1. Falls in the Elderly

2. Learning Objectives
Identify scope of the problem
Describe contributing factors for falls

3. How serious is the problem of
falls?

4. Incidence rates of Falls in U.S.
One of every three adults
over 65 years fall in every year
One of every two adults over
age 80 fall annually

5. Where are people likely to fall?
For people 65 years old or older…..
Nursing Home 10%
Public Places
30% Home 60%

6. How big is the problem?
• Falls are the leading cause of injury
among people over 65 years
• Of those who fall, 20-30% suffer severe
injuries that make it hard for them to
get around or live independently
Older adults are hospitalized for fall related injuries 5
times more often then they are for injuries from
other causes

7. Consequences of Falls
 Mortality
 Morbidity
 Fractures
 Soft tissue injuries
 Head trauma/TBI
 Joint distortions and dislocations
 Loss of confidence - fear of falling
 Restricted activity

8. Costs
In 2000, estimated fall-related injury cost was $19.2
billion
Medicare costs per fall averages between $9,000 and
$13, 500
Cost of fall injuries increase with age
Cost of fall injuries are higher for women than men

9. Unintentional Fall Death Rates by
Gender, Age 65 +, U.S. 1996
140
120
100 Men
Per 100,000
80 Women
60
40
20
0
65-74 75-84 85+
Source: National Center for Health Statistics, Vital Statistics

10. Unintentional Fall Age-Adjusted Death
Rates, Age 65 +, gender and race U.S.
35
White, Men
30
25
20 White, Women
15 Black, Men
10
5 Black, Women
0
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
Source: National Center for Health Statistics, Vital Statistics

11. Fractures
3% of all falls cause fractures.
Approx. 95% of hip fractures in older people aged over
65 years are the result of a fall
People who have a hip facture are 5 ~20% more likely to
die in the first year following the injury than any other
reason in the same age groups

12. Fear of Falling
Loss of self confidence
Decrease of physical activity level and quality of life
Fear of not being able to get up after a fall

13. Risk Factors
Intrinsic (Personal) risk factors for Falls
Aged (over 65 years)
Female
Poor mobility or fragility – lower extremity weakness,
and poor grip strength
Functional impairments - limited Activities of Daily living
(ADL)
Poor gait and balance
Low body weight

14. Intrinsic (Personal) risk factors for Falls
continued…
Cognitive impairment or dementia
Chronic illness
- Parkinson disease, visual difficulties, stroke, hypertension, or urinary
incontinence
Psychoactive medications
- tranquilizers or antidepressants
Previous falls
Heavy drinking

15. Relative risk ratio (RR) or Odd Ratio (OR) of Fall
5,0 4,4
4,5
Mean RR or OR
4,0
3,5 2,9 2,9 3,0
3,0 2,4 2,5 2,6
2,3 2,2
2,5 1,8
2,0 1,7
1,5
1,0
0,5
0,0
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C U J Am Geriatr Soc. 2001

16. Extrinsic or Environmental Factors
Polypharmacy – four or more prescription medications
combination
Home hazards
Clutter, or loose rugs
Poor lighting on stairs and hallways
Lack of bathroom safety, e.g. grab bars in bathtub
Footwear
Busy street or elevated walkways

17. Personal Prevention
Exercise/physical activity
especially geared to gait and balance and
flexibility
Medicines reviewed
Vision checked
Improving home safety

18. Assistant Devices
Hip pads
Mobility aids
Cane
Walkers
Wheelchairs
Bathroom aids
- Raised toilet seats
- Grab bars

19. Resources
CDC’s National Center for Injury Prevention and Control
National Resource Center on Aging and Injury
WHO –Ageing and Life Course
National Fire Protection Association
National Women’s Health Information Center
Elder Web
Additional Reading List