Falls Among Older Adults

MARIA TORROELLA CARNEY, EDWARD P. MANGANO M.D., F.A.C.P. COUNTY EXECUTIVE COMMISSIONER

Nassau County Department of Health Division of Chronic Disease, Research and Prevention

FALLS AMONG OLDER ADULTS:

FROM THE NATIONAL, STATE AND LOCAL PERSPECIVE

Falls among the older adult population are a major public health concern. This problem is often overlooked, viewed as an inevitable reality of getting older; however, falls are preventable and predictable events with associated risk factors in certain populations. The following report investigates the public health concern of falls among older adults on the national, state and local scale, calling particular attention to the problem in Nassau County and addressing ways to solve it.

Nassau County Department of Health Division of Chronic Disease, Research & Prevention

FALLS AMONG OLDER ADULTS:

FROM THE NATIONAL, STATE AND LOCAL PERSPECIVE

Falls are prevalent among older adults nationwide. Every year approximately one third of adults who are 65 years and older and one half of adults 80 years and older experience a fall1, 2. Among those adults who fall, half will fall again within the year2. Falls can be devastating for older adults nationwide. Approximately one out of ten falls among older adults result in a serious injury, such as a hip fracture or head injury, that requires hospitalization3. In 2005, traumatic brain injuries (TBI) accounted for 50% of fatal falls among older adults4. In 2006, adults 65 and older made up over half (566,000) of the 1.1 million fracture related hospitalization discharges5 In 2007, falls were the leading cause of death among all injury types in the adult 65 and older population (18,334) greater than motor vehicle crashes (6,632)and suicide by firearms (3,895 )6 In 2008, 2.1 million nonfatal fall injuries among older adults were treated in emergency departments and more than 559,000 of these patients were hospitalized6. Falls are costly to older adults nationwide. In 2000, the total direct medical costs (paid for by insurance companies and patients) of all fall injuries for older adults was $19.2 billion7. In 2002, Medicare costs per fall averaged between $9,113 and $13,5078.

Costs for fall-related injuries vary by age and sex factors- older adults and women report higher costs associated with their fall related injuries7.

Certain injuries vary in costs, with TBI and injuries to hips, legs and feet among the most common and costly7 .

Beyond the financial costs of falls, there is a significant cost to the quality of life of older adults who fall, namely the loss of independence, emotional distress and fear of future injury. Falls among older adults are preventable nationwide. Older adults can significantly reduce their risk of falling by doing the following:

Exercise regularly to increase strength and improve balance.

Ask their doctor or pharmacist to review their medicines to reduce side effects & interactions

Have an eye exam at least once a year for a checkup and always update eyeglasses.

Improve home safety by tripping hazards, adding grab bars and railings, and improving the lighting in their homes.

Nassau County Department of Health Division of Chronic Disease, Research & Prevention

FALLS AMONG OLDER ADULTS:

FROM THE NATIONAL, STATE AND LOCAL PERSPECIVE

Falls are prevalent among older adults in New York State. Falls are the leading cause of injury deaths, hospitalizations & emergency department visits among adults 65 and older in New York State 9.

Every day, because of a fall: o 2 older New Yorkers die o 136 older New Yorkers are hospitalized o 215 older New Yorkers are seen in Emergency Departments9

Falls can be devastating for older adults in New York State. Fall related hospitalizations among older adults in New York State are increasing. 60.0% of adults 65 and older who are hospitalized due to a fall end up in a nursing home or rehabilitation center 9. Among adults 65 and older who are Annual hospitalized due to a fall, 10.8% suffer a Hospitalizations Due to Falls, New York State Frequency traumatic brain injury and 28.4% experience a hip fracture9. Residents 65+ Rate per 10 0 , 0 0 0 60,000 2,000.00 1,950.00 Falls are costly to older adults Rate per

50,000 100,000 1,900.00 in New York State. 40,000 1,850.00 1,800.00 Falls account for $1.5 billion in annual 30,000 1,750.00 hospitalization charges and $123.5 million in 20,000 1,700.00 1,650.00 annual outpatient emergency department

Annual Frequency Annual 10,000 1,600.00 charges9. 0 1,550.00

199920002001200220032004200520062007 Falls among older adults are preventable Year NYSDOH, Bureau of Injury Prevention in New York State. New York State Office for the Aging is part of the Executive Department in NYS, advocates for policies and programs to support elderly New Yorkers and their families in partnership with the network of public and private organizations which serve them.

Home Safety Council, Older Adults provides information for older adults and their caregivers about home safety including falls, fires, and medication use.

ProAction Senior Wellness Program in Bath, New York provides educational resources and programming for injury prevention, mental health services, exercise and physical fitness, nutrition, osteoporosis, and stress management at no cost to seniors. “Safety in the Home” program provides individual safety surveys and educates adults about preventing falls and fractures in the home, medication management services provide screening of medicines and education to prevent incorrect medication use and adverse drug effects. Umbrella of the Capital District is a membership organization which provides high quality home maintenance to improve the home environment and prevent injuries

Nassau County Department of Health Division of Chronic Disease, Research & Prevention

FALLS AMONG OLDER ADULTS:

FROM THE NATIONAL, STATE AND LOCAL PERSPECIVE

Falls among older adults are prevalent in Nassau County.

