At a certain age, we become acutely aware of the reality of “Falling when older often becomes a life-altering event.” An older person who falls often goes through serious medical distress and suffering. Further we know for those individuals who survive their falls, they often lose much, if not all, of their independence and must rely on others for help. Our society, in light of the pain and diminished quality of life that falls cause, has yet to embrace a proven solution for older adult fall prevention. A preventative solution, which would not only reduce the risk of falling but relieve our healthcare system of the tremendous financial burden created by falls.
In this article, we will identify conditions that put older adults at high risk of falls and how one can minimize potential home hazards. We will shed light on the cost of older adult falls on our healthcare system and most importantly, offer a solution to those who are susceptible to falls and to their adult children who often assume responsibility for their older parents’ care and well-being. This same solution will be the answer to our already-over-burdened healthcare system.
What Conditions Make an Older Adult More Likely to Fall?
Research has identified many conditions that contribute to falling. These are called risk factors. Many risk factors can be changed or modified to help prevent falls[1]. They include:
- Lower body weakness
- Vitamin D deficiency
- Difficulties with walking and balance
- Use of medicines, such as tranquilizers, sedatives, or antidepressants. Even some over-the-counter medicines can affect balance and stability
- Vision problems
- Foot pain or poor footwear
- Home hazards or dangers such as
- broken or uneven steps, and
- throw rugs or clutter that can be tripped over.
Most falls are caused by a combination of risk factors. The more risk factors a person has, the greater their chances of falling. To help prevent falls, here are a few tips:
- When choosing carpet, thinner is better. Thin carpet feels similar to walking on a hard floor. Thick plush carpet causes ankles to wobble making older adults feel unsteady.
- Remove all electrical cords from walkways.
- Storage of frequently used items is ideal at waist level.
- Install tap lights or “the clapper” at the bedside.
- Place microwave on counter-top not overhead.
- Make sure your stairs have a sturdy handrail or two.
- Do not use a stepladder or stepstool.
- Place handrails beside toilet and in the bathtub.
- If a raised toilet seat is required, ensure it has handles.
- If a tub bench is required, make sure it has a back.
- Make sure you have non-slip strips in your shower or bath.
- All shoes should have non-slip soles with patterned tread.
- The ideal height of a chair or bed is when an individual’s knees are one inch lower than their hips when sitting.
- Having armrests on the chair assists so an individual can push and not pull, to stand up.
- Keep your eyeglasses at your bedside at night.
Although, these tips are helpful they do not address the underlying cause of older adult falls.
The Real Problem
The reality is that strength declines at 8 percent per decade starting at age 20 unless strength-resistance training is used to compensate. The following statistics clearly state the severe consequences of strength-loss as we age:
- Rates of fall-related fractures among older adults are more than twice as high for women as for men.[2]
- 33 percent of older people report some difficulty with balance or ambulation. After age 75, this percent increases in frequency and severity.[3]
- 33 percent of community dwelling seniors fall each year.[3]
- 66 percent of those who fall will fall again within six months.[4]
- Falls are the leading cause of death from injury among people 65 or over.[5]
- The elderly account for 75 percent of deaths from falls.[1]
- About 50 percent of the elderly who sustain a fall related injury are discharged to a nursing home rather than return home.[1]
- About 25 percent of seniors in the community restrict their activity due to the fear of falling.4 This fear of falling may cause them to limit their activities, leading to reduced mobility and physical fitness and increase their actual risk of falling.[6]
- Up to 75 percent of nursing home residents fall each year… 2 times the rate of seniors living in the community.[1]
- More than 90 percent of hip fractures are associated with falls.[4]
- 25 percent of those who fracture a hip die within six months of the injury.[4]
- Hip fracture survivors experience a 10-15 percent decrease in life expectancy and a meaningful decline in overall quality of life.[4]
Not only are these statistics sobering and represent declining quality of life but the burden that it places on our healthcare system increases daily. Falls among adults age 65 and older are very costly. Each year about $50 billion is spent on medical costs related to non-fatal fall injuries and $754 million is spent related to fatal falls.[7]
Non-fatal falls:
- $29 billion is paid by Medicare
- $12 billion is paid by private or out-of-pocket payers
- $9 billion is paid by Medicaid
As the number of Americans age 65 and older grows, the number of fall injuries and the cost to treat these injuries will soar. The charts below indicate this anticipated growth[8]:
Research has demonstrated for years that strength-resistance training has the ability to combat weakness and frailty and their debilitating consequences. When strength-resistance exercise is done 2-3x a week, this type of exercise builds muscle strength, muscle mass and preserves bone density, independence and vitality with age. In addition, strength training also has the ability to reduce the risk of osteoporosis and the signs and symptoms of numerous chronic diseases such as heart disease, arthritis, and type 2 diabetes, while also improving sleep and reducing depression.
