those who are active, but still others for those among. “If a senior would go to a program that doesn't meet her needs, it's not going to work out,” said Mindy Renfro, associate professor of physical rehabilitation at Touro University Nevada.
The single most important intervention is exercise – but not just any kind. Notably, simply walking – the kind of exercise most older adults get – won't help unless seniors have previously been sedentary. “If you're walking, by all means, don't stop: It is good for overall health and well-being,” Phelan said. “But to prevent falls, you need to concentrate on strength and balance.”
Exercise for example tai chi or the Otago Exercise Program could improve strength and balance, advises Cameron of the National Council on Aging. She suggested asking an area agency on aging, senior center, YMCA or YWCA about classes. The middle also offers formed fall prevention coalitions in 43 states. Look for one in your area here.
A national directory of resources that will help seniors make home modifications has been expanded via a new program led by USC's Leonard Davis School of Gerontology. Occupational therapists can evaluate homes and suggest changes to take down possibility of falling. Ask your personal doctor for a referral.
Your doctor's guidance will be needed to review medications that may contribute to falls. Using three or more psychotropic medications for example opioids, antidepressants, antipsychotics, benzodiazepines (for example Valium) and “Z” drugs for sleep (for example Ambien) puts seniors at substantial risk, said Dr. Donovan Maust, an assistant professor of psychiatry at the University of Michigan School of medicine.
Be careful during transitions. Older adults coming home from the hospital or starting new medications should be especially careful about falling, simply because they may be weak, deconditioned, exhausted and disoriented.
A new paper from researchers at the University of Michigan and Yale University highlights this risk. They checked out 1.2 million seniors readmitted towards the hospital within Thirty days of being discharged in 2021 and 2021. Fall-related injuries were the third most typical reason behind readmissions.
In other studies, Geoffrey Hoffman, an assistant professor at the University of Michigan School of Nursing, has asked seniors and caregivers about their experiences during discharge planning. None remembered receiving details about falls or just being advised they might be at risk.
Hospital staffers should discuss fall prevention before older patients leave a healthcare facility, Hoffman said, calling it “a time when it is critical to intervene on fall risk.”
Consider the message. In research studies and concentrate groups, seniors report they do not like negative messages surrounding falls such as “You can hurt yourself badly or die if you don't watch out.”
“Telling seniors what they need to complete to be safe feels patronizing to many people and raises their hackles,” Hoffman said.
Instead, seniors respond easier to messages such as “taking these steps is going to help you stay independent,” Burns of the CDC said.