A paper outlining the importance of the issues of falls in the elderly

1. Running head: Falls 1
Current Issues Presentation: Falls
Alexandria Amici
HCS 420.01: Current Issues in Healthcare Science
Professor Durant
4/25/2017

2. Falls 2
Falls are of vital importance when it comes to the health of those currently in our geriatric
population. They have serious effects on our individual as a whole, their family, and our society.
“Falls are the leading cause of injury-related visits to emergency departments in the United
States and the primary etiology of accidental deaths in persons over the age of 65 years. The
mortality rate for falls increases dramatically with age in both sexes and in all racial and ethnic
groups, with falls accounting for 70 percent of accidental deaths in persons 75 years of age and
older”(Fuller 2000). Unfortunately as patients get older, the chance of falls increases due to
decrease in overall function of individual. “Annually, falls among older adults are responsible for
more than 25,000 deaths, 2.5 million emergency department visits, and more than
700,000 hospitalizations” (Fuller 2000). Chance of falls only increase as the patient gets older.
The family and patient have specific needs that we must account to. There are interventions in
place to assist in health promotion and fall prevention. There are also state legislatures in place
that have helped those who have fallen and any programs assisting those individuals. The
geriatric population has enough trouble without adding falls to the top of their problems. Falls
need to be addressed constantly as those who have fallen have an increased chance of morbidity
due to falls.
Falls were an issue in the past but have only increased as the years progressed. “It is
projected that more than 340,000 hip fractures will occur in the year 2000, and this incidence is
expected to double by the middle of the 21st century” (Stevens 2016). Through history, death
from falls is shown to increase. “From 1992 through 1995, 147 million injury-related visits were
made to emergency departments in the United States” (Stevens 2016). The fact that records of
falls is increasing is a very big issue because of the impacts falling can coincide with. They
believe the increase in fall death is because of lack of reporting falls. If the cause of a fall is not

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reported, then the underlying issue may never be solved which shows a more heavily increased
chance of falling in the future. Treatment is a huge need when it comes to getting the patient
back to their current baseline of function. After a fall, it is difficult to get back from this or even
improve function from their previous level. Patients are also not receiving follow ups after falls
which result in an increased death rate because the problem was not fixed. The fall could have
also impacted their health physically and it was unknown. Those injuries may cause future
problems. “The recent rise in the death rate from falls of older Americans during 1999–2007 was
primarily due to the previously unreported dramatic nearly sevenfold increase in mortality from
the subset other falls on the same level” (Fuller 2000). A fall impacts the overall quality of life
in these patients.
The victim of a fall is heavily impacted by the result of the accident. “Falls involving a
hip fracture lead to 10-15% reduction in life expectancy” (The Trustees of Indiana University
2004). The patient can be impacted by other injuries and even death. Many physical injuries are
also a result of falls. “20-30% of those who fall suffer moderate to severe physical injuries
including breaks, cuts, and bruising” (The Trustees of Indiana University 2004). Along with
physical injuries, there can be mental problems as well. The individual is more likely to worry
about falls in the future. They may also become depressed and isolate themselves. The decrease
in overall confidence and self esteem will often lead to another fall. The decreased confidence
causes decreased mobility and they will fall again. “The elderly are hospitalized five times more
often for fall-related injuries than any other injury” (The Trustees of Indiana University 2004).
Family is heavily affected by the falling incident of a loved one. Falls are the leading cause of
putting that family member in a skilled health facility. This can cause financial burden on the
family. The family also experiences emotional worry that this person will fall again or even die.

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The health care system and society is also impacted by falls. Falls affect the cost and availability
of health services.”Falls lead to increased use of emergency room resources, increased costs
from hospital admissions and extended stays”( The Trustees of Indiana University 2004)Falls
cost Americans about $100 billion every year which is a huge financial issue to our health care
system and society. These impacts cause the family and patient to have specific needs for the
future.
A patient has many needs after a fall may occur. Occupational therapy can be used to
prevent a future fall and help maintain safety and health. Physical therapy can be used to
rehabilitate an injury. Counseling can help an emotionally traumatized patient. Any sort of
money management can be used to help the family also. Preventative measures can be used to
help with falls. Different interventions include a home safety checklist and an assessment that
evaluates falls. The home safety checklist includes appropriate changes, such as “removal of
hazards, selection of safer furniture (correct height, more stability) and installation of structures
such as grab bars in bathrooms or handrails on stairs”(Woodhouse 2013). When used properly
the assessment is very effective in preventing falls. If there is a problem with gait, which is the
pattern of walking or ambulation an individual has, one can do gait training, use an assistive
device like a cane, or balance strengthening. If medications are the cause, they can be given
education about the drugs they are on, different treatment of diagnoses needing medication, or
discontinuation or restriction of medications (Woodhouse 2013). If there is impairment in
strength, strength interventions and exercises can be used. A patient can do three sets of 10
repetitions of arm lifts using a weight and increasing the weight as the weeks progress. To help
prevent falls we can also eliminate environmental hazards, provide follow ups, involve family.