Our healthcare system is currently committed to rehabilitation following an accident or injury through physical therapy. This is helpful but it certainly falls short of preventing/reducing individuals’ pain, loss of quality of life and the huge medical costs incurred by our healthcare system relating to fatal and non-fatal falls. As noted above, 66 percent of those who fall will fall again within six months so until national or state driven prevention efforts embrace proven strength-resistance training strategies for fall prevention, aging adults must take on the financial responsibility to get strong and stay strong to avoid a fall which can be a life-altering event.
Research Indicates
- Everyone starts to lose strength within 3-5 days after strength training has stopped. So many older adults cannot afford to lose any strength because they are just getting by.
- Most people neglect their fitness regimes as they get older: only 25 percent of 65- to 74-year-olds, and 11 percent of people 85 and older say they exercise regularly.[9]
- Resistance training can increase muscle mass and strength which can translate into increased mobility, greater independence, and improved function with daily activities.”[10]
- General daily physical activity does not contribute to preventing cardiovascular decline, and it does not influence VO₂max. To influence a change requires more than just regular physical activity.”[11]
- Studies presented at Alzheimer’s Association International Conference found that resistance training was particularly beneficial for improving the cognitive abilities of older adults.
- Muscle strength and balance can be improved in persons by high-intensity resistance training and balance training.
- Long lasting and significant change in strength occurs over a 12- to 16-week period; however, in most instances, aging adults are discharged from physical therapy care in hospital and rehabilitation settings before such gains can be realized.
Custom In-Home Fall Prevention Service for Seniors
Strength-resistance training is an important part of living a healthy lifestyle. It helps improve the body’s essential functions in addition to a person’s emotional state. Tandem Strength & Balance is committed to helping elderly adults living in the Minneapolis/St. Paul 7-county metro area to enjoy active, engaged lifestyles regardless of age or diagnosis. Our custom fall prevention programs enable independence, which increases self-worth and overall quality of life. If you’re interested in a free in-home consultation to identify why you are struggling and what steps can be taken to make life better, contact Tandem Strength & Balance online or by phone. Our objective goes beyond returning individuals to their previous level of function; we help them realize a level of function they didn’t dream possible.
References:
[1] Center for Disease Control and Prevention [2] Stevens et al. 2005, [3] Hornbrook et al. 1994, Haudsdorff et al. 2001, [4] National Institute on Aging, [5] Murphy 2000, [6] Vellas et al 1997, [7] Florence CS, Bergen G, Atherly A, Burns ER, Stevens JA, Drake C. Medical Costs of Fatal and Nonfatal Falls in Older Adults. Journal of the American Geriatrics Society, 2018 March, DOI:10.1111/jgs.15304, [8] National Center for Injury Prevention and Control July 2020, [9] National Institutes of Health, [10] Transcript of Dr. Elizabeth Pegg Frates, Dept. Physical Medicine and Rehabilitation, Harvard School of Medicine, Aug 2010; www.strokeassociation.org, [11] Research to Action Conference, Canadian Center of Activity and Aging; July 2009.