Falls and fall prevention in the elderly

Epidemiology. A fall is an unintentional, sudden descent to a lower level. Most geriatric falls that result in an emergency department (ED) evaluation occur from a standing level of less than six feet (2 m), and these are the falls referred to in this chapter. Falls and fall-related injuries are frequently encountered conditions in geriatric ED patients. In fact, 27% of community-residing geriatric adults will fall each year and the rates of injurious falls continue to increase faster than that expected by the “baby boomer” population surge alone [1,2]. The incidence of falls increases with age and as many as 50% of those over age 80 years will fall each year [1]. Over half of falls in community-residing older adults occur in and around the home and as many as 20% of falls result in serious injury [3]. Fall-related hospitalizations increased 50% from 373,128 to 559,335 cases in the US between 2001 and 2008 [4]. In response, the Centers for Medicare and Medicaid Services identified eight preventable conditions called “never events” in 2007. Falls in hospitals were one of those “never events,” now known as preventable serious adverse events, which would restrict or reduce future hospital reimbursements [5]. Morbidity and mortality. Standing-level falls produce injuries that are disproportionate to the mechanism and are the leading cause of traumatic geriatric mortality, at a cost of $19 billion (2000, $US) annually in the US alone [6,7]. Falls frequently precede a downward spiral of fear of falling, social isolation, functional decline, and institutionalization [8]. The term “long lies” are used to describe an inability to arise following a fall, a phenomenon that may leave a fall victim on the ground for over three hours after a standing-level fall [9,10]. Injurious falls are defined by the occurrence of severe lacerations or fractures from a standing-level fall. In the period between 2000 and 2004, the National Hospital Ambulatory Care Survey reported 21 million injury-related ED visits in the US in those over age 65, and falls represent 48% of all injury-related ED encounters at a rate of 5.9 patient visits per 100 patient-years [11]. With a total of 48 million geriatric patient visits to US EDs between 2000 and 2002, trauma represents over 20% of these ED encounters [12]. In the United Kingdom, injuries are the root cause of 33% of geriatric ED visits [13].