Seniors' falls — an emerging public health crisis

By Dorothy Grant
Medical Journalist

Not long ago, " Marian" a woman in her 70's, was a renowned academic and world traveller enjoying a completely independent life style. Sadly, as a result of bad fall she broke one of her hips. After a long hospital stay, she made a full recovery but, only a short time later, fell again and experienced another hip fracture. This time she was unable to regain normal mobility. She is now confined to a wheel chair and is a despondent resident of a nursing home.

Tragically, Marian's story is no longer an unusual situation. Today, serious fall injuries among Canada's senior population are dramatically increasing in numbers and have become a public health problem that could reach crisis proportions.

Dr. David Petrie, a Halifax orthopaedic surgeon, often performs surgery on older people who like Marian have experienced a disastrous fall or falls. He warns that this kind of personal calamity will become even more commonplace in the near future.

" By the year 2010, it is now being predicted that one third of the beds on orthopaedic wards in hospitals will be occupied by older patients recovering from fractured hips. "

Dr. Petrie's concern clearly reflects a growing awareness that it is time to seek solutions for an impending crisis and this is now happening.

At a recent meeting of the American Academy of Orthopaedic Surgeons held in New York, an international effort was launched that will focus on hip fracture prevention and care and which, it is hoped, "will lead to more efficient and effective treatment and better functional outcomes."

Dr. Susan Freter is a Halifax geriatrician who believes it is essential people stop believing that the falls seniors experience are simply unavoidable accidents.

"Falling is a serious problem among older adults because it is very common and can have devastating consequences. Although over one third of people over the age of 65 years fall every year, falling should not be considered an inevitable consequence of aging."

The good news is that Health Canada (HC) and Veterans Affairs Canada (VAC) have come together in a joint initiative to actively nurture community-based fall prevention programs aimed at improving the independence and quality of life for veterans and seniors. In order to achieve this goal, they are providing funding for some community based fall prevention pilot projects in the Atlantic provinces, Ontario and British Columbia.

Researchers who have studied fall prevention programs have already arrived at an important conclusion. They insist that, because multiple problems are involved in fall injuries, multiple interventions have the greatest potential to help "remedy" a complex and daunting public health challenge.

So where do we go from here? First, in order to achieve a successful fall reduction campaign it will be necessary to call on the skills and co-operation of the health professionals in your communities. This means involving family doctors, orthopaedic surgeons, nurses, pharmacists, physiotherapists and occupational therapists, etc. Also very important to your initiative, will be the active partnership of many committed supporters representing governments at all levels, voluntary organisations and the private sector. And, the endorsement and participation of seniors, their families and their caregivers will be a key component in making any community-based initiative a productive endeavour.

Dr. Freter points out something very significant which is already known about the challenges that face any fall prevention strategy. "We now know many of the factors which put people at risk for falling, and by addressing as many of these factors as possible, we can reduce an older person's risk of falls."

Included among these identified risks factors are those of a medical nature such as osteoporosis, gait and balance impairment, chronic illness, poor vision and multiple medications. There are also the innumerable threats that "lurk" ominously in homes. Poor lighting, slippery surfaces, and lack of safety equipment such as a grab bar near a toilet and tub are only a few of these hazards.

There has been some interest in the issue of falls that occur in public places but more attention needs to be directed at eliminating the risks that are commonplace in many outdoor environments.

Fortunately, there are a number of fall prevention strategies that do appear to hold considerable promise. These include: Encouraging activity among seniors by providing regular, easy to access customised exercise programs designed specifically for older participants. These programs should focus on balance, flexibility and maintaining and building strength, especially in the lower limbs.

A clinical assessment and review done by member/ members of the health care team. Its purpose is to pin point an individual's specific personal risk factors and to create a management plan that will help reduce the obvious dangers these risk factors represent.

Visits to homes by occupational therapists or a specially trained health professional (or a volunteer who have received appropriate instruction and guidance) whose responsibility is to produce an inventory of simple safety measures that can be undertaken. A return visit to ensure that this has been done should be an important aspect of this kind of intervention.

Subsidisation or an innovative partnership sponsorship may be required to help defray cost and installation.

Educational programs aimed not only at the health care community, but at a much larger target group which will include seniors, governments at all levels and the general public. This agenda will help make a greater risk prevention awareness a societal " norm" and result in a much greater knowledge of effective risk reduction strategies, not only among seniors, but for people of all ages.

Increased attention and research on the use of safety items such as canes, walkers, spiked snow-boots and other new innovative products such as hip protectors which have been shown to help reduce the incidence of fractures.

The creation of networks of dedicated community-based organisations that will contribute, both in time and effort, to the development and the maintenance of sustainable fall prevention programs for seniors.

Reducing fall related injuries among Canadian seniors by only 20% would result in a remarkable achievement. It would translate, annually, into 8,000 fewer hospital stays and more than 1,800 fewer permanently disabled seniors. This would, of course, save our health care system millions of dollars, but something much more meaningful would have taken place. Many older men and women would be able to enjoy a better quality of life, free of the pain and the emotional and physical trauma that are often the tragic consequences of serious fall injuries.

By the year 2031, it is estimated that there will be more than 5 million seniors in this country. Faced with this astonishing inevitability, Canadians across this country should understand why it makes such very good sense to enthusiastically endorse the laudable goals of all community-based fall prevention projects!

To learn more about this Initiative and other matters important to seniors visit - www.hc-sc.gc.ca/seniors-aines.