In the Journals

Only half of older adults discuss falls with physician

Despite data indicating that falls among elderly patients remain common, approximately half do not discuss falling with their health care provider, according to findings published in Morbidity and Mortality Weekly Report.

The researchers further noted that many of these incidents are preventable and recommended a multifactorial clinical approach to help elderly patients reduce the number of falls. Steps physicians can take include screening elderly patients for fall risk, managing patient medications associated with falls and recommending vitamin D supplements to improve bone, muscle and nerve health.

“Falls are the leading cause of fatal and nonfatal injuries among adults aged ≥65 years (older adults),” Gwen Bergen, PhD, of the CDC National Center for Injury Prevention and Control, and colleagues wrote. “During 2014, approximately 27,000 older adults died because of falls; 2.8 million were treated in emergency departments for fall-related injuries, and approximately 800,000 of these patients were subsequently hospitalized.”

To approximate the number and rate of falls and fall-related injuries among elderly patients in the United States, CDC researchers reviewed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey. An annual, random-digit-dialed telephone poll, the BRFSS survey reaches noninstitutionalized residents aged 18 years and older in all 50 states and the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands.

In 2014, participants aged 65 years and older were asked how many times they had fallen in the past 12 months. Those who answered that they had fallen one or more times were additionally asked how many of those falls had resulted in an injury. For the purposes of the survey, “injury” was defined as a fall that hampered regular activities for at least 1 day, or caused the participant to see a physician. The total sample of the CDC review included 147,319 survey participants. Researchers weighted the data to represent state-level population estimates, then aggregated to determine a nationwide estimate.

According to the researchers, 28.7% of elderly adults in 2014 reported falling at least once in the previous year, representing an estimated 29 million falls. In addition, among those who reported falling, 37.5% reported that at least one incident resulted in an injury, representing an estimated 7 million fall injuries. Women, at 30.3%, were more likely than men, at 26.5%, to report a falling incident (P < .01). Women were similarly more likely than men to report a fall injury — 12.6% compared with 8.3% (P < .01).

The rate of falls among older adults appeared to increase with age (P < .01), from 26.7% among participants aged 65 to 74 years, to 29.8% for those aged 75 to 84 years, and 36.5% among persons aged 85 years and older. Likewise, the percentage of elderly participants who reported a fall injury also increased with age (P < .01), from 9.9% among those aged 65 to 74 years, 11.4% in those aged 75 to 84, and 13.5% among those aged 85 years and older.

“Older adult falls are largely preventable, and health care providers (eg, physicians, nurses, nurse practitioners, physician assistants, pharmacists, physical therapists, and occupational therapists) can play an important part by discussing falls with older adult patients and providing appropriate interventions,” Bergen and colleagues write. “The American and British Geriatrics Societies Clinical Practice Guideline recommends that health care providers use a multifactorial approach to prevent falls that includes activities such as asking about falls, assessing gait and balance, reviewing medications and prescribing interventions such as strength and balance exercises, or taking vitamin D. This type of approach has been estimated to be capable of reducing falls by 24%.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.

Despite data indicating that falls among elderly patients remain common, approximately half do not discuss falling with their health care provider, according to findings published in Morbidity and Mortality Weekly Report.

The researchers further noted that many of these incidents are preventable and recommended a multifactorial clinical approach to help elderly patients reduce the number of falls. Steps physicians can take include screening elderly patients for fall risk, managing patient medications associated with falls and recommending vitamin D supplements to improve bone, muscle and nerve health.

“Falls are the leading cause of fatal and nonfatal injuries among adults aged ≥65 years (older adults),” Gwen Bergen, PhD, of the CDC National Center for Injury Prevention and Control, and colleagues wrote. “During 2014, approximately 27,000 older adults died because of falls; 2.8 million were treated in emergency departments for fall-related injuries, and approximately 800,000 of these patients were subsequently hospitalized.”

To approximate the number and rate of falls and fall-related injuries among elderly patients in the United States, CDC researchers reviewed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey. An annual, random-digit-dialed telephone poll, the BRFSS survey reaches noninstitutionalized residents aged 18 years and older in all 50 states and the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands.

In 2014, participants aged 65 years and older were asked how many times they had fallen in the past 12 months. Those who answered that they had fallen one or more times were additionally asked how many of those falls had resulted in an injury. For the purposes of the survey, “injury” was defined as a fall that hampered regular activities for at least 1 day, or caused the participant to see a physician. The total sample of the CDC review included 147,319 survey participants. Researchers weighted the data to represent state-level population estimates, then aggregated to determine a nationwide estimate.

According to the researchers, 28.7% of elderly adults in 2014 reported falling at least once in the previous year, representing an estimated 29 million falls. In addition, among those who reported falling, 37.5% reported that at least one incident resulted in an injury, representing an estimated 7 million fall injuries. Women, at 30.3%, were more likely than men, at 26.5%, to report a falling incident (P < .01). Women were similarly more likely than men to report a fall injury — 12.6% compared with 8.3% (P < .01).

The rate of falls among older adults appeared to increase with age (P < .01), from 26.7% among participants aged 65 to 74 years, to 29.8% for those aged 75 to 84 years, and 36.5% among persons aged 85 years and older. Likewise, the percentage of elderly participants who reported a fall injury also increased with age (P < .01), from 9.9% among those aged 65 to 74 years, 11.4% in those aged 75 to 84, and 13.5% among those aged 85 years and older.

“Older adult falls are largely preventable, and health care providers (eg, physicians, nurses, nurse practitioners, physician assistants, pharmacists, physical therapists, and occupational therapists) can play an important part by discussing falls with older adult patients and providing appropriate interventions,” Bergen and colleagues write. “The American and British Geriatrics Societies Clinical Practice Guideline recommends that health care providers use a multifactorial approach to prevent falls that includes activities such as asking about falls, assessing gait and balance, reviewing medications and prescribing interventions such as strength and balance exercises, or taking vitamin D. This type of approach has been estimated to be capable of reducing falls by 24%.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.