FALL PREVENTION IN THE HOME SETTINGPaige Catizone

FALLS AND THE ELDERLY

•Facts*

HOW BIG IS THE PROBLEM?

• One in three adults aged 65 and older fall each year.

• Of those who fall 20% out of 30% suffer moderate to severe injuries which makes it harder for them to get around, or live independently, and increase the risk of an earlier death.

• Older adults are hospitalized for fall related injuries five times more often than they are for injuries in other cases.

HOW ARE COSTS CALCULATED?

• Direct costs is what the patient and insurance companies pay for treating fall-related injuries. These costs include fees for hospital and nursing home care, doctors and other professional services, rehabilitation centers, community-based services, use of medical equipment, prescription medication, changes made to the home, and insurance processing.

• Direct costs do not account for the long-term care effects of these injuries, such as disability, dependence on others, lost time from work and household duties, and reduce quality of life.

HOW COSTLY ARE FALL-RELATED INJURIES AMONG OLDER ADULTS

• In 2012 , the total direct medical costs of fall injuries for people 65 and older was $30 billion.

• By 2020 the direct and indirect cost of fall injuries is expected to be $67.7 billion.

• Among older adults fall-related injuries is one of the 20 most expensive medical conditions.

• Among seniors treated for fall injuries, 65% of direct medical costs were for inpatient hospitalizations, 10% for medical office visits and home health care, 8% for hospital outpatient visits, 7% for emergency room visits, and 1% for prescription drugs and dental visits.

• About 78% were reimbursed by Medicare.

HOW DO THESE COSTS BREAK DOWN?

• The cost of fall injuries increase rapidly with age.

• Costs of both fatal and nonfatal falls are higher for women than in men.

• In 2000, medical costs for women who were 58%, of older adults, were two to three times higher than the cost for men.

TYPE OF INJURY AND TREATMENT SETTING

• In 2000, 78% of fall deaths and 79% of total costs were due to traumatic brain injuries and injuries to the lower extremities.

• Injuries to internal organs were responsible for 28% fall deaths and accounted for 29% of costs.

• On average, the hospitalization cost for a fall injury is $34,294. (2012)

DID YOU KNOW?

Falls are the most common cause of injury and the 6th leading cause of deaths for seniors.

Canadians spend about $3 billion a year on seniors' fall injuries.

Almost half of admissions in a long term care facility are fall-related.

Half of the people who have a hip fracture never regain their pre-fall level of functioning.

Falls usually happen because of the combined effects of a number of factors, such as a loss of balance, side effects of a curtain medicine, impaired mobility or vision, and environmental hazards.

DID YOU KNOW? CONTINUED

• Most falls occur in seniors; homes, while doing usual daily activities.

• 40% of falls that require hospitalization involve hip fractures.

• Woman are 3 times more likely than men to be hospitalized for a fall.

• Seniors may develop a "fear of falling," causing them to restrict their activities which can increase their risk of falling due to weak muscles, stiff joints and poor balance.

FALLS AND THE ELDERLY

•What contributes to senior falls?*

INDOOR RISKS

• Poorly lit stairs, ramps or doorways

• Stairs that are not uniform form top to bottom or those with narrow steps

• Stairs without handrails or marking on the edges of the steps

• Lack of, or incorrectly installed grab bars in bathrooms

• Slippery floors, throw rugs, loose carpets

• Walking surfaces cluttered with objects like cords, pets, or newspapers

• Toilet seats are too low or too high

• Poorly maintained or improper use of mobility aids and equipment

OUTDOOR RISKS

• Uneven or cracked sidewalks

• Stairs without handrails

• Stairs without clear edge markings on all steps

• Poor lighting; either not enough or too much glare

• Snow, ice, wet leaves on stairs or walkways

• Unmarked curb edges or corners without curb ramps

• Long crosswalks without pedestrian islands

• Objects on sidewalks such as bikes or garbage cans

• Controlled crosswalks with times too short for a safe walking place

RISKY BEHAVIORS

• Wearing loose fitting or worn out shoes, or shoes with thick soles

• Taking medication without a regular review for fall risk by a physician, or pharmacist

