Fall Risk
The problem of falls among older adults has been recognized and studied for many years, including myriad analyses regarding assessment and prevention of falls in this population. The U.S. Census Bureau reported that there were 35.9 million people age 65 and over in the United States as of July 1, 2003. As this population increases, the specific issues pertaining to its members, including falls, must be addressed by hospitalists.
How Big Is the Problem?
The Center for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control reports that:
- More than one-third of adults 65 and older fall each year in the United States;
- Falls are the leading cause of injury deaths for older adults;
- In 2003, about 1.8 million people 65 and older were treated in emergency departments for nonfatal falls, and about 460,000 of these patients were hospitalized;
- The rates of fall-related deaths among older adults rose significantly over the past decade;
- Many individuals who fall develop a fear of falling. That may cause them to limit activity, leading to reduced mobility and physical fitness and increasing their risk for additional falls; and
- In 2000, direct medical costs totaled $179 million for fatal falls and $19 billion for nonfatal fall injuries.1
One study exploring the relationship between the mechanism of fall and the pattern and severity of injury in geriatric patients compared with younger patients concluded that falls were the mechanism of injury in 48% of the older patients (those 65 and older) included in the study compared with 7% in the younger group. Further, 32% of falls in the older group resulted in serious injury, while this was true of only 4% of falls in the younger cohort.2
Risk Assessment
When an inpatient in an acute-care hospital falls, a number of negative outcomes can occur, including a longer hospital stay and higher rates of discharge to long-term care.
Falls are associated with higher levels of anxiety and depression and loss of confidence for the patient. They lead to increased costs for patients and hospitals. Feelings of anxiety and/or guilt among staff members may follow. Ultimately, a fall can result in complaints or even litigation from patients or their families.3
Traditional methods of fall risk evaluation may not be effective for assessing the risk of falling for a hospitalized patient, regardless of the reason the patient is hospitalized. The classic risk factors are generally well recognized among physicians and clinical staff and include:
- Age 65 and older;
- A history of falls;
- Cognitive impairment;
- Urinary/fecal incontinence/urgency;
- Balance problems, lower extremity weakness, arthritis;
- Vision problems;
- Use of more than four daily medications or use of psychotropics or narcotics; and
- ETOH.
