Issue link: http://viewer.e-digitaledition.com/i/620826
FA LL S AC C OUNT FOR eight million emergency department visits annually in the United States, with 2.5 million of these falls occurring among the elderly. As this population lives longer and strives to pursue an active lifestyle, the risk of falling in and outside of the home contin- ues to be a substantial public health issue. In 2013, $34 billion was spent on health care directly related to the result of a fall. The average hospital cost for a fall injury in the U.S. is $35,000, and 250,000 elderly patients are hospitalized each year for a hip fracture resulting from a fall. Fa lls are a lso the leading cause of death in those age 85 or older, with 20 percent of fa lls causing severe bone fractures or head injuries. The most common fractures in the elderly after a fall include hip, wrist, shoulder, pelvis and spinal fractures. Physicians who care for older adults can play a key role in identifying fall risk factors in their patients. Medical risk factors include: + Heart and lung disorders that can lead to deconditioning + H istor y of a prev ious fa l l (t hese patients are twice as likely to sužer another fall) + History of a recent hospitalization + Mu scu l a r wea k ne s s a nd /or ba l- ance issues + Neuropathy + Side ežects of prescription medication In addition, elderly patients often fall victim to environmental fall hazards, such as wet and/or slippery surfaces, loose throw rugs, tripping over walkers or canes, crowded and cluttered rooms, inadequate lighting, and footwear with no treads and/or smooth socks. Many older adults have more than one of these risk factors as a part of their medical history or social situation. W hile fa lls can lead to a f inancia l burden to patients and the healthcare system as outlined above, the resulting hospitalization after a fall can affect many aspects of a patient's life. Medically, patients admitted for a fall are at a higher risk for deep vein thrombosis in both legs, as well as pulmonary embolism. Blood thinners can also lead to bleeding complications. Other medical sequelae of hospital admission after a fall include high rates of pneumonia, urinary tract infections and deconditioning. Socia lly, the long-term impact can result in the need for prolonged care at an extended care facility or rehabilitation center. Patients routinely need to become reliant on a cane or walker and lose their pre-injury independence. Many patients are unable to return to a job or activity that increased their quality of life. Patients also feel they become a burden on their families during this recovery time. To focus on fall prevention, the fol- lowing is a list of things physicia ns can encourage patients and caregivers to rev iew in order to ma inta in fa l l safety precautions: + E n s u r e r o om s a r e w e l l-l i t a n d light switches are easily accessible at nighttime. + Use a cane or walker if there are con- cerns with balance or weakness. + Clear paths of clutter and objects that may cause a trip or fall in the home. + Discuss medication side ežects with your doctors to see if these could lead to a fall. + Ca r r y a cel l phone or a life-a ler t device to alert a family member if a fall should occur. Medically, it is important to perform weight-bearing exercise and eat a well- balanced diet to maintain good physical condition and muscle strength. It may also be prudent to recommend a calcium/ vitamin D supplement or a multivitamin should be added to patients' routines. A bone-density screening may also be appropriate for men and women with risk factors for a fall. These fall prevention techniques are key elements in maintaining an overall hea lthy and safe lifestyle among the elderly while minimizing consequences associated with a significant fall injury. Dr. Johnson is an orthopedic trau- matologist at Mercy Medical Center in Canton, Ohio. ■ A Key Element in Maintaining Wellbeing among the Elderly Population BY ERICK A JOHNSON, MD Fall Prevention: 2 2S P E C I A L S E C T I O N : O R T H O P E D I C S