Commentary

Defying Gravity

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Last week, I fell in the driveway. I was taking the trash to the curb when I tripped and fell into the large blue recycling bin. Although it was 6 AM, I jumped up and looked around, horrified that someone may have seen my episode of gracelessness. I did bump my head and spent the rest of the day feeling stupid while rubbing the sore spot.

This incident, though more ego-bruising than anything, really conveyed to me the concerns of falling—not only for the elderly, but for all of us. So, not to be confused with the signature song from the musical Wicked sung by Elphaba (the Wicked Witch of the West) who has a desire to live without limits, my editorial this month discusses sobering limits in our everyday lives. And it does implicate gravity!

According to the National Council on Aging, about 1 in 3 adults ages 65 and older fall each year.1 Unintentional falls are the leading cause of nonfatal and fatal injuries (eg, hip fractures, head trauma) for older adults and result in about 57 fall-related deaths per 100,000 people per year.1,2 In 2013, more than 25,000 elderly individuals in the United States died from unintentional fall injuries.3

Who falls? Who doesn’t? But data indicate that among community-dwelling individuals older than 65, women fall more frequently than their male counterparts.4 But while injury and mortality rates rise dramatically for both sexes, regardless of race, after age 85, men in this age-group are more likely to die from a fall than are women.5

There are many risk factors that contribute to falling (see the table6), with gait and balance problems reported as the most significant contributor to falls among older adults.7 In addition, researchers report an increase in diseases linked to falls: diabetes, heart disease, stroke, arthritis, and Parkinson disease. In many cases, the medication used to treat the disease increases the risk for falling.8 It behooves every clinician to assess for and address any modifiable risk factors at each patient visit; one valuable resource is the CDC’s Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults.9

The issue of falling must be addressed on a larger scale, though. In response to the sobering statistics about falls, retirement communities, assisted living facilities, and nursing homes are trying to balance safety with their residents’ desire to live as they choose. They are hiring architects, interior designers, and engineers to find better ways to create safe living spaces, including installing floor lighting (similar to that on airplanes) that automatically illuminates a pathway to the bathroom when a resident gets out of bed.10

Continue for fall prevention in the community >>

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