Falls in the Elderly

About 40% of elderly people (age 65 and above) fall every year. 20-30% of those who fall, are at least moderately injured. In the United States, falls are a leading cause of death and disability in elderly people. Approximately 1 in 20 older adults receives emergency department treatment each year, because of a fall. Falls cause a large proportion of institutionalization, and in 1994, costs of fall-related injuries among the elderly totaled more than $20 billion. (see U.S. Fall Deaths Rates).

Skeletal conditions, include osteopenia and osteoporosis, can lead to falls in the elderly. In healthy individuals, bone mineral density peaks around age 35 and then declines. Certain individuals may never obtain healthy bone mineral density, and others may lose it too rapidly.

Osteopenia refers to individuals with low bone mineral density, but above the density threshold for osteoporosis. Osteoporosis refers to bone mineral density that is extremely low; bones are thin and weak leaving them susceptible to unexpected fracture. Any resulting vertebral skeletal deformities and unexpected fractures may cause affected individuals to fall. Bone scans can diagnose affected individuals early. (view osteopenia in hip)

The most serious outcome of falls in the elderly is hip fracture. A secondary prevention strategy for falling among the elderly includes reducing the amount of energy transferred to the hip during a fall. In the United States, osteoporosis affects more than 10 million and hip fracture approximately 212,000 elderly annually. (see Trends in Hospital Admissions due to Hip Fractures in the elderly)

Falls in the elderly is of global concern. The world's elderly population is expected to grow by more than 80% in the next 25 years. At least 10 industrialized countries are expected to have 20% of their population aged 65 or older. Without strong intervention, fall-related injuries will only increase. Challenges for public health professionals include preventing rapid bone loss, preventing falls in diverse populations, and secondary prevention of fall-related fractures.

Fall Risk Factors in the Elderly:

Host factors: impaired gait, balance, vision, and cognition; neurological and musculoskeletal disabilities; and use of psychoactive medication.

Environmental hazards: uneven or slippery surfaces, poor lighting, loose rugs, unstable furniture and objects on the floor.

Current Public Health Strategies:

I. Understanding the etiology behind race differences in fractures

II. Understanding the injury mechanisms of fall-related fractures

III. Identifying and evaluating the efficacy of fall and fracture interventions

IV. Identifying clinical screening measures for individuals at high risk for falls and osteoporosis

V. Evaluating the efficacy of pharmacological and nutritional therapies for osteoporosis

kaf24@pitt.edu March 2001