Injuries among Nassau County Residents, 65+ Motor Vehicle Cras h Fire/Flame 88% of all injury hospitalizations were 5% 0% Overexertion due to falls in the older adult popula- 1% Pedestrian tion of Nassau County, followed by 1% Respiratory motor vehicle accidents at a mere 5%. Poisonings 2% Interference Although motor vehicle accidents are a 1% major injury and concern across age Falls Struck by Object/Person groups, among older adults fall related 88% 1% in injuries are the biggest problem10. Cutting Instrument

Bicycle 1% NYSDOH SPARCS 0% Data, 2004-2006 8

NYSDOH SPARCS Data, 2004-2006 8 Rate of Hospitalizations due to Falls Among Those 65+ As age increases the proportion A Comparison of Locations of fall related injury hospitaliza- 2500 Nassau County Suffolk County tions increases drastically, more Westchester so than any other type of injury. New Y ork State 2000 Precise reasons for the high rate New Y ork City of falls in Nassau County are unknown; however, it is likely that 15 0 0 the suburban environment plays an important role. In addition, 10 0 0 Nassau County is one of the old- est suburbs in the nation, with Per 100,000 PopulationPer this age may come unsafe home 500 environments.

0 From 2004-2006, Nassau County reported a rate of 2,290 fall related hospitalizations per 100,000 population as compared to 2,269 in Suffolk, 2,110 in Westchester, 2,027 in New York State and 1,824 per 100,000 in New York City8. When comparing rates of falls by sex between Nassau County and the State both men and women in Nassau County report higher rates of fall related injuries than New York State. Overall, the female rate of fall related injuries is greater on both the state and county level, which is consistent with national data. Women are more likely to suffer nonfatal injuries because of a fall, while men are more likely to suffer from fatal injuries due to falls6.

Nassau County Department of Health Division of Chronic Disease, Research & Prevention

FALLS AMONG OLDER ADULTS:

FROM THE NATIONAL, STATE AND LOCAL PERSPECIVE

Falls can be devastating among older adults in Nassau County.

Top Ten Diagnoses of Fall Related Injuries: Inpatient Data 700

600 This graph highlights the most com- 500 mon principal diagnoses given to pa- 400 tients who are hospitalized for fall 300 related injuries. The rate of hip frac- 200 Rate per 100,000 tures (630.2 per 100,000 population) 10 0 is clearly the most common followed 0 ) ) e s s s I e s s by traumatic brain injuries (TBI) tur B s re res re n c T tigue tu io a a tu ease s c c s u Fr isea ra i t (227.5 per 100,000 population) and D F D Fractures l y ry a r Con (Hip to eg Fra m vis Fractu to L Ar l a circulatory diseases (218.8 per la pin ir u Pe S p mur rc s e i e f F C R 100,000 population). k o c e N NYSDOH SPARCS Data, 2004-2006 8 Gen Symp (syncope, dizziness, f

Contrasting with inpatient data, the graph below shows that more superficial injuries such as contu- sions (759.2 per 100,000), open wounds (691.8 per 100,000) and arm fractures (510.3 per 100,000) are the most common fall related injuries reported in outpatient data among Nassau County resident who are 65 years old and older . Top Ten Diagnoses of Fall Related Injuries: Outpatient Data

800 In Nassau County, women 700 had a significantly higher 600 rate of hip fractures than 500 400 men, and reported a 300 higher rate of all princi- 200

Rate per100,000 10 0 pal diagnoses with the 0 exception of traumatic s . s s) es e) ries e res n i ur u &.. ur u o jur brain injury (TBI), circula- usion s act asi In ractures nt act r ont br F A ied tory disease and respira- C m Joi ( f Open WoundsAr of Leg Fr s Trunk F tory disease. rain Injuries Unspeci emur (Hip Fract F St Traumatic Brain Inj cial of & fi ns er Neck Sup Sprai Musculoskeletal (Backaches, ... NYSDOH SPARCS Data, 2004-2006 8

Nassau County Department of Health Division of Chronic Disease, Research & Prevention

FALLS AMONG OLDER ADULTS:

FROM THE NATIONAL, STATE AND LOCAL PERSPECIVE

Falls among older adults are preventable in Nassau County.

This graph shows the most common places Place w here falls occur, NYSDOH SPARCS where falls take place in Nassau County lead- Outpatient Data Nassau County, 65+ 10 Data, 2004-2006 ing to emergency department visits. Of sig- nificance is the commonality of falling in “other specified places” which include a vari- Industrial place and premises ety of public locations in a community. Home 1% Other 29% The implications of this data is important specified Place of when considering potential environmental recreation and places* hazards and steps that can be taken to pre- sport 50% 1% vent falls in the older adult population. Street and highw ay Environmental hazards which can lead to falls Residential 4% need to be considered in the construction and Institution Public building 11% 4% maintenance of community spaces.

