Effort fights ‘epidemic’ of deadly elderly falls

Elderly people seldom want to talk about it.

It’s scary, and if it’s happened to them and they’ve survived, they’re often embarrassed.  And worried. One time too many and — whoosh — it’s off to a nursing home.

But it’s happening more and more: People 65 and older are falling and an increasing number are dying as a result. Nationally, the rate of death after a fall jumped more than 35% between 2005 and 2014.

In Wisconsin, public health experts are calling it an epidemic. The state’s elderly death rate from falls is second highest in the country and double the national average.

Experts can’t say for sure why.

While studies are underway and advocacy groups and others scramble for better answers, specialists with the University of Wisconsin-Madison have teamed up with their counterparts in Oregon, as well as with the federal Centers for Disease Control and Prevention and health care records software giant Epic Systems, to build a program that helps predict whether an older person will fall. It not only calculates the risk — it steers physicians to preventative treatments.

“We know that over half of people who fall don’t even talk to their health care provider about it,” said Hilary Eiring, a public health policy analyst with the CDC's National Center for Injury Prevention and Control.

As a result, they don’t get proper treatment and are more likely to fall again, she said.

Falls are the leading cause of injury-related deaths nationally as well as in Wisconsin for people 65 and older. In Wisconsin, 37,000 people in that age group went to an emergency room after a fall in 2014, the most recent year for which statistics are available. Medicare costs for nonfatal falls nationwide topped $31 billion in 2015.

The screening system — called Stopping Elderly Accidents, Deaths & Injuries, or STEADI — forces the conversation between doctors and their older patients.

Designed to make it easy and cost-effective for physicians across the country to build it into their routine care of elderly, the screening system takes into account many well-established risk factors for falls, such as what medications a person is taking and how many medications they are on, their leg strength and balance, their vision and whether they’ve fallen previously.

The program determines if the patient is at low, moderate or high risk of falling and then directs the doctor to a variety of correlating treatments.

The screening system was launched as a tool kit for physicians in 2012, but few used it because it was not incorporated into software used to record health histories. Now, as it is integrated into electronic health records, use of the screening system is expected to increase.

Epic is the only company offering it electronically nationwide, according to the CDC, but the screening is also being integrated into systems of other electronic health record companies, such as GE Centricity.

The cost of a fall

Betsy Abramson is the executive director of the Wisconsin Institute for Healthy Aging.

She tells the story of her mother-in-law, who was a healthy and active 94-year-old before she slipped on a bathroom mat in the middle of one night in June 2014 and broke her hip.

The injury led to four hospitalizations, two surgeries and four emergency room visits, as well as 100 days in a rehab unit, followed by nearly a year of round-the-clock home care.

Total cost: $800,000.

She died 16 months later.

Abramson said her mother-in-law’s fall — like most — was preventable.

There are many things older people can do to ensure they don’t fall. Some seem like common sense. Others are more medically related. Whether it’s moving dishes within better reach and keeping a light on in the bathroom at night or having a vision test and taking a tai chi class, all require some type of action.

The top risk factors include:

• Taking certain types of medications — those with warnings about driving or operating machinery while taking — as well as the number of medications. Taking four or more different types of medications significantly increases the risk of falling.
• Inadequate vitamin D intake.
• Vision problems. Not having proper eyeglass prescriptions, or having cataracts.
• Weakness in lower legs, or foot or ankle disorders.
• Trouble with balance.
• Cords, loose rugs, clutter, poor lighting and other obstacles in the home. 

The biggest risk factor for a fall is a previous fall.

Judy Howden had fallen a few times, once seriously in 2013, before she got introduced to a fall-prevention workshop called Stepping On. The program teaches strength and balance exercises and other strategies to help prevent falls.

Howden, 76, has a neurological disease and other health issues that leave her shaky on her feet. So much that she and her husband of 53 years sold their spacious, historic home near Washington Park and bought a small bungalow a block away.

“A lot of people at this juncture might say, 'Why don’t you get in a wheel chair and be safe, silly,' ” Howden said. “But all of my doctors have said ‘If you stop moving the risk is far greater.' If I’m trying to keep living, I’ve got to keep moving.”

Now when Howden moves, she plans each step. She holds on to furniture when needed, and when grocery shopping uses the cart like a walker. She doesn’t go to the theater anymore. She doesn’t go to the theater anymore. She learned strategies in the Stepping On classes for walking sideways to get in and out of the aisles, but she’s not comfortable moving quickly with the crowds. She holds on to railings whenever possible and replaced the bathtub in their new house with a walk-in shower with a holding bar. 

“I do very little conversing while I’m walking. I have to think and concentrate to force my feet to do what I want them do.

“My life keeps getting more narrow. … But I keep thinking if I learn enough stuff, I can to do what my doctors say and keep moving for a longer period of time in a safe way.”

Small changes can make big difference

Jane Mahoney helped bring the Stepping On program to Wisconsin from Australia, where it was created.

As a professor of medicine in the division of geriatrics with the UW-Madison School of Medicine and Public Health, Mahoney was also a lead designer of the STEADI program.

She said making it easy and incentivizing the screening for physicians is critical to the program’s success. Prompting doctors to prescribe specific treatment interventions works, she said.

She cited the example of lowering the dosages of certain medications that people might have been taking for decades.

“We know older adults don’t need the same dosage they needed at middle age,” Mahoney said. “The body metabolizes the drugs differently and they are more susceptible to side effects.”

Reviewing and modifying use of medications — especially sleeping and anti-anxiety medications — cuts the risk of falling by nearly 40%, according to the CDC.

Mahoney and others specialists aren’t certain why Wisconsin’s death rate among elderly people who fall is so high. According to CDC figures from 2004-2010, the national rate of deaths from unintentional falls of those age 65 and older is about 48 in 100,000. In Wisconsin, it’s about 105 per 100,000, second only to Vermont.

Much of the difference could be attributable to better reporting in Wisconsin, said Becky Turpin, adult injury prevention coordinator with UW Health at University Hospital. CDC data show counties throughout much of the country don’t fully report fall deaths and there is no national requirement to track such deaths.

Binge and regular heavy drinking could also be a factor, Turpin said. Like the state’s youth, Wisconsin’s older adults also drink more than the national average and that could lead to more serious falls.

“We know our older population is growing leaps and bounds. Folks are living longer but not necessarily healthier,” she said.

Learn more

For more information on the Stepping On program, call (608) 243-5690 or email info@wihealthyaging.org.

To learn more about the STEADI screening, visit www.cdc.gov/steadi