It is your therapists responsibility to perturb your walking a lot so you know exactly how to prevent falling. My therapists did nothing for that. I just went out walking in the woods next to me on unmaintained trails with fallen trees, roots and lots of standing water and muck each spring. I stumble a lot but because I've been practicing this for years I don't fall very often. Dance around quite a bit to stay upright but you have to challenge yourself bit by bit to get to that level of confidence.
Trends in Deaths From Falls Among Adults Aged 65 Years or Older in the US, 1999-2020
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US Preventive Services Task ForceUSPSTF Recommendation: Interventions to Prevent Falls in Community-Dwelling Older AdultsUS Preventive Services Task Force; David C. Grossman, MD, MPH; Susan J. Curry, PhD; Douglas K. Owens, MD, MS; Michael J. Barry, MD; Aaron B. Caughey, MD, PhD; Karina W. Davidson, PhD, MASc; Chyke A. Doubeni, MD, MPH; John W. Epling Jr, MD, MSEd; Alex R. Kemper, MD, MPH, MS; Alex H. Krist, MD, MPH; Martha Kubik, PhD, RN; Seth Landefeld, MD; Carol M. Mangione, MD, MSPH; Michael Pignone, MD, MPH; Michael Silverstein, MD, MPH; Melissa A. Simon, MD, MPH; Chien-Wen Tseng, MD, MPH, MSEE
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JAMA Patient PagePrevention of Falls in Older AdultsJill Jin, MD, MPH
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Preliminary CommunicationEffect of a Home-Based Exercise Program on Subsequent Falls Among Older Adults After a FallTeresa Liu-Ambrose, PT, PhD; Jennifer C. Davis, PhD; John R. Best, PhD; Larry Dian, MD; Kenneth Madden, MD; Wendy Cook, MD; Chun Liang Hsu, PhD; Karim M. Khan, MD, PhD
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Research LetterMortality From Falls Among US Adults Aged 75 Years or Older, 2000-2016Klaas A. Hartholt, MD, PhD; Robin Lee, PhD, MPH; Elizabeth R. Burns, MPH; Ed F. van Beeck, MD, PhD
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Medical News in BriefSystematic Review: What Works to Prevent Falls for Older PeopleEmily Harris
In 2020, 42 114 deaths in the US were related to falls, with 86% occurring among adults aged 65 years or older.1 Falls are the leading cause of injury and among the leading causes of death among older adults in the US.2,3 The increase in the number of older adults in the US and in the number of falls within this population underscore the need for population-level studies on this issue. Calls for such analyses date back to the 1990s,4 yet the majority of studies focus on injuries related to falls.3 More recent calls have also emphasized the need to study racial and ethnic differences in falls among older adults in the US.5 This study examined trends in deaths from falls among US adults aged 65 years or older by sex and by race and ethnicity between 1999 and 2020.
Elizabeth: Finally, another research letter from JAMA and this is looking at trends in deaths from falls among adults aged 65 years and older in the U.S. between 1999 and 2020. Falls, hip fracture, a procedure relative to that is often followed by death. That's a trajectory we've noted many times in this podcast.
In 2020, this research letter cites, there were 42,114 deaths in the U.S. that were related to falls, and 86% of those occurred among adults aged 65 and older. Falls are the leading cause of injury and among the leading causes of death among older adults in the U.S.
The really bad news is when you take a look at the trajectory those trends and deaths from falls are increasing. This study then further examines how is it doing relative to sex, race, and ethnicity during those years.
They used the CDC's WONDER platform to take a look at this and they calculated these age-adjusted mortality rates. What they found out is that age-adjusted mortality rate was highest for men across this period. It was highest among white people, followed by American Indians or Alaska Natives. This is one of the few times that we note that the risk is higher for Caucasians than it is for other ethnicities. When we take a look at magnitude of the increase, it was highest among women and white older adults.
Rick: It's clear this is a substantial problem, especially for elderly individuals. Some of the limitations in this particular study is this is all done from coding. They looked at the hospital records and they said, "Here is a record of the person who had a fall. Here is a record that the person died." There is a lot of other information missing. What other comorbid conditions did the patient have? Did they have a stroke? Did they have severe diabetes, or obesity, or a cardiovascular disease? Have they fallen before? Were they on blood thinner medications? Where did they fall, by the way?
There are more falls recorded more recently than previously. It looks like the age adjusted-mortality rate has gone up. We do need to address falls, there's no question about it, but the overall issues are, what are the surrounding circumstances that contributed to that?
Elizabeth: I agree. I mean, I think more specific information relative to all of the things that you've identified would be very helpful. Having said that, I would also say that even among hospitalized patients, this is a huge problem. We have also reported on the benefits of things like tai chi and helping people to maintain their balance and try to avoid falls. I would like to see this translated into more interventions, especially those that we already know are helpful.
Rick: When you say intervention, you're talking about specifically prevention -- that is, things that maintain muscle tone, things that maintain stability, and things that maintain ambulation. It can even be something as simple as having glasses where you can see what's going on and outfitting your home.
I agree with you. We need to look at this holistically. Things that we can do to prevent falls are things that improve overall health as well.
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