Friday, February 7, 2014

Preventing Elders' Fatal Falls Could Save $30 Billion a Year?

From: New America Media

Whatever you do, don't fall.

This is the steely warning people hear repeatedly once they pass the age of 65. And for good reason: Especially when it comes on top of other chronic health problems, a hard fall often signals the
beginning of the end for an elder — causing broken bones or injuries that can immobilize the body, depress the spirit and force overall well-being to plummet.

“It's becoming more apparent how serious an issue this is,” says Susan Ann Talley, a physical therapy professor at Wayne State University. 
Studies on Fear of Falling 

The number of papers presented on falls and their prevention at the annual meeting of the Gerontological Society of America, has risen steadily in the last five years. Among the findings discussed at the most recent gathering in November: 

• Poor sleep quality — a problem for many elders — increases the risk of falls. 

• Elders feel guilty after a fall, and so do their caregivers. 

• Fall prevention programs that include home assessments have been shown to reduce injuries for elders living at home. 

• Nursing homes and assisted living facilities remain a problem. Recent studies found a 15 percent annual rate of serious falls in long-term care facilities — 17 percent for people with cognitive impairment and 22 percent for those in memory care units. And evidence-based intervention programs — doing risk assessments on patients and giving them Vitamin D supplements, for example — do not seem to help. 

Preventing falls in facilities is notoriously difficult, with an incident rate twice that of elders who live at home, says LuMarie Polivka-West, senior vice president of policy for the Florida Health Care Association, a state group of long-term care providers. She relates this to the lower-body weakness that persists for many elders who live in institutions and may be less mobile — sometimes by choice. 

“The fear of falling is a very real problem in assisted-living facilities,” she says. “Residents know that a fall might force them to move to a higher level of care, and that's frightening because they may not be able to afford it.” 

Polivka-West says Florida is well below the national average for fall-related injuries in nursing homes. 

--Barbara Peters Smith
“Among older people who are injured in a fall and go to a hospital, less than 50 percent ever go home again.”

One in three older Americans falls each year. That comes to over 1.4 million falls, at an estimated annual medical cost of $30 billion.

Almost 22,000 Deaths

With Americans living longer because of medical advances that have chipped away at cardiac and cancer fatalities, death rates from falls have risen in the last decade. In 2010 about 21,700 older adults died of injuries sustained in an unintentional fall.

This has brought a swarm of attention to the phenomenon of falling. Even as research dollars for the science of aging have dwindled, the study of falls now commands a larger piece of a smaller pie. So far, the work is yielding more fascinating questions than easy answers.

In simple terms, those who live the longest are the ones who manage to stay on their feet, says Jay Olshansky, a public health professor at the University of Illinois, Chicago.

“Lots of folks who make it to older ages operate on cruise control,” says Olshansky, who studies longevity. He notes they are the people who somehow avoid sudden and major health crises, “like a fall.”

Despite increasing awareness of the danger, one out of three older Americans falls each year. That comes to more than 1.4 million falls, at an estimated annual medical cost of $30 billion. These incidents account for 95 percent of hip fractures and are the most common cause of traumatic brain injury. 

The toll climbs with age: If you are 75 or older, you are four or five times more likely than a 65-to-74-year-old to spend a year or more in a long-term care facility after falling.

In theory, such outcomes are preventable — but researchers are just beginning to understand all that it might take to tackle what has become an epidemic. That's because for elders, falling is a complicated series of actions that can happen all too easily, with just a moment's inattention.

The Whole Balance

Jeanne Seiberling of Sarasota learned this painfully a few months ago, as she was taking a friend shopping. Walking from her car in the parking lot, she missed her step and tumbled.

“I think I was so busy talking to my friend, I wasn't looking,” Seiberling recalls. “I missed the curb, and the whole balance went, and I hit my head against the wall.”

Onlookers called an ambulance, which she refused, but she did accept a ride to the hospital and wound up with four stitches in her head. Seiberling, an active 84-year-old resident of the Plymouth Harbor retirement community who often does the driving for her husband and friends, did not allow the incident to slow her down.

“I will say that accidents can happen at our age,” she says. “But now I'm very careful going up and down anything.”

Not only is she lucky that her fall did not cause lasting injuries, Seiberling is also fortunate in her determination to remain as mobile as possible. Specialists say a fear of falling can compound the problem for elders, leading to a decrease in activity and an uptick in frailty and depression.

“Fear of falling is a complex construct, not very well understood, and it's not always related to having had a fall,” says Talley, the Wayne State professor. “We don't know if it's psychological, cognitive or physical, or if it's instilled by telling people how bad it is to fall.” 

Talley continued, “They really do get into this vicious downward spiral. They're less physically active and that makes them more debilitated or weaker. Their quality of life decreases.” That makes them more likely to fall.

The Evidence Mounts

Because a fall is something that could be avoided, government bodies, academic centers and professional organizations have ramped up their emphasis on prevention efforts. The first step, Talley says, was to identify the population most at risk and try to increase awareness about those risks.

And progress is being made throughout the industry with researchers like Sue Ann Guilderman of the University of Minnesota questioning the traditional prevention policies that have been tried and failed. 

For example, the practice of putting alarms in beds and chairs that alert staffers when a person at risk of falling is on the move simply causes a reactionary response. According to LuMarie Polivka-West, of the Florida Health Care Association, “Once the alarm goes off, they're responding to something that is already happening. And people in facilities, even those with Alzheimer's, do not want to be restrained,” she added.

Guilderman’s research has found that something as simple as letting residents sleep through the night, without awakening them for medications or bathroom visits, can reduce falls. As a result, said Polivka-West, “The emphasis has moved to trying to manage falls. You can't stop them, and you have to respect the resident's right to move freely.” 

Now that the problem has been identified, a new phase of research has begun, and it gets trickier: Trying to determine how and why people fall.
Once the easy solutions are out of the way — making the home environment safer, and checking elders' medication lists for troublesome drug interactions — there remains a proportion of elders who fall despite everyone's best intentions. But researchers are not giving up.

The Anatomy of a Fall

The most recent Journal of the American Podiatric Medical Association claims to be the first scientific journal completely dedicated to fall prevention. Foot problems, especially for the growing number of diabetic Americans, are turning out to be a key component in the falling trend.

Peripheral neuropathy — a loss of feeling in the feet that plagues many diabetics — contributes to a fear of falling. One study found that diabetic patients moved more quickly and felt less fearful after exercising in tandem with a virtual reality program. Other studies in the journal found a measurable benefit from non-slip socks — even inside shoes — and called for more research into falls prevention footwear.

In the general population, Talley's team at Wayne State has also identified “a piece of the puzzle” in stemming the fear of falling. Their study found that stepping activities that call for speedy movement of the legs and feet can lead to better confidence and mobility.

Talley says the ability to step quickly — something elders can lose without being aware of it — is vital to arresting a fall once it begins. This knowledge comes from scientifically breaking down the human mechanics of a spill.

“When you start the fall, it's like your body goes beyond where your feet are,” she says. “If you lean too far, your base of support isn't beneath you anymore. To catch you, your step has to be in the right direction. You have to be able to take a big enough step, and then your foot has to get there fast enough. It's not a conscious process; it has to become automatic.”

It is possible, Talley thinks, that step training could help even cognitively impaired residents in memory facilities. 

“There's some evidence that practicing stepping will increase confidence and mobility for anyone,” she says. “But we need to find out more. It's all well and good to understand that older people are at risk for falling. But the things that contribute to a fall are multifaceted.”