Preventing Falls Crucial In Helping Older Adults Maintain Independence

Unintentional falls are the leading cause of injury and death among older Americans, making it a major concern for those who love and care for a senior. Of the roughly 1-in-4 seniors (14 million) who take a tumble each year, it’s a fatal incident for more than 41,000 older adults, according to the U.S. Centers for Disease Control and Prevention. It’s also the most common reason why adults aged 65 and up land in the hospital. On an annual basis, the demographic accounts for 3.6 million emergency room visits and 1.2 million hospitalizations.

When falls lead to serious injuries, like fractures or head trauma, the injury can cause a loss of independence, increased reliance on medical support and admission to nursing homes. The reduced mobility and deconditioning that follows can also result in a cascade of other ailments, such as worsening heart disease or other chronic diseases.

Also, falling once doubles the chance of falling again. And the older a person is when they fall, the more likely it is that they’ll be admitted to a facility for at least one year, the American Geriatric Society said.

Among older adults who receive care in a hospital, the estimated annual average cost per inpatient visit for falls injuries is $18,658 and $1,112 per emergency department admission, according to the National Council on Aging.

Between 2015 and 2020, the total health care annual cost of non-fatal older adult falls grew from $50 billion to $80 billion. According to the CDC, Medicare covers 67% of fall-related costs, Medicaid pays 4%, and 29% is paid privately or out-of-pocket.

In the U.S., the number of older adults will more than double over the next several decades to top 88 million. By the end of the decade, all baby boomers will be 65 years or older. And by 2050, the 65-plus demographic will account for 20% of the country’s population.

As a result, the number of injuries caused by falls, related medical costs and fatalities are only expected to grow. Based on current trends, the annual cost of treating older Americans who have fallen is projected to reach more than $101 billion within the next five years.

Simple steps

However, health care professionals believe simple, cost-effective strategies could go a long way toward improving public health and easing the burden on health care systems.

As of 2024, 75% of adults aged 50 and older want to remain in their current homes as they age and 73% hope to stay in their communities, according to an AARP survey.

Given the advancements in home health care and smart technology, living out the golden years at home is a conceivable reality for many. But the choice to age in place, versus moving to an assisted living facility, involves careful thought and extensive preparation.

Parulekar

“People are aging better, so that option is available to more people. And I think that’s the distinguishing factor is because, of course, we want all of us to be able to age in place much as possible. But it has to be safe,” said Dr. Manisha Parulekar, director of Hackensack University Medical Center’s geriatric division and associate professor of internal medicine at Hackensack Meridian School of Medicine.

Parulekar, a board-certified geriatrician whose areas of interest include dementia, delirium, polypharmacy, quality improvement, geriatric medicine education and health care system improvement, said, “We take care of thousands of patients and people who are more aware of what we call the physiology of aging – the certain changes that are going to happen in our physical health, our mental health, our cognitive health.”

She stressed the importance of making sure one’s health is “monitored in a systematic format” and adopting lifestyle changes to ensure that there is safety and making sure that individual has the support that they need to be able to live in their own home.”

When it comes to family and friends who want to address concerns about an older loved one residing at home, she said, “The first thing that we talk about is that it’s not a one-time conversation and we can’t expect to resolve the matter within five or 10 minutes.”

In addition to medical facts or issues, the discussion should also take into consideration a senior’s personal beliefs, values and needs, said Parulekar.

“Coming together as a team and making sure that we all come in with the understanding that the center of the conversation is to be able to let that person live independently as long as possible in a safe manner and then making this an ongoing conversation and with emphasis every time. The emphasis is that we want you to be independent and we want you to be safe,” she said.

Liz Rabban, owner of TruBlue Home Service Ally Morristown and Montclair, a franchise that offers handyman, home maintenance and senior home modifications, agreed. “The conversation around aging safely at home is often delicate because it touches on a senior’s sense of independence and identity,” she said. “Discussions about home modifications or safety upgrades can be interpreted as a loss of control or a signal that they’ve become a burden to others.”

Craig Rubinstein and Liz Rabban (second and third from left), owners of TruBlue Home Service Ally Morristown and Montclair, with their team. The company offers handyman, home maintenance and senior home modifications. – PROVIDED BY TRUBLUE

“Many older adults also find it difficult to confront the realities of aging and the physical limitations that may come with it. Within families, emotions often run high — differing opinions, guilt, exhaustion and generational dynamics can complicate decision-making. There’s also a layer of vulnerability and concern about privacy when changes to the home are suggested,” said Rabban. “It’s crucial to approach these conversations with empathy, respect, and a focus on maintaining the senior’s quality of life. We engage our customers with sensitivity – and both personal and professional experience.”

