Alaska's Home Fall Prevention Checklist: Use this checklist to find and fix hazards in your home.
Fall prevention is key to retaining independence for older adults. Falls are a significant contributor to premature morbidity (lack of wellness) and mortality (death) in seniors. Loss of mobility, self-confidence and independence due to falls creates an enormous financial and emotional burden on seniors.
Sobering statistics
One-third of adults aged 65 years and older experience a fall each year and the risk increases proportionally with age. Non-fatal falls continue to pose a significant social and economic burden on individuals and the healthcare system, and fall-related deaths among this population have more than doubled over the last decade. Falls caused more than 38,000 deaths among U.S. seniors in 2021, making them the leading cause of injury death in that age group. In 2013 nonfatal falls led to 2.8 million emergency department visits with nearly one-third requiring hospital admission, incurring $34 billion in association healthcare costs. Five years later these costs surpassed $50 billion (Medicare $29 billion, Medicaid $8.7 billion and private insurance paying out $12 billion). The cost of treating fall injuries among older adults is projected to exceed $101 billion by 2030. A fall resulting in a hip fracture typically costs $50,000 to $65,000 for surgery, hospitalization and initial rehab, with long-term care adding significantly more. Alaska is one of the most expensive states to live in.
Fall prevention resources are widely available. The main challenge in putting in place fall prevention strategies is a lack of trained workers to monitor compliance or modify the home with safety features. Work force development for providing all levels of help to our rapidly aging population is a major focus in state and national organizations serving seniors.
Factors at play
Many factors raise the odds of a fall, including lower body weakness, fluctuating blood pressure (orthostatic hypotension), inadequate serum levels of vitamin D3, trouble with walking and balance, polypharmacy (taking 4 or more prescription medications), use of certain medicines such as tranquilizers or antidepressants, vision or hearing diminishment, foot pain or poor footwear, environmental hazards in the home such as broken steps or throw rugs that can be tripped over, clutter on the floor of your home, and frisky pets to name the most common, modifiable, risk factors. Many seniors experience falls that could have been prevented. One study showed that 90% of hip fractures are caused by falls, many of which could have been prevented. Further, fear of repeat falling can cause decline in quality of life, including depression, social isolation, and feelings of helplessness.
There are many evidence-based programs and mechanisms to reduce fall risk. For example it is well established that placing grab-bars in bathrooms and in entryways, and having good railings on stairs, reduces injurious falls.
Promising research
Two of my favorite evidence-based NCOA (National Commission on Aging) endorsed programs, which I recommend deploying in a hybrid, combined, manner are CAPABLE (Community Aging in Place-Advancing Better Living for Elders) and HARP (Home Hazards Removal Program). CAPABLE was developed at Johns Hopkins University and accredited by NCOA.
It's a client-centered, home-based program to improve older adults' function. The program consists of a series of home visits from an occupational therapist (six weekly visits), and registered nurses (four visits including one 6-month follow-up) and a handy worker, who all work in collaboration with the older adult to increase mobility, function and capacity to safely age in place. health outcomes include improvement in function, reduction in depression, increased motivation and reduction in healthcare utilization leading to decreased total cost of care. CAPABLE has been shown to yield both short-term and longer-term benefits.
The OT visits focus on creating a client-based program to improve balance and strength, especially focusing on mobility, leg and arm strength, and feasible balancing exercises such as tai chi and chair-yoga and basic calisthenics. The RN visits focus on review of medications with the aim of recommending de-prescribing to the elder's primary care provider, as well as checking blood pressure, vision and hearing, and Vitamin D3 levels. A Lifeline device (through AARP) may be indicated, and the nurse could organize ordering the device and orienting the client to its use. The handy worker would be brought in to install grab-bars and railings as needed and maybe bigger projects like raising the toilet and leveling the floor throughout the home. This team approach would be likely to cast a wider net of support-for example for an elder who has a frisky pet that gets underfoot but cannot herself engage in animal behavior classes. Perhaps a neighbor or friend could be called on for such services.
The NCOA validated fall prevention programs can be grouped into four main categories:
1. In-person events targeting older adults such as workshops, seminars or health fairs;
2. Direct outreach to high-risk individuals via home visits, phone calls or personalized mailings;
3. Spreading awareness through trusted support networks including both paid and unpaid caregivers, churches/religious organizations, community groups that interact with older adults, fire and police departments which may have community outreach programs;
4. Integrated approaches which involve implementing a comprehensive approach including screening, clinical assessment, are referral to community-based prevention programs.
This is all to say it really does take a village and being kind to our aging neighbors. Most of you reading this are already seniors-if you are an active senior, pay it forward.
A closing point of interest involves cultural and linguistic sensitivity to how we "frame" aging. One Dutch study looked at why fall prevention programs tend to be underpowered and suggested a need to communicate differently about the topic, for example by reframing "aging" and "fall prevention." Respondents preferred to be approached with invitations to take a "life course" perspective about falls, and not being addressed with confrontational words. Focusing on the benefits ("living independently for longer") improved the understanding of the relevance of participating in a fall prevention program, versus focusing on the negatives of aging and falling. One scholarly article on culturally appropriate approaches to fall risk reduction in BIPOC communities reframes "falling" as "stumbling."
Resources
https://www.ncoa.org/tools/falls-free-checkup/
https://www.nia.nih.gov/health/falls-and-falls-prevention
Emily Kane is a naturopathic doctor based in Juneau. Contact her online at http://www.dremilykane.com.
