Falling seniors: A preventable problem, a 'huge health burden'

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Fractured hips, pneumonia and significantly reduced mobility are among the most deadly health risks faced by seniors.

But for many, these threats are not an inevitable part of aging. They are caused by falls, an entirely preventable problem that leads to a vast array of serious injuries and the onset of debilitating illnesses that rob seniors of their independence, mobility, and in many cases, their lives.

"It's just a huge health burden," said Vicky Scott, clinical associate professor at the University of British Columbia and senior adviser on fall and injury prevention for the B. C. government. "[Falls are]that trigger event that seems to really spiral [the health of seniors]downward."

In Canada, the issue of seniors falling isn't unrecognized. Leading Canadian researchers have helped bring attention to the problem, and now many parts of the country have fall prevention programs for homes, hospitals, residential-care facilities and other centres.

But experts say the implementation, enforcement and scope of these programs are often lacking and there is not enough pressure on health-care facilities or home-care programs to prioritize fall-prevention strategies.

At the same time, such programs don't account for the fact that thousands of seniors living independently aren't aware of the risks they face and never have a discussion about it with their physician.

These glaring gaps lead to countless injuries, unnecessary deaths and a major strain on the health-care system - and a growing number of experts in the field say things need to change.

"It's common, it's preventable and the prevention for this will protect from other diseases as well," said Karim Kahn, leader of fracture prevention at the Centre for Hip Health and Mobility, a Vancouver-based research institute focused on arthritis and hip-related fractures.

Studies show that one in three people 65 and older, and perhaps more, will fall at least once a year.

Not all falls lead to serious injury. But falls cause more than 90 per cent of all hip fractures in seniors. One in five seniors who fractures a hip will die within a year of the break.

Falls are also a significant cause of head injuries, femur fractures, wrist and hand injuries and back and knee problems, as well as a shattered sense of self-confidence that leads many seniors to restrict activities and become fearful of venturing away from home.

Almost half of all falls occur in the place seniors feel most secure: in and around their home. Tripping while going up or down stairs, stumbling while walking across a room or slipping on ice are some of the most common falls suffered by seniors.

In 2008-2009, nearly 75,000 Canadians 65 and older were hospitalized after falling, according to a forthcoming report from the Public Health Agency of Canada.

Falls kill thousands of seniors a year and cause one-half of deaths due to injury among the elderly, a rate higher than deaths due to pneumonia or diabetes.

A large number of seniors don't die immediately after a fall. But for many, the problems are just beginning. Lengthy hospital stays, months of difficult recovery and relocation from home to a retirement facility are common. So are serious complications that arise when a person is bedridden and weakened for significant amounts of time after a fall, particularly pneumonia, which is often fatal.

"The story is that you go from having a functional, happy person … [to someone]in a nursing home," Dr. Khan said.

The health-care costs associated with falls are estimated at $2.8-billion. Others estimate that when lost productivity is factored in, the total cost balloons to more than $6-billion.

As a person ages, they're more at risk for the factors that lead to falls, such as loss of vision, reduced fitness and muscle strength, dementia, chronic health problems such as arthritis, as well as infections and other illnesses. Prescription drugs are a major risk factor because they can lead to dizziness or affect alertness. The presence of stairs, poor nutrition, too much alcohol and even canes that have worn tips are some other contributing factors.

Gene Seward, a resident at the Lodge at Broadmead in Victoria, said he has suffered a few falls in recent years. Although he didn't suffer any serious injuries, he said that it has become difficult for him to walk as a result, which limits his mobility.

What patients, doctors and other health-care professionals often fail to realize is that a fall - even if a person isn't injured - is typically a sign of underlying problems that need to be addressed.

For instance, a fall could signal a person is having trouble seeing or hearing, that their medication is causing deleterious side effects, or that a person is taking too many risks for their age, such as climbing ladders.

But too often, individuals and even health-care workers don't think minor falls mean anything. Seniors dismiss falls from their minds and doctors neglect to ask whether patients have fallen in recent months, according to Dr. Scott. The problems continue to be ignored and a person may fall again, but this time suffer a fracture or injury that dramatically changes his or her life.

"A catchphrase here might be 'Don't dismiss that fall,' " Dr. Scott said. "Prevention is key but key to good prevention is good education."

Dr. Scott would like to see the entire health-care team, from doctors to nurses to pharmacists to physiotherapists, involved in monitoring patients for falls and actively determining how to eliminate risks to prevent future falls.

But it has been a major challenge to translate knowledge about fall prevention into the daily practice of health professionals. Dr. Scott said it could be as simple as getting doctors to ask every patient if they have suffered a fall recently.

"If they ask that question just once a year we could make a huge difference," she said. "They just don't ask."

In many ways, that lack of discussion illustrates problems that permeate all aspects of fall prevention.

Many parts of Canada have adopted fall-prevention programs in hospitals, nursing homes and home-care settings. Accreditation Canada recently adopted standards requiring those facilities to have fall-prevention plans, with 83 per cent of institutions complying so far this year.

But such strategies, often focused on removing low furniture that could be a hazard or telling a person how to avoid certain risks, often aren't comprehensive enough to make a real difference, Dr. Scott said.

Trained clinicians need to be in charge of such programs to ensure they are fully implemented, thoroughly understood by staff and used properly. But budget constraints and other pressing priorities means this isn't happening in many centres, Dr. Scott said.

If a dent is to be made in the prevalence of falls and the devastating impact they have on the lives of Canadians, policy makers and health professionals need to make prevention a top priority, said Famida Jiwa, president and chief executive officer of Osteoporosis Canada.

"It's surprising to me that from a policy perceptive, with all the focus on wait times for hips and knees [replacement surgery] the issue that some of these fractures can be prevented never comes to the forefront," she said. "Its a huge burden on the health-care system."

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