En español |Once dismissed as simply a part of aging, falling has become a growing public health crisis of near-epidemic proportions, posing challenges for policymakers, caregivers and adults of all ages.
Between 2000 and 2013, the number of older adults who died from falls each year more than doubled, from 10,273 to 25,464. Millions more are injured. The medical costs of falling run more than $30 billion a year, and may double by 2020, according to the Centers for Disease Control and Prevention (CDC).
The good news is that researchers have identified programs that have proved effective in reducing the risk of injury and death from falls. But there is not nearly enough money to go around. The federal government provides virtually no support, leaving prevention to a patchwork of community groups, hospitals, and state and local agencies.
"This is the next tsunami of health care problems coming our way," said David Griffin, a podiatrist and fall-prevention advocate with Kaiser Permanente Medical Group, who spoke at the Falls Prevention Summit sponsored by the White House Conference on Aging last spring.
The fast-growing toll from falling reflects the aging of boomers, and people living longer with chronic disease. But injuries caused by falls are not just affecting older people. Falls are the leading reason for emergency room injury visits by adults ages 45 to 64, just as they are for those 65 and older, according to data collected by the Consumer Product Safety Commission's national injury-surveillance system.
Falling in your 50s and 60s
Some of the same conditions that raise fall risk for older adults — arthritis, inner-ear problems and diabetes — similarly affect middle-aged Americans. One difference is that younger adults are more likely to fall outdoors — tripping and falling while jogging or tumbling off a roof or ladder.
Mark DeLuca, 58, tripped over a dog leash while camping with his wife last July at Chautauqua Lake in western New York, landing flat on his back and severely bruising his spinal cord. He spent three months in hospitals and rehab facilities, and while he can feed himself and has regained bowel and bladder function, he still cannot walk or shower without help.
The same month, Linda Perkins, 67, fell down the steps at her Limington, Maine, home, suffering a traumatic brain injury. Family members found Perkins, a claims handler for a disability insurance company, unconscious on a concrete basement floor. "She was trying to carry a little end table up the stairs and lost her balance at some point and fell," says her daughter, Tammy. "She still has a hard time talking in complete sentences, but she is doing a lot better than she was."
The wide swath of victims includes former President George H. W. Bush, 91, who fell at his home in Maine last summer, breaking a bone in his neck, and presidential candidate Hillary Clinton, 68, who suffered a concussion after falling in December 2012.
One in 3 adults over the age of 65 fall every year, with many sustaining serious injuries such as a broken hip or head trauma. (Falling is broadly defined by the CDC and others as "unexpectedly coming to rest on the floor or other lower-level.") Every year, more than 2.5 million older adults are treated for fall-related injuries in emergency departments, and some 734,000 are hospitalized.
"That is a startling figure," says Sen. Susan Collins (R-Maine), chair of the Senate Special Committee on Aging. "That should be a wake-up call that we need to focus more on the prevention of falls." Collins, 62, broke her ankle last December after slipping on an icy driveway in Maine. She wore a protective boot for six weeks, and months after the accident was still getting physical therapy. "It gave me a whole new appreciation for how even a minor fall like that can have long-term consequences."
Health care providers have not made fall prevention a priority. "Falling is an issue that competes with a lot of other chronic health issues," says Robin Lee, an epidemiologist at the CDC. Another problem, she says, is that doctors have not always been aware of how to approach the issue of falls with patients. To change that, the CDC created a program called Stopping Elderly Accidents, Deaths & Injuries (STEADI), which establishes a protocol for providers to ask about falls and suggest treatment. UHS Medical Group in Binghamton, N.Y., has been piloting the program under a five-year federal grant at 18 of its primary care offices, which serve 17,500 older adults.
While the group had screened patients for depression, pain and alcohol and drug use, the idea of checking for the risk of falling was brand new, and some doctors resisted at first. "It was one more thing we had to do with our patients in a busy clinical setting," said Bridget Talbut, the nurse manager at UHS. But fall-related hospital and ER visits declined 12 percent in the first 18 months of screening, and hip and leg fractures fell 20 percent.
The money to implement programs to limit falls has been hard to find. Congress' answer to the multibillion-dollar problem: about $7 million a year in federal fall-prevention grants. Gaps in Medicare leave many proven fall-prevention products and services uncovered, such as grab bars in the bathroom and stair railings.
"A lot of programs have been shown to be effective in reducing falls and some in reducing health care costs. But not enough people have access to them," says Kathleen Cameron, director of the National Falls Prevention Resource Center. "We don't have enough funding for implementation."
Balance Training Programs on the Rise
Today she is padding across a studio floor heel first, one step at a time, in a Rockville, Md., senior center — "walking like a duck," as her instructor, Nadine Main, puts it.
A dozen or so older people are taking a class in balance and flexibility — and taking some important steps in heading off the risk of a serious fall. Some, like Baker, have taken bad falls; others have just been feeling insecure on their feet. "It sneaks up on them, and it scares them," says Main, 48. —RS
Some advice to help you stay on your feet
Balance stand. Stand on one foot while brushing your teeth and hold your weight on one leg for 30 seconds or longer. Then switch sides.
Toe the line. Walk heel-to-toe by positioning your heel in front of the toes on your opposite foot each time you take a step along an imaginary line.
Sit and stand. Get up from a chair and then sit back down. Repeat.
At the gym. Ask a trainer to teach you exercises using balance balls or boards. Or join a yoga, tai chi, Pilates or dance class.
Strength training. Using weights or resistance bands can improve balance while also improving muscle tone and bone strength.
Invisible ice. Black ice can build up on driveways and streets near car doors and along the paths you walk. Be sure to keep these areas salted on freezing days.
Slippery when wet. If your bath requires climbing over the side, consider having a grab bar installed on the wall to help with balance when getting in and out of the tub.
Home pathway perils. Loose rugs or carpeting can cause a fall — and so can slick hardwood floors. Check the common paths you walk every day for hidden hazards.
Keep a clear head. Some medications can make the first act of your day a risky one. Don't try to get out of bed too quickly. Sit up, and make sure you aren't too dizzy to rise.
High-heel hazard. That pair of shoes you only wear to banquets or weddings might trip you up. High heels and other shoes can add to the chances for a fall in unfamiliar places.
Aerosmith lead singer Steven Tyler fell backward off the stage in the summer of 2009, when he was 61, during a concert in South Dakota. He was airlifted to a hospital with head injuries and a broken shoulder. He healed, but not before a tour had to be canceled.
The Supreme Court justice fell and broke her ankle in June 2009 while rushing through New York’s LaGuardia airport on her way to Washington to meet U.S. senators poised to vote on her confirmation.
In May 2005 the former star of Frasier was giving a speech at California Disneyland’s 50th anniversary celebration when he accidentally fell off the stage. Fortunately, Grammer didn’t suffer any serious injuries.
The former American Idol judge and singer fell over her dog in her Los Angeles home in May 2007. She suffered bruising from her arm to her hip, a fractured toe and a broken nose.
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