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There are a lot of teaching strategies that can be used to help with the issue of falls for
services and families involved. There is the timed Up and Go Test, One leg balance test, and
balance and gait testing. Balance and gait testing involves functional balance measures that are
quantifiable and correlate well with the ability of older adults to ambulate safely in their
environment. The one leg balance they stand on their leg for five seconds which measures
strength. The up and go test helps evaluate gait by having patients walk a distance and evaluate
their ability to do so (Fuller 2000). The tests can also be used to measure changes in mobility
after interventions have been applied(Fuller 2000).There is also a mnemonic for physical signs to
look for after a fall is experiences to watch for further damage. The mnemonic is called I HATE
FALLING: A Mnemonic for Key Physical Findings in the Elderly Patient Who Falls or Nearly
Falls. It stands for I-Inflammation of joints (or joint deformity),H-Hypotension (orthostatic blood
pressure changes, A-Auditory and visual abnormalitie,T-Tremor (Parkinson's disease or other
causes of tremor),E-Equilibrium (balance) problem, F-Foot problems, A-Arrhythmia, heart block
or valvular disease, L-Leg-length discrepancy-Lack of conditioning (generalized weakness),I-
Illness-Nutrition (poor; weight loss), and G-Gait disturbance(Fuller 2000). With the use of these
strategies and interventions the chances of falls help decrease in homes and facilities. Common
causes of falls involve the physical deficits someone may have like a decrease in their function,
their medications being administered wrong, patient history, and the environment in the home
such as tripping hazards. These are all barriers for preventing falls. The interventions could not
work if there is no follow up to the patient or the family does not listen to physician’s orders.
Services and political action has been taken to ensure more safety concerns in the area of
falls. The National conference of State Legislatures has taken action towards preventing falls and
maintaining a safe environment for those who are impacted by these accidents. The CDC has

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developed a fall prevention tool kit called STEADI (Stopping Elderly Accidents Deaths and
Injuries). This tool helps them reduce falls by implementing the American Geriatrics Society’s
clinical guideline for fall prevention (National Conference of State Legislatures 2016).States
have also taken action towards helping those with falls and preventing them. The list of states
who have created legislatures are California, Connecticut, Florida, Hawaii, Maine, Minnesota,
Massachusetts, New Mexico, New Jersey, Oregon, and Texas. For example, California created
the “Cal. Health and Safety Code §125704 (California Osteoporosis Prevention and Education
Act) this requires the department of health services to develop effective protocols for the
prevention of falls and fractures and establish these protocols in community practice to improve
the prevention and management of osteoporosis”(National Conference of State Legislatures
2016). Even with these actions taking place, falls are still a huge issue to focus on today.
Falls are an important issue to be addressed in today’s society. They are a big reason for
mortality rates in the most recent years. There are interventions in place to help with this issue. A
patient and family are heavily impacted by the problem of a fall and have many needs after a fall
occurs. Fall deaths have increased over the years. Political action has been taken to help stop
deaths occurred by falls. There are many educational opportunities and fall preventions that can
be used to help maintain the health of those in the geriatric population.

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References
(2016, January). ELDERLY FALLS PREVENTION LEGISLATION AND STATUTES.
National Conference of State Legislatures. Retrieved from
http://www.ncsl.org/research/health/elderly-falls-prevention-legislation-and-statutes.aspx
Falls: How Big is the Problem? (2004). The Trustees of Indiana University. Retrieved from
http://www.indiana.edu/~bioofag/module2/kw_unit3_HAA2/falls/content/01_03_impact.
htm
Fuller, G. (2000, April 1). Falls in the Elderly. American Family Physician. Retrieved from
http://www.aafp.org/afp/2000/0401/p2159.html
Stevens, J. (2016, October). Older Adult Falls. Center for Disease Control and Prevention.
Retrieved from https://www.cdc.gov/homeandrecreationalsafety/falls/index.html
Woodhouse, K. (2013). 10 Topics in Reducing Harm from Falls. Retrieved from
http://www.hqsc.govt.nz/assets/Falls/10-Topics/topic1-falls-in-older-people-15-April-
2014.pdf