47 Safety

Falls Among Older Adults: An Overview

Each year, one in every three adults age 65 and older falls. Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. Fortunately, falls are a public health problem that is largely preventable.

How big is the problem?

• One out of three adults age 65 and older falls each year, but less than half talk to their healthcare providers about it.
• Among older adults (those 65 or older), falls are the leading cause of injury death. They are also the most common cause of nonfatal injuries and hospital admissions for trauma.
• In 2008, over 19,700 older adults died from unintentional fall injuries.
• In 2009, 2.2 million nonfatal fall injuries among older adults were treated in emergency departments and more than 581,000 of these patients were hospitalized.
• In 2000, direct medical costs of falls totaled a little over $19 billion—$179 million for fatal falls and $19 billion for nonfatal fall injuries. This equals $28.2 billion in 2010 dollars.

What outcomes are linked to falls?

• Twenty to thirty percent of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas. These injuries can make it hard to get around or live independently, and increase the risk of early death.
• Falls are the most common cause of traumatic brain injuries (TBI). In 2000, TBI accounted for 46% of fatal falls among older adults.
• Most fractures among older adults are caused by falls. The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.
• Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities leading to reduced mobility and loss of physical fitness, which in turn increases their actual risk of falling.

Who is at risk?

Fall-related Deaths

• In 2008, 82% of fall deaths were among people 65 and older.
• Men are more likely to die from a fall. After taking age into account, the fall death rate in 2007 was 46% higher for men than for women.
• Older whites are 2.5 times more likely to die from falls as their black counterparts.
• Rates also differ by ethnicity. Older non-Hispanics have higher fatal fall rates than Hispanics.

Fall Injuries

• The chances of falling and of being seriously injured in a fall increase with age. In 2009, the rate of fall injuries for adults 85 and older was almost four times that for adults 65 to 74.
• People age 75 and older who fall are four to five times more likely than those age 65 to 74 to be admitted to a long-term care facility for a year or longer.
• Women are more likely than men to be injured in a fall. In 2009, women were 58% more likely than men to suffer a nonfatal fall injury.
• Rates of fall-related fractures among older women are more than twice those for men.
• Over 90% of hip fractures are caused by falls. In 2007, there were 264,000 hip fractures and the rate for women was almost three times the rate for men.
• White women have significantly higher hip fracture rates than black women.

How can older adults reduce risk?

To lower their hip fracture risk, older adults can:

• Get adequate calcium and vitamin D—from food and/or from supplements.
• Do weight bearing exercise.
• Get screened and treated for osteoporosis.

Falls in the Bathroom

Activities that take place in the bathroom, such as showering and bathing, are a simple part of most peoples’ daily routine. Yet, slips in the tub and falls in the shower or from the toilet may cause serious injuries.

According to a CDC study published in the Morbidity and Mortality Weekly Report, an estimated 234,000 people ages 15 and older were treated in U.S. emergency departments (ED) in 2008 for injuries that occurred in bathrooms. Four out of 5 of these injuries were caused by falls—which can have especially serious consequences for older adults.

Almost one-third (30 percent) of adults aged 65 and above who were injured in bathrooms were diagnosed with fractures. Among adults aged 85 and older, 38 percent were hospitalized as a result of their injuries.
Read the new CDC study on bathroom injuries and the related press release.

Steps for Safety in the Bathroom

Certain home safety measures may reduce the risk for all household members of being injured in the bathroom. Some prevention strategies include:

• Adding non-slip surfaces and grab bars inside and outside the tub or shower to reduce slips and falls.
• Installing grab bars next to the toilet for added support, if needed.

Preventing Falls among Older Adults

Four out of five injuries that took place in bathrooms in 2008 were the result of falls. Falls can be especially dangerous for adults ages 65 and older.

Older adults can take steps to make falls less likely. If you are 65 or older, take the following steps to reduce your risk of falling:

• Get some exercise: Lack of exercise can lead to weak legs, which increases the chance of falling. Exercise programs like Tai Chi can increase strength as well as improve balance, making falls less likely for aging adults.
• Be mindful of medications: Some medicines—or combinations of medicines—can have side effects like dizziness or drowsiness. This can make falls more likely. Having a doctor or pharmacist review all your medications can help reduce the chance of risky side effects and drug interactions.
• Keep your vision sharp: Poor vision can make it harder to get around safely. To help make sure you’re seeing clearly, have your eyes checked every year and wear glasses or contact lenses with the right prescription strength.
• Eliminate hazards at home. About half of all falls happen at home. A home safety check can help identify fall hazards, like clutter and poor lighting that should be removed or changed.

