Slips, Trips, and Falls – Why They Matter to Seniors

Elizabeth Goldberg, MD

More than one in every three older adults fall each year. Twenty percent of falls result in moderate to severe injuries. In fact, falls are the leading cause of traumatic brain injury. Falls often lead to hospitalization, loss of independence, and death. They are also costly. The total medical cost for falls is about $50 billion in the U.S. each year.

Are you at risk?

There are many risk factors for falls. These include:

  • balance and walking problems
  • lower body weakness
  • trouble with vision
  • being on medications for sleep, anxiety, or depression

Patients who come to the emergency department (ED) for falls are at higher risk for recurrent falls. After a fall, a patient’s six-month fall risk is nearly 30 percent higher. They are also more likely to develop weakness, poor balance, and depression in the following months.

We know most falls are preventable and predictable. When a senior has fallen once, the risk of falling again doubles. This is where prevention can help.

How seniors can prevent falls

A combination of risk factors causes most falls. Luckily, there are some things you can do to prevent them:

  • Check for home hazards, such as loose rugs, objects on the floor and bad lighting.
  • Review medication with your doctor.
  • Start strength and balance exercises; Tai Chi and yoga are especially helpful exercise programs for fall prevention.
  • Get your eyes and feet checked.

Get a falls risk assessment

A falls risk assessment can be performed in your doctor’s office. The doctor asks specific questions and completes an exam to help them determine your risk of falling. Depending on how high your risk is, your doctor might suggest seeing a physical therapist to improve your strength, getting a vision or hearing assessment, or changing your medications. All seniors who come to the ED after a fall should have a falls risk assessment.

The GAPcare program

Because seniors are more likely to fall again after they have fallen once, we believe a fall prevention program in the ED is important. The Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention (GAPcare) is a pilot program that started recently in the Rhode Island Hospital and The Miriam Hospital emergency departments. The National Institute of Health is sponsoring this research program.

Adults age 65 and older who come to the ED after a fall can participate. Those seniors receive information on how to make their home safer. A multidisciplinary team meets with them at their bedside in the ED. In the team approach, the ED physician works together with a pharmacist and physical therapist to conduct a falls risk assessment and develop an action plan for the patient to prevent future falls. This is done as part of the patient’s ED care. The goal is to help patients recognize what they can change to decrease their fall risk.

Following the visit, we keep in touch with patients for six months to see how they are recovering and if the program has helped them. We know that many older adults have trouble getting to appointments outside their homes and we want to make it easier by offering this care while they are already in the hospital. Our hope is that the program is helpful to seniors and the protocol can be rolled out to other EDs around the country. 

If you or a loved one is at risk for falls, please talk to your doctor about a falls risk assessment. 

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