• Consuming alcohol to the point of impaired judgement and balance

• Trying to get objects that are out of reach rather than asking for assistance

• Carrying heavy, or awkward handbags that can affect balance

• Not using assistive devices such as walkers or canes when needed or using them incorrectly

SOCIAL AND ECONOMIC RISKS

• Living alone without a way to access help

• Lack of social networks that lead to isolation and depression

• Lack of knowledge or access on how to acquire needed health care services or health promotion information

• Poor eating habits, with low protein or low fluids

FALLS AND THE ELDERLY

•What can be done to lower the risk of Falling at home?*

STAIRS AND STEPS

• Make sure you have light switches at the top and bottom of the stairs and that the stairs are well lit

• Make sure your stairs are in good repair and free of clutter and have a non-skid surface

• Make sure runner mats, carpeting or other floor covering on your stairs are well fastened or secure

• Make sure there are solid handrails or banisters on both side of the stairway

• Remove your reading glasses when going up and down the steps

• Never rush up and down the stairs, it is a major cause for a fall

KITCHEN

• Place frequently used items in an easy-to-reach location with heavy items closer to the floor

• If you have a good balance, use a stable step stool with a safety rail for reaching high places, otherwise ask for help. Do not stand on chairs or other unstable furniture

• Always wipe up any spills immediately to avoid slipping

• Avoid use of floor wax, or use a non slip kind

• Ask for help with tasks that you feel you can't do safely

OUTSIDE

• Keep front steps and walkways in good repair and free of snow, ice, and leaves

• Keep your front entrance well lit, consider motion-sensitive lighting

• Put away all gardening supplies such as hoses, rakes, etc. when not in use

LIVING ROOMS

• Remove all throw rugs or scatter mats or use a non slip backing with flat edges and make sure they are not in high traffic areas, or at the top or bottom of steps

• Watch that your pets are not under your feet, put a bell in their collar so you know where they are

• Make sure all walking areas are clear of clutter, telephone or electrical cords and other obstacles are out of the way

• Make sure all rooms, stairs, and balconies are well lit with non glare lighting

• Make sure you have a non slip surface on stairs, balconies, porches, patios, etc.

• Consider getting a personal alarm device that you wear around your neck or wrist to call immediate help by just pressing a button

BEDROOM

• A light switch near your bedroom entrance is ideal. If this is not available try a motion sensitive or clapper device that automatically turns on the light

• Make sure there is a clear path from your bed to the bathroom or the door

• Have a cordless phone near your bed

• Have a lamp beside your bed, there are lamps that you just touch the base to turn on

• Place night lights in the halls and bathroom in case you get up in the middle of the night

• Sit on the edge of your bed for a minute before getting up after from sleeping all night

BATHROOM

• Use a rubber bath or shower mat, or a non slip surface in your tub or shower

• Install a grab bar by the toilet, bathtub, and shower. Obtain the advise of an occupational or physical therapist on the correct type and placement of the devices

• Use a bath seat so you can take a shower or bath sitting down

• Keep an absorbent towel available to wipe up moisture or spills immediately.

FALLS AND THE ELDERLY

•What can I personally do to decrease my risk of falling?*

ANSWERS:

• Maintain an active and healthy lifestyle through appropriate exercises, good nutrition, regular physical checkups, and eye and ear exams

• For those who are active outside of the home, exercises to promote balance, and strength are best for reducing falls

• Avoid carrying too much

• Wear footwear that provide good support, that have non slip treads and that are not too thick

• Be socially active, join a community group and get together with family or with friends.

REFERENCES

• www.cdc.gov/homeandrecreationalsafety/falls/fallcost.html

• Article called "Seniors' falls can be prevented." from BC INJURY research and prevention unit. Authors, Dr. Vicky Scott PhD and Fahra Rajabai, MSc