Falls

Ranging from minor to fatal, falls in the older adult population can have devastating health consequences; however many falls are preventable with proper education and intervention.

Falls are common among older adults, and the incidence of falls is increasing as the U.S. population ages. An estimated 46 million older adults fell in 2014, and that number is expected to increase to 74 million by 2040. The incidence of fall-related deaths is also increasing, and at its current pace, it is expected to exceed motor vehicle and firearm-related deaths. Falls are the number-one cause of death due to injury among older adults. They account for $50 billion per year in health care costs.

Falls range from minor to fatal. Although some would argue that studies should focus only on injurious falls, even minor falls can cause psychological distress and fear, leading older adults to feel dependent and chained to their bedrooms. In addition, stigma is a major problem; in one Medicare analysis of approximately 45,000 patients, only 28% of older adults reported their falls. Falling one time doubles an individual’s risk for falling again.

Best Practice Notes

Falls are preventable, but who assumes responsibility for prevention has been a topic of debate. Five studies showed that physical therapy reduced the risk for future falls. Multifactorial interventions showed mixed results with respect to falls incidence. Traditionally, emergency physicians have stated that fall prevention education should occur in the primary-care setting; however, while educational interventions appeared to increase awareness of fall risk and services, they did not reduce the incidence of falls. Since falls account for 2 million ED visits, with 10% of those among patients aged 65 years and older, and often overlap with cognitive impairment (again, seen in the ED), the ED might be the only setting with an opportunity to intervene and prevent falls.

Research Priority Areas

Top voted Falls research priority areas ranked during the 2019 GEAR Consensus conference are as follows:

Intervention components and effectiveness: fall prevention intervention as a bundle or unraveling components? What should be in the bundle?
Determining optimal outcomes: What are the optimal outcomes and how to best track falls for measurement of outcomes outside of ED?
What are the Stakeholder patient prioritized outcomes (such as maintaining independence, reduce fear of falling, stigma) and patient targeted intervention?
What is the best assessment of fall etiology to design targeted intervention?
What is the optimal EMS intervention and/or assessment/ information transfer to ED regarding home safety? EMS connection to existing resources?