||In 2012, fall related events comprised 18% of EMS responses among persons 65 years and older. Approximately one-third of community-dwelling persons older than 65 years of age fall each year, most commonly in the home setting, with 10 to 15% of these events resulting in serious injury. For elderly persons who suffer hip fracture, half require hospital discharge to a nursing home and more than a quarter die in the year following injury.
The overall national rate of Emergency Department visits for injurious falls among the elderly was 57.4 visits per 1,000 persons 65 years and older. Among 65 to 74 year olds, there were 37.7 ED visits for injurious falls per 1,000 women and 22.9 ED visits per 1,000 men. The rate more than doubled for the next age cohort (77.2 ED visits for injurious falls per 1,000 women 75 to 84 years and 49.6 ED visits per 1,000 men 75 to 84 years). That rate nearly doubled again for the last age cohort (143.2 ED visits for injurious falls per 1,000 women 85 years and older and 105.6 ED visits per 1,000 men 85 years and older.1
A recent review of fall prevention interventions recommends that successful fall prevention programs are those that consider health screening of at risk elderly people, followed by interventions which are targeted at both intrinsic and environmental risk factors of individual patients (Gillespie et al. 2000). Stevens and Olson (2000) add that prevention strategies which include a multifaceted approach with both behavioral and environmental components are most necessary. Important elements include education and skill building to increase knowledge about fall risk factors, exercise to improve strength and balance, home modifications to reduce fall hazards and medication assessment to minimize side-effects.
Falls are a major cause of injury and result in substantial morbidity and even mortality. Two of the strongest risk factors for falls are older age and prior history of falls. As part of the One Step Ahead Fall Prevention Program, King County EMS in conjunction with local Fire Departments have collaborated to identify and intervene with those at highest risk in the community. The EMS Division screens 9-1-1 calls to identify older adults who have required EMS care for a fall. Healthcare professionals can also refer patients to the program if they meet the program criteria: 65 years old and older; independent living not in subsidized housing facilities, nursing homes or retirement facilities; at risk for a fall or has fallen in the past 6 months; no dementia and Alzheimer's and must be ambulatory.
This program enables an efficient and directed approach to identify those persons living in the community who are at the highest risk of serious injury due to falls. Once high-risk persons have been identified, they are offered a multi-pronged, no-cost approach to reduce their individual risk and receive follow-up to assure that their fall risks are being addressed.
The One Step Ahead Fall Prevention Program has had an increasing role over time. Since the program started in 2003, 1,096 participants have enrolled in the program, 690(63%) are female and 406(37%) are male. Of the 1,096, 939(86%) had a fall prior to the intervention. Of the 939 who had a previous fall, 560 (60%) completed the post monthly surveys and 90% of these said the program reduced their risk for a fall. In addition, of the 939, 82% of the participants did not have a fall after the intervention, as compared to the Pilot Study where 58% did not fall after the intervention.
Our specialist works with the individual to help coordinate fall prevention care. For example, in a third of individuals the specialist arranges for safety equipment to be installed around the home to reduce risk. This equipment includes grab bars for the bathroom, improved lighting, and repositioning or even removal of carpets. Another example is the use of optimal footwear so that individuals wear supportive well-fitting shoes that enhance rather than detract from balance. A final example is letter of communication, sent upon approval of the participant, to their personal physician. The letter explains the Fall Prevention program and details the findings of the evaluation so that the physician may consider if other medical management might also help prevent additional falls. A core component of each specific intervention is providing education to the participant so that the decrease in risk can be sustainable. The Program has been a large success among the participants. There is a very high level of participant satisfaction based on surveys. Moreover, follow-up indicates a relatively low risk of repeat falls when compared to national averages in this high-risk group.
You can use the CDC STEADI checklist to see if you are at risk for a fall. For more information about the fall prevention program, please feel free to call 206-263-8544.
1 Data source: Healthcare Cost and Utilization Project (HCUP) Nationwide Emergency Department Sample (NEDS).