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Home > RNJ > 2011 > January/February > Editorial: Safe After 60

Editorial: Safe After 60
Elaine Tilka Miller, PhD RN CRRN FAHA, FAAN, Editor

Helen, a spunky 88-year-old widow, was excited to go out to dinner with her daughter and granddaughter. While she was rushing to put on her favorite coat she tripped on the hall rug and came crashing down to the hard, slate floor. Suddenly, the anticipated fun-filled evening was replaced with severe pain in her left leg and side, while blood flowed down her forehead from hitting the door as she fell. Unfortunately, this is a common scenario as our population ages. In many instances, a fall may lead to a sequence of changes (e.g., injury, decreased functional ability, transitioning from an independent living situation to one with more assistance) that have a profound influence on the lives of older adults and their families.

Approximately 30% of community-dwelling adults 65 years and older will fall in a given year; adults 80 years and older are at greatest risk and experience falls at a rate of 1 in 2 (Gillespie et al., 2009). Of those who fall, 66% are likely to fall again within 6 months. Moreover, injuries from falls are associated with increased mortality, decreased functional abilities, and reduced quality of life (Sterling, O’Connor, & Bonadies, 2001). In 2006 falls among older adults resulted in approximately 17,000 deaths and 1.84 million visits to emergency departments in the United States (Stevens et al., 2006). In addition to the personal costs associated with falls, the economic costs are substantial; direct medical costs in 2000 alone totaled more than $19 billion and are projected to be $240 billion by 2040 (Stevens et al.). Given these multiple high personal and financial costs and rapidly expanding numbers of older adults, the National Center for Injury Prevention and Control (NCIPC) at the Center for Disease Control and Prevention (CDC) recently made older adult fall prevention a central priority in its research agenda (NCIPC, 2009).

Because Helen lives in a small community setting, she was taken to an urgent care facility rather than a hospital-based emergency room. In both the United States and the United Kingdom, approximately 30%–50% of individuals are not taken to a hospital when they fall (Weiss, Chong, Ong, Earnest, & Balash, 2003). Although with this type of care the injury is treated, the underlying fall risk factors frequently are not assessed. As a result, prevention strategies to reduce the major fall risk factors (e.g., poor muscle strength and tone, limited exercise, loss of bone mass, impaired vision, medications limiting mental alertness, and environmental hazards that contribute to more than 30% of falls) are not considered or addressed (Gillespie et al., 2009).

In most cases, fall-prevention programs are targeted to older adults who are hospitalized for their fall-related injuries. However, fall-prevention programs and general health education should begin long before adults experience initial falls. Framed within the context of “safe after 60,” older adults must increasingly learn more about normal aging changes that may place them at greater risk for falls. Along with recognizing key contributors to increased fall risk, older adults must take more responsibility for performing those behaviors that minimize the likelihood of falls. A recent review of the fall-prevention evidence by Costello and Edelstein (2008) for community dwelling older adults revealed the following:

  • Multifocused interdisciplinary fall-prevention programs (e.g., health and fall risk assessment with referral, home visit assessment, exercise, and balance training) appear to be effective for older adults with a previous fall history.
  • Medication and vision assessment, referral, follow-up, and adjustments should occur for all older adults and those at greatest risk for falls.
  • Exercise alone is effective in reducing falls and should include a combination of muscle strengthening, balance, or endurance training for at least 12 weeks.
  • Home hazard assessment and modifications may be beneficial in reducing initial and subsequent falls.

Rehabilitation nurses must remain cognizant that fall-prevention strategies are applicable to the nonhospitalized, community-dwelling older adult as well as those who are hospitalized. Be proactive and educate older adults about actions that will minimize their risk for falls. Recognize that patients who have fallen and are not hospitalized are more likely to fall again and probably have not received any formal fall-prevention interventions. Whether you are a nurse in a doctor’s office, a clinic, hospital, or urgent care waiting room, or attending a family event, take advantage of every teachable moment to educate all older adults (60 years and older) and their families regarding feasible actions to reduce potential falls.

References

Costello, E., & Edelstein, J. E. (2008). Update on falls prevention for community-dwelling older adults: Review of single and mulitfactorial intervention programs. Journal of Rehabilitation Research and Development, 45(8), 1135–1152.

Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Lamb, S. E., Gates, S., Cumming, R. G., et al. (2009). Interventions for preventing falls in older people living in the community. Cochrane Database Systematic Review, (2), CD007146.

National Center for Injury Prevention and Control (NCIPC) Centers for Disease Control and Prevention. (n.d.). Injury research agenda, 2009–2018. Atlanta, GA: Author.

Sterling, D. A., O’Connor, J. A., & Bonadies, J. (2001). Geriatric falls: Injury severity in high and disportionate to mechanism. Journal of Trauma, 50, 116–119.

Stevens, J. A., Corso, P. S., Finkelstein, E. A., & Miller, T. R. (2006). The costs of fatal and non-fatal falls among older adults. Injury Prevention, 12(5), 290–295.

Weiss, S., Chong, R., Ong, M., Ernst, A. A., & Balash, M. (2003). Emergency medical services screening of elderly falls in the home. Prehospital Emergency Care, 7, 79–84.