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Angela Marr, MPH
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  1. Older Adult Falls Prevention Angela Marr, MPH

  2. Introduction • 30-35% of people 65+ fall each year1 • Those who fall are 2-3 times more likely to fall again2 • 10%-20% of falls cause serious injuries3 __________ 1. Hornbrook, Gerontologist, 1994; Hausdorff, Arch Phys Med & Rehab,2001 2. Tinetti, New Eng J Med,1988; Teno, JAGS,1990 3. Sterling, J Trauma-Inj Infection & Critical Care,2001

  3. If an older adult falls, 2-3 times more likely to fall again Fall and Nonfatal Fall Injuries Among People 65+--2006 14,903 Died 432,629 Hospitalized 1,309,722 Treated & released ?Millions (Oliver, 2009), (Arias, 2008)

  4. Fall Death Rates by Sex & Age, 2006 Men Women __________ NCHS, Vital Records, 2006

  5. Trends in Age-Adjusted Fall Death Rates Men & Women 65+, 2000-2006 Men 35% Women 45% ___________ NCHS, Vital Records, 2006

  6. Leading Causes of Nonfatal Unintentional Injuries Among People 65+, 2006 Total = 3.1 million injuries N=1.84 million __________ NEISS-AIP, 2006

  7. Nonfatal Fall Injury Rates by Sex & Age, U.S., 2007 Women Men __________ NEISS-AIP, 2007

  8. Trends in Age-Adjusted Nonfatal Fall Rates Men & Women 65+, 2001-2007 Women 6% Men 8% _________ NEISS-AIP 2001-2007

  9. Where Do Falls Happen? • At home, outside…….......35% • At home, inside…………..23% • Away from home, in a familiar place……………..23% • Away from home, in an unfamiliar place…………..19% ______ Berg WP, Age & Ageing, 1997

  10. Why Do Falls Happen? • Slipped or tripped….….59% • Misplaced step…….…..12% • Loss of balance……….. 9% • Legs give way ….….….. 4% • Other ……………………16% ______ Berg WP, Age & Ageing, 1997

  11. Economic Impact In 2000, cost of fatal fall injuries among people 65+: Total: ~$19 billion • Fatal falls: $0.2 billion • Nonfatal injuries: $19 billion • ___________ • Stevens JA, Inj Prev, 2006

  12. Quality of Life • 20% - 36% fear falling1 • 20% die within a year after hip fracture2 • 25% in a nursing home one year later3 ___________ 1. Vellas BJ, Age & Aging, 1997; Friedman SM, JAGS, 2002 2. Lu-Yao GL, AJPH, 1994 3. Magaziner, J Gerontology: Medical Sciences, 2000

  13. Biological Risk Factors Poor control and prevention of chronic health problems Mobility Problems due to muscle weakness or balance Vision changes or vision loss Behavioral Risk Factors Medication side effects and interactions Inactivity (physical, mental, social) Alcohol use Environmental Risk Factors Home and environmental hazards Poorly designed public spaces Incorrect use of assistive devices Fall Risk Factors Preventing Falls: How to Develop Community-based Fall Prevention Programs for Older Adults (CDC, 2008)

  14. Exercise for balance & strength Effective Fall Prevention Strategies • ___________ • Lord SR, JAGS, 2003

  15. Review & manage medications Effective Fall Prevention Strategies ___________ Cumming RG, Drugs & Aging, 1998 Ray W, Topics in Geriatric Rehab, 1990

  16. Effective Fall Prevention Strategies • Maximize vision • ___________ • Lord SR, JAGS 2001

  17. Effective Fall Prevention Strategies • Improve home safety ___________ Day L, BMJ 2002; Gill TM, APHA, 1999

  18. Older Adult Fall Prevention

  19. Fall Prevention Interventions Preventing Falls: What Works A CDC Compendium of Effective Community-based Interventions from Around the World (CDC, 2008), (Carande-Kulis et.al, 2010)

  20. Discussion: Tai Chi Moving for Better Balance • Exercise Based Intervention • Addresses biological risk factors • Promotes strengthening of muscles and improved balance • Control chronic health conditions through exercise • Addresses behavioral risk factors • Promotes physical, mental and social activity

  21. Discussion: Stepping On • Multifaceted Intervention • Addresses biological risk factors • Strength and balance exercises • Nutrition education • Poor vision assessment • Addresses behavioral risk factors • Medication management • Promotes physical, mental, and social activity • Addresses environmental risk factors • Assessment of hazards in and around the home • Assist with home adaptations and modifications

  22. Injury Prevention When It Comes ToInjury Prevention,We’re DoingMore Than JustCrossing Our Fingers.