Healthy steps

Older adults who fear taking a spill may begin limiting their activities and social engagements, which can cause further physical decline, depression, isolation and feelings of helplessness.

To arm patients with knowledge and tools to reduce that worry, as well as build strength, balance and conditioning, in May 2023 Hackensack University Medical Center’s division of geriatric medicine launched the state’s first hospital-based program aimed at preventing falls in older adults.

Through the Falls Risk Assessment Program, experts trained in geriatric medicine evaluate each person’s risk of falling and prescribe an individualized plan to reduce the risk of falling and to maintain independence.

According to the hospital, older adults are screened for factors that may raise their falls risk, like problems with gait and balance, taking multiple medications that may affect balance, cognitive impairment, mood disorders, malnutrition, lower body weakness, vision problems and hearing loss. The assessment also takes into account home environment concerns, like throw rugs, poor lighting, clutter and lack of handrails.

After speaking with the patient and conducting a physical examination, the team personalizes a plan of care that could include steps like referrals to physical therapists, reviewing medication and recommending evidence-based community programs like “A Matter of Balance.” They may also refer patients to occupational therapy home assessments for creating a safer home environment.

Falls “may seem like such a minor thing” but the reality is they can take someone “from being fully independent to becoming dependent on others and in need of resources,” Parulekar said.

“There’s a lot of literature that people don’t bring up falls when they talk to their physicians, and physicians may not necessarily ask about falls when they’re seeing their patients,” she said. “So, we really make it a point to ask that question at every single visit and ask questions about home safety and discuss what is a safe home environment. We have a lot of education materials present in our waiting areas so our patients can take a look and become more aware of the risks and various resources that are available. Or various interventions that they can do safely to minimize the risk of falling.”

“I think where we see people getting in trouble or people not paying attention is adjusting to the physiology of aging. So, not continuing to do tasks like getting on the step stool and changing curtains or using a ladder to work in the house or outside the home,” she said, stressing, “It is really important to make sure that we are adjusting our lifestyle based on what you’re able to do at that particular stage in life.”

Of the 43,334 older Americans who died due to an unintentional fall in 2023, 543 of those occurred in New Jersey, according to the state Department of Human Services.

On a daily basis, an average of 287 New Jerseyans aged 60 and up are treated in the emergency room or as inpatients after a fall. Nearly 48% of those admissions are adults aged 80 or older.

In 2022, the average cost for an inpatient hospitalization to treat an older adult for a non-fatal fall was $113,406. The total cost statewide for all hospital treated falls for adults 60-plus was $3.2 billion, state health officials said.

The state also noted that many people with fall injuries do not see a doctor, receive no medical care or attempt to treat themselves, making it hard to determine the true impact.

Taking action

Given that the population of residents who are 60 years old and up is expected to grow to 24.5% of the state’s population by 2030, New Jersey has been taking action to prevent falls through a variety of initiatives.

In 2009, the Department of Human Services launched the New Jersey Falls Prevention Workgroup to help county agencies and community-based organizations reduce fall risks for local seniors. In addition to developing and implementing a fall prevention campaign geared to older adults, the group aims to build capacity for evidence-based falls prevention programs statewide via partnerships.

Part of the outreach also includes marking Falls Prevention Awareness Week in late September to highlight fall hazards and increase awareness about how to prevent and reduce falls.

An example of a community-based partnership is in Middlesex County, which is among the counties in New Jersey that have the largest populations of residents aged 65 and older. Of Middlesex County’s 863,623 residents, 16.7% are senior citizens, according to the U.S. Census Bureau.

After receiving a $516,939 grant in May 2023 from the U.S. Department of Health and Human Services’ Administration for Community Living, the Robert Wood Johnson University Hospital Injury Prevention Department teamed up with the Middlesex County Office of Aging and Disability Services to bring evidence-based fall prevention programs to the community.

The main goal of the four-year grant is to increase the number of older adults and adults with disabilities who participate in evidence-based falls prevention programs. It also seeks to identify and implement strategies that will promote the sustainability of such programs.

To achieve that, the effort is focused on expanding community partnerships through engagement in the Middlesex County Empowering Senior Fall Prevention Network to broaden the reach of two specific interventions led by trained coaches:

• Bingocize – a program coaches that combines exercise and fall prevention education with the game of bingo.
• A Matter of Balance – a program specifically designed to reduce the fear of falling and improve activity levels for older adults.

 

Additionally, grantees are collaborating with key partners, including RWJBarnabas Health, Hackensack University Medical Center, Saint Peter’s University Hospital, Catholic Charities Dioceses of Metuchen, New Jersey Health Initiatives, local senior centers, nonprofits and the Office of Aging for Middlesex County.

The effort also provides ongoing training for Rutgers Health students to implement a newly created “Check for Safety” home assessment program.

