Date: July 1st, 2008
Falls are a menace to older adults and our overstrained health care system. The direct medical costs of falls among older adults now total more than $19 billion, most of which must be absorbed by Medicare and Medicaid. A new bill recently passed by Congress seeks to address the problem of falls, but will have little impact without adequate funding.
Life Changes in an Instant
For those who live with an older adult, there is no more heart-stopping sound than the crash that signals your aged loved one has fallen. For older adults who live alone, a single fall can destroy their independence and launch them into a downward spiral of frailty and confinement.
Falls are a critically-serious problem for older adults and our overstrained health care system. The dimensions of the problem are sobering:
- More than one-third of adults 65 and older fall each year
- Of those who fall, 20% to 30% suffer moderate to severe injuries that make it hard to get around or live alone and increase the chance of early death
- The mortality rate from falls among older Americans increased 39% between 1999 and 2005
- Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes
Falls Cost the Nation Billions
The costs of falls among older adults are staggering. In 2003, economists at the Research Triangle Institute in North Carolina worked with the Centers for Disease Control and Prevention (CDC) to estimate the direct medical costs of falls among adults ages 65 years and older in the United States. They found that, in 2000, direct medical costs totaled:
- $0.2 billion for fatal falls
- $19 billion for nonfatal fall-related injuries
Of the nonfatal injury costs,
- 63% ($12 billion) were for hospitalizations
- 21% ($4 billion) were for emergency department visits
- 16% ($3 billion) were for treatment in outpatient settings
- Fractures accounted for just 35% of nonfatal injuries, but 61% of costs
Most of these expenses are shouldered by Medicare and Medicaid. It is projected that direct treatment costs from elder falls will escalate to $43.8 billion annually by 2020. The magnitude of this economic burden underscores the critical need to implement cost-effective fall interventions.
Risk of Falls Underestimated
Despite these daunting numbers, there remains a general lack of understanding about this growing public health issue among older adults, their family members, and even health care providers. One survey found that 69% of older adults did not see falling as a personal threat; another found that more than 60% rated their risk as low.
Many people who fall, even those who are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and physical fitness, and increasing their actual risk of falling. They may not be aware that there are ways of reducing their risk factors.
Falls are Not Inevitable
Falls have myriad causes: reduced muscle tone, blood pressure changes, vision problems, medication side effects, and one’s general health can all impact a person’s balance. But falls and fall-related injuries are not normal consequences of growing old.
To reduce the risk of falls, the CDC and other agencies recommend the following:
- Clinical assessments
- Regular exercise
- Reviewing medications to reduce side effects and interactions
- Having yearly eye exams; poor vision can increase the chances of falling
- Reducing fall hazards in the home
There is strong evidence that community-based programs offered through the aging services network can improve balance and reduce falls. Some examples of promising physical activity programs offered in the community include:
- A Tai Chi program in Oregon that showed a reduction in participant falls by 55%
- Stepping On, which showed a fall reduction of nearly two-thirds in a Wisconsin community
- A Matter of Balance, a program which is successfully addressing seniors’ fear of falling and promoting self-efficacy, with fewer falls reported by participants whose average age is 79.
Ultimately, success in reducing the number and severity of older adult falls will be reached through partnerships among federal, state, and local agencies along with the cooperation of many non-governmental organizations. What is required is leadership to make the initial investments in research, program model building, and education dissemination. Congress has recently taken the first step by passing the Safety of Seniors Act (H.R. 845).