Fall-related injuries worse for kids and seniors
Falls accounted for 41 percent of admissions to the Mayo Clinic Trauma Center in Rochester, Minnesota, between 2013 and 2015. Nine percent of those admitted were children 14 and under, with the majority of injuries — mainly playground-related fractures — occurring in kids 5 to 9 years of age.
According to Kimberly (Kim) J. Lombard, trauma injury prevention coordinator at Mayo Clinic's campus in Minnesota, younger children are especially at risk because their motor and decision-making skills aren't fully developed. But playgrounds themselves can be more or less dangerous, depending on the level of supervision, condition and type of equipment, and surface — in studies, rubber surfaces have lower injury rates than grass or concrete, for instance.
Lombard says emergency providers have an opportunity to raise awareness of these risks. "You can have a nonjudgmental, nonblaming conversation with the family, helping them figure out what caused the injury. By asking key questions, you may help the parents think about what they might do differently in the future. We're not telling kids not to play, just that their environment and behaviors may have to change," she explains.
Older adults most at risk
Although children's falls are a concern, adults 65 and older are far more likely to fall and to sustain serious or fatal injuries as a result. According to the Centers for Disease Control and Prevention, at least 25,000 older Americans die of falls each year — a number that has been rising steadily for the last decade.
Falls are also the leading cause of nonfatal injuries among seniors. One fall in 10 causes a hip fracture or head injury requiring hospitalization, often followed by a lengthy recovery in a long-term care facility. Fewer than a quarter of patients are able to function independently when they return home. Even harmless falls have consequences. Fearing they'll fall again, older adults can become more isolated and inactive, which causes loss of muscle strength and balance — both major fall risks.
Lombard says this is another area where emergency providers can play a crucial, interventional role. "Fall prevention is multifactorial," she points out, noting that risk factors such as medication side effects, poor footwear, low vision and bone health are all issues providers can address. Improving muscle strength and balance are also top priorities — and not just by walking but also by incorporating strength training into a regular fitness program.
Lombard recommends referring patients to evidence-based fall prevention programs that tackle all these issues. "We would like providers to look for resources for older adults, to see what's available in the community through local health departments and agencies on aging. The number of initiatives is growing rapidly," she says. "Providers may also find champions within their own organizations by reaching out to physical therapists, pharmacists and geriatricians. We have to work collectively — this is too much for one person; it takes the hands of many."
Mayo Clinic has begun offering Stepping On, a seven-week, evidence-based fall prevention program aimed at educating and building confidence in community-dwelling older adults who have fallen or are afraid of falling. The program has proved to reduce falls by 31 percent in this population.
Stepping On, which is taught by both a program leader and a peer leader, draws on the expertise of a range of specialists, including pharmacists, physical therapists, vision specialists and community safety experts.
"We're in the business of changing behavior and that is never easy to do, so the program uses different methods to accomplish that," Lombard says. "It's a great program made even better because there is a lot of sharing of resources and stories among the participants. We want to hear about the changes they've made and goals they've accomplished. It makes others want to do the same."
The goal is to expand the program into the community and region and to train more people to offer it, Lombard says. "There is a real disconnect between the clinic and the community, and we need to do a better job of connecting programs with patients. Emergency providers are in a prime position to intervene by making referrals to specialty care services such as physical therapy and connecting patients to evidence-based fall prevention programs."
For more information
Centers for Disease Control and Prevention. CDC compendium of effective fall interventions — What works for community-dwelling older adults, 3rd edition.