National, State, and Community Initiatives to Prevent Older Adult Falls and FallRelated Injuries

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National, State, and Community Initiatives to
Prevent Older Adult Falls and Fall-Related
Injuries

• Ellen Schneider
• Assistant Director for Communications and Program
  Relations
• UNC Institute on Aging
• eschneider_at_schsr.unc.edu
• May 7, 2008

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Objectives

• Discuss the magnitude of older adult falls
• Overview whats happening at the national and
  state level to address falls prevention
• Provide falls prevention resources

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Magnitude

• Falls are the leading cause of fatal and nonfatal
  injuries in older adults
• Every 35 minutes, an older adult dies from a
  fall.

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Leading Causes of Injury Death,
65 Population


Fall 26.9 Motor Vehicle 18.3 Unspecified
16.5 Suicide- Firearm 9.5 Suffocation
9.0
Source National Center for Health Statistics,
National Vital Statistics, 1999-2005
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Cost of Fall Injury

• Lifetime medical cost for fall injuries
  estimated at 27 billion
• Highest burden of injury
• 90 greater than second highest cause
  (motor-vehicle)
• Productivity losses for fall injuries estimated
  at 54 billion
• Second only to motor-vehicle losses

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Cost of Fall Injury

• Direct costs of fall injuries in 2000 was 19
  billion
• Hospitalization accounted for two-thirds of the
  costs
• ED treatment accounted for one-fifth
• Medicare costs for hip fractures alone
• 4.7 billion in 19911
• 32.4 billion in 20201
• 240 billion projected for 20402
• The costs of fall injuries tend to increase with
  age3

1. CDC, MMWR, 1996
2. Cummings SR, Orthopaedics Related
Res,1990 3. Stevens, 2006
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Putting the Future in Perspective
Total Number of Persons Age 65 or Older by Age
Group, 1900 to 2050, in Millions
2000 US Census Bureau, Decennial Census Data,
Population Projections
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Putting It in Perspective
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Falls Outcomes and QOL

• 20 - 30 fear falling1
• 20 die within a year after hip fracture2
• 25 in a nursing home one year later3
• 35-40 of people 65 fall each year4
• Those who fall are 2-3 times more likely to fall
  again5
• 10-20 of falls cause serious injuries6

__________
1. Vellas BJ, Age Aging, 1997 Friedman SM,
JAGS, 2002 2. Lu-Yao GL, AJPH, 1994


3. Magaziner, J Gerontology Medical Sciences,
2000 4. Hornbrook, Gerontologist, 1994
Hausdorff, Arch Phys Med Rehab, 2001 5.
Tinetti, New Eng J Med, 1988 Teno, JAGS,1990 6.
Sterling, J Trauma-Inj Infection Critical Care,
2001
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Fall-Related Deaths, by Age and Sex
Source Incidence and Economic Burden of Injuries
in the United States, 2006
Rate (per 100,000)
Age Group
Fatal fall injuries disproportionately affect
older populations
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Hospitalizations, by Age and Sex
Source Incidence and Economic Burden of Injuries
in the United States, 2006
Rate (per 100,000)
Age Group
Fall-related injuries resulting in
hospitalization three times greater among older
adults
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Why Falls, Why North Carolina?

• MMWR Weekly Report
• March 7, 2008 / 57(09)225-229
• Self-Reported Falls and Fall-Related Injuries
  Among Persons Aged gt65 Years --- United States,
  2006
• Number estimated falls gt177,518 falls
• Number estimated injuries gt59,953
• 2005 BRFSS data set, 3 months preceding survey.

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Fall-Related Deaths, NC and US
Source National Center for Health Statistics,
1999-2005
Rate (per 100,000)
Age Group
Rates of fall death are similar in North Carolina
and the U.S. across age
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Fall-Related Deaths Over Time, 65 Population
Source National Center for Health Statistics,
1999-2005
Rate (per 100,000)
Year
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Putting the Future in Perspective
Total Number of Persons Age 65 or Older by Age
Group, 1900 to 2050, in Millions
2000 US Census Bureau, Decennial Census Data,
Population Projections
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Prevention Strategies

