By Bezaitis, Athan G.
Aging Today , Vol. 29, No. 4
The facts about falls in the United States speak loud and clear. According to the Centers for Disease Control and Prevention, treating elders for the adverse effects of falls in 2000 cost more than $ 19 billion that year in the United States: $12 billion for hospitalizations, $4 billion for emergency room visits and $3 billion for outpatient care. Medicare pays for most of these expenses. The Centers for Medicare and Medicaid Services projects that by 2020, direct-treatment costs from elder falls will escalate to $43.8 billion a year.
Loss of life, the onset of disability and the burden of exorbitant medical costs have done little to raise awareness of the issue. Adding insult to injury, experts estimate that up to 30% of falls are avoidable. An important sign of progress on fall prevention was the passage by Congress of the Safety of Seniors Act, signed into law by President Bush in April. (For more details, see the article by Bonita Lynn Beattie elsewhere in this "In Focus" section.) Although this legislation identifies key strategies for reducing falls, such as better training for professionals and targeting of at-risk groups, Congress has yet to fund the provisions of the bill.
The enactment-and eventual funding-of the new law will go a long way toward knitting together the numerous fall-prevention efforts around the United States, according to Jon Pynoos, codirector of the Fall Prevention Center of Excellence (FPCE), a consortium of four organizations based at the University of Southern California's Andrus Gerontology Center.
Throughout the United States, the largely community-based infrastructure for fall prevention has little cohesion, according to Pynoos. The current patchwork of outreach initiatives varies by target population served, geographic location, services provided and funding source. Until recently, most interventions have been implemented with varying degrees of success in doctor's offices, patients' homes, hospitals, nursing homes, senior centers and specialized research centers. The long-term goal for Pynoos and other advocates is to establish and coordinate model fall-prevention programs that other organizations can replicate and sustain throughout the United States.
Research has shown that the gold standard for fall prevention is a multifactorial approach requiring input and analysis from three medical professionals. Although ostensibly expensive, a fall-prevention evaluation should include a physical examination performed by a doctor; a progressive exercise regimen implemented by a physical therapist; and an environmental precautions analysis, especially of potential home hazards, conducted by an occupational therapist. The medical evaluation of at-risk individuals requires a physician to analyze risk factors, such as medications, vision, gait and fall history. Following this assessment, the doctor recommends appropriate types and levels of exercise.
"Major dangers for falls are the socalled intrinsic risk factors, or those coming from an individual-as opposed to the extrinsic or environmental risk factors," said FPCE codirector Laurence Rubenstein, who also codirects the UCLA/VA Greater Los Angeles Healthcare System, long run by the University of California, Los Angeles, and the Veterans Affairs hospital system. "The most important intrinsic risk factors are muscle weakness and gait or balance problems. A person with these factors has a three-to-four-times greater likelihood of falling as someone without them," he said.
Other important risk factors are also known to nearly double the likelihood of a fall, Rubenstein said. These include functional impairment of daily activities, depression, cognitive impairment, being age 80 or older, or taking psychoactive medications. Some of these deficits can be improved with proper detection and treatment adjustments, he noted.
Rubenstein added that the majority of older adults do not exercise regularly, and 35% of people ages 65-plus fail to participate in any leisure activities at all. …