Many people joke that at first we take care of our children, and in the end they take care of us. This is quite the fascinating comparison for a number of reasons, some more comical than others. We feed them, change them, and bathe them. These are all things that are very applicable in the care of the elderly as well. However, there is one more comparison which is not often made in this context, which might be the most relevant. The baby proofing product industry has boomed in the last few decades, some might say justly so. I do not have to convince anybody of the danger of sharp corners, small objects, or small children having access to hazardous cleaning products and other materials. Home safety for the elderly is an industry that is booming as well, but how effective are all the gadgets, railings, and other recommendations as far as preventing falls? What else can we do to prevent falls?
How serious of an issue is this, and why should I care?
The Centers for Disease Control and Prevention (CDC) website published in 2016 that each year over 300,000 people over the age of 65 are hospitalized for hip fractures, 95% of which are a result of falls. Now for some scary statistics. Elderly patients admitted with a hip fracture have 10% chance of death within 1 month, and a 30% chance of death within a year. 25% are readmitted within 6 months, and 30-50% of the patients will never return to their previous level of function. This means loss of independence for many, which is an incredibly significant difference in the life of any adult. Losing your independence is a huge financial and personal burden, and greatly increases your chance of depression among other consequences. This is why the issue of prevention must be looked at with such great importance and care.
How much can we really prevent and/or influence falls in the elderly population?
I’m going to start by being skeptical. Out of 19 studies from conducted from 1992 to 2008 to see how much different interventions can prevent falls in elderly individuals, 11 of those studies gave results that were not statistically significant. This means that 11 of the 19 studies did not show a significant difference in the number of falls between the intervention group, and the other group. This included 3 multifactorial studies that looked at a combination of hazards at home, social support mechanisms, education, a review of the medication, and some included exercise programs as well. But wait, don’t give up yet.
There were a number of studies which had positive results. A study in 2002 showed that although the number of falls was not significantly reduced with home hazard management alone, there was very large reduction in the chance of falling when this was combined with an exercise plan, and vision correction. In 2005 a study was carried out in a specifically visually impaired population. This found that the home hazard management did have a significant reduction in the number of falls compared to a group that participated in social visits. An additional study was conducted in 2002 in an institution for assisted living. A very intensive multifactorial intervention was implemented, including staff training, environmental adjustment, exercise, medication review, aids, hip protectors and post fall problem-solving conferences. The study was very promising and significantly reduced that chances of falling for the elderly individuals living in that institution.
In 2009 a large review of the literature was conducted including 111 studies with relevant data. The combination of data did in fact show that appropriate intervention reduces the risk of falling. This was true for group-exercise, home-based exercise, Tai Chi, along with mixed and multifactorial interventions. Vitamin D alone did not reduce the risk of falls, though there is evidence to suggest that it can help elderly individuals with Vitamin D deficiency. In 2015 one of the most interesting studies was done in New York to try and put a dollar value to the different interventions to prevent falls. They looked at hospitalization costs, other treatments and providing care as opposed to costs of prevention programs. The interventions included the Otago Exercise Program, Tai Chi, as well as moving for better balance. All three proved in this study to be cost effective, saving anywhere from 120$-530$ per person.
While we are provided with some conflicting evidence, we can say that certain populations can benefit from intervention. Aside from this, it’s very important to be educated and aware of the dangers of falling, and the potential implications of such an event.
Knowledge is power. It’s very important for each of us to understand what our options are, and what evidence supports each option. Preventing diseases before they start is often the most efficient way to be healthy, and this starts by screening for the diseases that are appropriate for us depending on age, gender, and other factors. Download our app to go through a short list of questions, and receive a personalized list of the appropriate screening recommendations for you. More information about each of these tests is provided through the app, so that you can stay informed and educated.
Here are some references of articles referred to in this post. I am happy to provide more information to those who seek, please send us a message and we’ll be happy to get back to you.
Fall and injury prevention in older people living in residential care facilities. Annals of Internal Medicine2002;136:733–41., , , .
Randomised controlled trial of prevention of falls in people aged greater than or equal to 75 with severe visual impairment: the VIP trial. BMJ2005;331(7520):817–20., , , , , , et al.
Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;(9):CD007146.
Carande-Kulis, V., Stevens, J. A., Florence, C. S., Beattie, B. L., & Arias, I. (2015). A cost–benefit analysis of three older adult fall prevention interventions. Journal of Safety Research, 52, 65–70.