Falls have a huge impact on individual well-being and the rising cost of medicine. Fall related medical costs totaled 30 billion dollars in 2010 after being adjusted for inflation.1 About one out of every three adults past the age of 65 fall every year.2 The incidence increases with age and many of these falls result in injury.2 In about a third of those who fall the fear of future falls causes a limitation in activity, which in turn actually increases the risk of falling.3 In the older patient the risk of injury is significantly higher with falls when compared to younger poulations.4 This data indicates that falls present a significant risk to patients as well as posing a financial burden.

The act of assessing patients for fall risk and addressing any identified modifiable risk factors is an important part of what those in health care do. The impact that  can be had was recently reinforced again by a meta-analysis and systematic review published in the British Medical Journal.5 The review looked to address the question of whether fall related injuries are reduced by exercise interventions and if so to what extent.  After assessing relevant literature on the topic 17 studies were included in the review. The data from over 2000 participants in both the exercise and the control groups was pooled and assessed. While there are a few limitations in this review the data does suggest some interesting conclusions. The pooled data suggests that exercise intervention has a positive preventative effect on falls that result in injury as well as falls that lead to medical care. The evidence points to fall prevention exercise programs having a higher protective effect for severe fall related injuries. This would indicate that encouraging those at risk to participate in an appropriate exercise program reduces the risk of falling as well as significantly (up to 67% risk reduction for falls resulting in fractures) reducing fall-associated injuries.5

A systematic approach to balance intervention starts with the evaluation. Tests for balance abound and vary from quick and easy tests like the timed up and go (TUG) test to a more involved screen such as the BERG balance test. Developing familiarity with all the available tests will allow the clinician to chose the appropriate test(s) during an initial evaluation. The course on Fall Prevention and Balance Restoration for Seniors does a good job of going over norms and directions on how to administer many of the most significant balance tests. It also gives a good idea of balance exercises and their progression. An additional resource provided by the Center for Disease Control is the STEADI (Stopping Elderly Accidents, Deaths & Injuries).6 This has been done to provide those in health care with information and tools necessary to assess and treat fall risk.

Falling is a very real risk among the aging population. The identification and elimination of modifiable risk factors can make a difference and should be a focus when treating this population.

 

References:

 

1.         CDC – Older Adult Falls – Costs of Falls Among Older Adults – Home and Recreational Safety – Injury Center. Available at: http://www.cdc.gov/homeandrecreationalsafety/falls/fallcost.html. Accessed December 16, 2013.

2.         Tromp AM, Pluijm SM, Smit JH, Deeg DJ, Bouter LM, Lips P. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol. 2001;54(8):837–844.

3.         Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age Ageing. 1997;26(3):189–193. doi:10.1093/ageing/26.3.189.

4.         Sterling DA, O’Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. J Trauma. 2001;50(1):116–119.

5.         El-Khoury F, Cassou B, Charles M-A, Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347(oct28 9):f6234–f6234. doi:10.1136/bmj.f6234.

6.         CDC – STEADI – Older Adult Falls – Home and Recreational Safety – Injury Center. Available at: http://www.cdc.gov/homeandrecreationalsafety/Falls/steadi/index.html. Accessed December 22, 2013.