Rutgers Health students participate in the “Check for Safety” home assessment program, which offers a 30-minute visit where volunteers inspect each room of a senior resident’s home, including entrance and exits, to identify fall risks and make recommendations to improve safety. – PROVIDED BY RWJBARNABAS HEALTH

The free checks are offered to anyone who participates in Bingocize or A Matter of Balance, as well as any resident age 60-plus and individuals over 18 with disabilities who live in Middlesex County. During the 30-minute visit, volunteers inspect each room of the home, including entrance and exits, to identify fall risks and make recommendations to improve safety.

Since “Check for Safety” ramped up in May 2024, it has provided 105 evaluations, according to Diana Starace, coordinator of the Trauma & Injury Prevention Program at Robert Wood Johnson University Hospital in New Brunswick.

As for the most common hazards, Starace said, “I’d say it’s probably not having a grab bar in the bathroom or in the shower. Or it could be just as simple as picking up the throw rugs, putting down carpet tape on edges of carpet, or even helping them to rearrange their kitchen cabinets so they’re not climbing on a step stool every day to get the things they need.”

According to Rabban, key areas where seniors are most at risk are usually entryways, stairs, bathrooms and transitions between rooms.

“Bathrooms are at the top of the list — slippery surfaces, high tub walls and missing grab bars can lead to falls. We also see a lot of trip risks in older homes, like uneven flooring, outdated step-downs between rooms, or poor lighting in hallways and stairwells. And sometimes, it’s the little things, like the wrong type of doorknob or a thermostat that’s too hard to read,” she said.

In a bid to give families peace of mind and practical steps, TruBlue Home Service Ally prioritizes modifications and maintenance. Typical recommended renovations and upgrades include grab bars and railings, improved lighting, non-slip flooring, walk-in showers or tub cuts, wider doorways and clear pathways, Rabban said.

Starace

After a “Check for Safety” visit, Starace said, “We do work with them on the phone making sure that we are finding creative ways to get those recommendations fulfilled.”

“So, if they need a grab bar, we have several different ways that we can help to make sure that that resident gets the grab bar and then hooking them up with another organization who can go in and actually do the installation if they do not have the resources to get that done,” she said.

Starace went on to add, “I’ve been in this role for over 20 years. And I often say that although I love my job, sometimes it is somewhat discouraging because you can educate and train all you want and hand out tons of resources, but you don’t often get to see the outcomes.”

“With this home safety assessment, we know that we’re going to help these folks out,” she said. “ … We’re saying ‘Listen, these are the things are the things that we need to get done. Let’s figure out how we’re going to get the, done.’”

Starace continued, “We don’t have a way to extrapolate that to say that we are actually preventing X-amount of injuries. We can only say that we are improving the home environment, making it safer, mitigating those fall risks, and that, in turn, should decrease the risk of falls.”

‘We can make a difference’

Rita Truex, a clinical instructor at Rutgers School of Nursing who specializes in community health programming and community health nursing, said it’s been a valuable experience for students involved. “This semester, we have 17 junior nursing students taking the training now. We offer it through their nursing care of adults with common health conditions class as a clinical rotation. It’s really an amazing opportunity to not only learn those skills, but to ensure the safety and wellbeing of seniors in the local community,” she said.

Truex

“One of the things that’s important for all health profession students, but nursing students specifically, is that we want to enhance population-based health and prevention. Why it becomes important for them is that they can see the things that occur in the community that affect the health of the people that they may in the future see in the hospital. And it also is important because it helps students explore different areas or avenues for their career, possibly outside of hospital-based nursing,” Truex said.

“When we talk about enhancing patient and population care, we want to integrate these community-based clinical experiences in every clinical course, and it equips our nursing students with essential skills to promote preventive health outcomes and then reduce the risk of disease and injury,” she said.

Truex said, “With these partnerships and these injury prevention programs, they gain that firsthand experience in identifying and addressing home safety concerns that contribute to falls among senior citizens … We like the idea of having our students go out and sustain this program for a number of reasons, not just for the students’ experience, but also because we know that we can make a difference by implementing this training and this fall assessment. We know that we can potentially prevent a lot of falls that way.”

Starace also highlighted the value of ongoing relationships with partners like Rutgers Health, saying these types of collaborations have helped sustain several programs over the years.

“The partnership that we have now with Rutgers Health … is rewarding because we know that it’s a win-win for everybody. We don’t have a lot of staff to support these programs and we’re really trying to saturate Middlesex County with this information. And our students who are helping us are learning right along with us. They’re making it easier for us and they are really getting so much out of this. Not just the learning part – but the leadership, the teamwork, the presentation skills and the self-confidence. All of that is built into this. So, I just think it’s an amazing partnership that I hope is going to continue for lots of years,” Starace said.