• Research supports these intervention strategies
  that work
• Comprehensive clinical assessment1
• Exercise for balance strength2
• Medication management3
• Vision correction4
• Reducing home hazards5

__________

• 1. American Geriatrics Society, JAGS, 2001
• 2. Lord SR, JAGS, 2001
• 3. Cumming RG, Drugs Aging, 1998
• 4. Ray W, Topics in Geriatric R Rehab,1990
• 5. Day L, BMJ 2002 Gill TM, JAGS, 1999
  

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NCOA Coordinating Growing Momentum in Fall
Prevention
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NCOA Coordinating Growing Momentum in Fall
Prevention

• 2008
• Online Resource Tool
• National Advisory Group convened
• Safety of Seniors Act enacted

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Safety of Seniors Act, H.R. 3701

• Passed Senate last year and House in 2008
  Pres. Bush signed on April 23
• Education strategies to raise awareness about
  elder falls
• Research to identify at-risk populations, and
• Demonstration projects aimed at preventing falls
  among older Americans. 
• Funding (20.7M) to be addressed in separate
  appropriation in FY 2009 not yet approved

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State Falls Prevention Coalitions
AK
WA
VT
ME
MT
ND
MN
NH
OR
MA
NY
WI
SD
ID
RI
WY
MI
CT
NJ
PA
IA
NE
DE
NV
OH

Hawaii
IL
IN
MD
UT
CO
WV
VA
CA
KS
KY
MO
NC
TN
SC
OK
NM
AZ
AR
AL
MS
GA
Northern Marianas
TX
LA
FL
Guam
Fall Prevention Coalition States
Emerging Fall Prevention Coalition States
States exploring coalition options
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NC Falls Prevention Coalition

• Building community capacity and infrastructure
• through collaboration. Researchers, planners,
• health care and aging all working together to
• Spread the message that falling is not inevitable
• Provide programs and services that address the
  problem both on a population basis and
  individually
• Provide seamless transitions to community
  programs from health care
• Maintain current in practice and share with
  colleagues

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Collaborative Partners

• Pharmacist s
• Medication Review counseling, assistive
  devices
• Physical Therapy
• Balance assessment and exercises
• Gait training and assistive device
• Occupational Therapy
• ADL assessment, home safety, problem solving
• Other Provider Partners
• Community planners, policy makers, first
  responders, etc.
• Environmental safety, safety networks
• Aging Services Network
• Home services, home safety and equipment,
• community-based (evidence-based) fall
  prevention and physical activity programs

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Example State FP Coalition Activities

• Make senior fall prevention a priority issue in
  State Injury Prevention Plan
• Hold a statewide or community summit for
  providers (health care, aging) on fall prevention
  and awareness
• Develop FP tool kits for different target groups
  (health care, first responders, aging services
  providers, older adult groups)

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Example State FP Coalition Activities

• Collect most recent fall prevention research and
  disburse it to coalition members
• First day of Fall Fall Prevention Awareness Day
• Fall Prevention Social Awareness
• campaigns

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Resources

• Center of Excellence for Fall Prevention
  www.stopfalls.org
• National Resource Center on Supportive Housing
  and Home Modification
• www.homemods.org
• National Safety Council
• www.nsc.org/issues/fallstop.htm

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State Falls Prevention Websites

• California
• http//www.stopfalls.org
• Connecticut
• http//www.fallprevention.org
• Michigan
• http//www.michigan.gov/injuryprevention
• Minnesota
• http//www.mnfallsprevention.org
• Ohio (Hamilton County)
• http//www.fallpreventiontaskforce.org/index.html
• Washington
• http//www.fallsfreewashington.org

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Additional Resources

• National Center for Injury Prevention and Control
  (CDC)
• Fact sheets, cost information
• http//www.cdc.gov/ncipc/factsheets/nursing.htm
• Posters, publications and brochures
• http//www.cdc.gov/ncipc/duip/fallsmaterial.htm
  
• Traumatic Brain Injury Awareness
• http//www.cdc.gov/ncipc/factsheets/tbi.htm
• http//www.cdc.gov/ncipc/Spotlight/BIAM.htm

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Acknowledgements

• Lynn Beattie, VP, Injury Prevention, National
  Council on Aging
• Carri Casteel, UNC Injury Prevention Research
  Center

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