Place Where Falls Occur, Contrasting with outpatient Place of Recreation Inpatient Data Nassau County, 65+ data, fall related injuries and Sport which result in hospitaliza- 1% Farm 0% Industrial Place & Street and Highw ay *beach, canal, caravan site, tions most commonly take Premises 3% derelict house, desert, dock, 0% place in the home, followed Public Building forest, harbor, hill, lake, park- by residential institutions 3% ing lot, pond, prairie, pubic place, railway line, reservoir, and other specified places. Other river, sea/shore, stream, This seems to mean that Specified Places swamp, trailer court, woods more serious injuries (as 13% measured by the difference Residential Home between outpatient and inpa- Institution 64% 16% tient classification) take place in the home as op- NYSDOH SPARCS posed to any other location. Data, 2004-2006 10

The greatest threat to the safety of older adults in Increasing your home safety is easy! terms of locations seem to their own homes. Home Fall Prevention Checklist

Nassau County Department of Health Division of Chronic Disease, Research & Prevention

FALLS AMONG OLDER ADULTS:

FROM THE NATIONAL, STATE AND LOCAL PERSPECIVE

Falls are preventable among older adults in Nassau County. The most common cause of fall related injuries among Nassau County residents 65 and older is due to “slipping, tripping or falling.” These are falls that occur on a single level. It is notable that a consider- able amount of fall related injury data include unknown or unspecified causes. Better documentation of fall related injury causes will enhance fall prevention efforts. When current local data is taken together, the most common place and cause of a fall related injury is due to “slipping, tripping and falling” in the home. Prevention of fall related injuries is related to older adults taking steps to better their physical health and their home environment.

Cause of Fall, Outpatient Data Nassau County, 65+

Fall from chair Fall from other location* : on or from Fall from w heelchair 2% sidewalk curb, from one level to an- 2% Fall from ladder other, from commode, escalator, from Fall from other location* 1% other furniture, fall resulting in striking 2% Fall resulting in striking against sharp object against other object ** other fall: accidental fall on the 3% Fall from bed Slipping, same level, not otherwise specified 4% Tripping or Other stairs or steps Falling 6% Unspecified 39% fall 20% Other fall** 21% NYSDOH SPARCS Data, 2004-2006 10

Nassau County Department of Health is taking steps to specifically address the issues of falls among older adults with an aim of prevention. Fall injury prevention is among Nassau County Local Health Priorities • On October 22nd, NCDOH participated in a conference entitled Standing Up for Falls: An Interdisciplinary Approach Sponsored by Long Island Geriatric Education Consortium, Winthrop University Hospital. Future Steps: • Standardized fall injury intake forms - pilot • Share data with local health department • NCDOH Healthy Homes program to evaluate home safety • Falls squad to investigate non-hospitalized fall cases

Educational Resources:

Nassau County Department of Health: Terry Thomann, Falls Prevention Program Coordinator , 516- 227-9446 [email protected]

Senior Citizens Affairs

What YOU Can do to Prevent Falls

CDC Injury Prevention & Control, Falls- Older Adults World Health Organization- Global Report on Falls Prevention in Older Age New York State Office for the Aging Home Safety Council, Older Adults ProAction Senior Wellness Program Umbrella of the Capital District

References:

1. Cassel, C.K., Leipzeg, R.M., Cohen, H.J, Larson, E.B., & Meier, D.E. Geriatric Medicine: An Evidence-Based Approach. New York: Springer- Verlag, 2003

2. O’Loughlin, J.L., Robitaille,Y., Boivin, J.F., & Suissa, S. "Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly." American journal of epidemiology 137, no. 3 (1993): 342- 354.

3. Nevitt, M.C, Cummings, S.R. & Hudes, E.S. “Risk factors for injurious falls: a prospective study”. Journal of Gerontology, 46 (1991): 164-170.

4. Thomas, KA., “Fall-related traumatic brain injury deaths and hospitalizations among older adults, United States.” Journal of Safety Research, 39 (2008): 269-272.

5. DeFrances, C.J., Lucas, C.A., Buie, V.C., & Golosinskiy, A. “2006 National Hospital Discharge Survey”. Na- tional health statistics reports, 5 (2008). 1-20

6. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Web– based Injury Statistics Query and Reporting System (WISQARS) accessed November 1, 2010.

7. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006;12:290–5

8. Shumway-Cook A, Ciol MA, Hoffman J, Dudgeon BJ, Yorston K, Chan L. Falls in the Medicare population: incidence, associated factors, and impact on health care. Physical Therapy 2009.89(4):1-

9. New York State Department of Health, Falls in Older Adults, New York State accessed October 27, 2010

10. New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS) Hospitalization Data, Nassau County 2004-2006.