Violence Elder Abuse

Elder maltreatment includes several types of violence that occur among those ages 60 and older. The violence usually occurs at the hands of a caregiver or a person the elder trusts. There are six types of elder maltreatment:

• Physical—This occurs when an elder is injured as a result of hitting, kicking, pushing, slapping, burning, or other show of force.
• Sexual—This involves forcing an elder to take part in a sexual act when the elder does not or cannot consent.
• Emotional—This refers to behaviors that harm an elder’s self-worth or emotional well being. Examples include name calling, scaring, embarrassing, destroying property, or not letting the elder see friends and family.
• This is the failure to meet an elder’s basic needs. These needs include food, housing, clothing, and medical care.
• This happens when a caregiver leaves an elder alone and no longer provides care for him or her.
• Financial—This is illegally misusing an elder’s money, property, or assets.

Elder maltreatment can have several physical and emotional effects on an elder.

Many victims suffer physical injuries. Some are minor like cuts, scratches, bruises, and welts. Others are more serious and can cause lasting disabilities. These include head injuries, broken bones, constant physical pain, and soreness. Physical injuries can also lead to premature death and make existing health problems worse.

Elder maltreatment can have emotional effects as well. Victims are often fearful and anxious. They may have problems with trust and be wary around others.

Many cases are not reported because elders are afraid to tell police, friends, or family about the violence. Victims have to decide: tell someone they are being hurt or continue being abused by someone they depend upon or care for deeply.

Risk Factors

A combination of individual, relational, community, and societal factors contribute to the risk of becoming a perpetrator of elder maltreatment. They are contributing factors and may or may not be direct causes.

Understanding these factors can help identify various opportunities for prevention.

Risk Factors for Perpetration

• Individual Level
  • Current diagnosis of mental illness
  • Current abuse of alcohol
  • High levels of hostility
  • Poor or inadequate preparation or training for care giving responsibilities
  • Assumption of caregiving responsibilities at an early age
  • Inadequate coping skills
  • Exposure to maltreatment as a child
• Relationship Level
  • High financial and emotional dependence upon a vulnerable elder
  • Past experience of disruptive behavior
  • Lack of social support
• Community Level
  • Formal services, such as respite care for those providing care to elders, are limited, inaccessible, or unavailable
• Societal Level
  • A culture where there is high tolerance and acceptance of aggressive behavior.
  • A culture where health care personnel, guardians, and other agents are given greater freedom in routine care provision and decision making.
  • A culture where family members are expected to care for elders without seeking help from others.
  • A culture where persons are encouraged to endure suffering or remain silent regarding their pains.
  • A culture where there are negative beliefs about aging and elders.

In addition to the above factors, there are also specific characteristics of institutional settings that may increase the risk for perpetration of vulnerable elders in these settings, including: unsympathetic or negative attitudes toward residents, chronic staffing problems, lack of administrative oversight, staff burnout, and stressful working conditions.

Protective Factors for Elder Maltreatment

Protective factors reduce risk for perpetrating abuse and neglect. Protective factors have not been studied as extensively or rigorously as risk factors. However, identifying and understanding protective factors are equally as important as researching risk factors.

Several potential protective factors are identified below. Research is needed to determine whether these factors do indeed buffer elders from maltreatment.

The goal is to stop elder maltreatment before it starts. While not much research has been done, there are several things we can do to prevent it:

• Listen to elders and their caregivers
• Report abuse or suspected abuse to Adult Protective Services
• Educate oneself and others about how to recognize and report elder abuse
• Learn how the signs of elder abuse differ from the normal aging process
• If you take care of an elder here are some things you can do to prevent violence:
• Get help from friends, family, or local relief care groups
• Take a break—if only for a couple of hours
• Involve more people than just family in financial matters
• Find an adult day care program
• Seek counseling or other support if you are feeling depressed
• If you are having problems with drug or alcohol abuse, get help