LEARNING OUTCOME AND OBJECTIVES:  Upon completion of this course, you will have gained increased knowledge related to preventing falls in clinical and community-based settings. Specific learning objectives to address potential knowledge gaps include:

• Discuss the impact of falls on patients, clinicians, caregivers, and facilities.
• Summarize the components involved in maintaining balance.
• Understand the primary roles of the interdisciplinary team members in managing patients at risk of impaired balance and falls.
• Identify common risk factors for balance impairments and increased falls.
• Describe how to assess a patient for increased risk of falls.
• Discuss appropriate fall prevention and risk mitigation strategies for individuals at increased risk of falling in both clinical and community settings.

FALLS AND THEIR IMPACTS

Falls present a serious and growing public health problem. The World Health Organization defines a fall as “an event which results in a person coming to rest inadvertently on the ground or floor or other lower level” (WHO, 2021a). Falls may be fatal or nonfatal, though most are nonfatal.

Falls have been identified worldwide as the second most common cause of unintentional death. It is estimated that approximately 684,000 people die from fall-related injuries each year, with over 80% of fatal falls occurring in low- or middle-income nations (WHO, 2021a). In the United States, over 36 million falls in older adults (ages 65+) are reported each year, resulting in nearly 3 million people being treated in emergency departments, with over 800,000 older adults subsequently hospitalized and over 32,000 deaths (CDC, 2020a).

Fall risk continues to rise with increased age. Globally, people over age 65 are estimated to have a 1-in-3 risk of a fall during a given year. For older adults, a fall can be a serious threat to health, mobility, and long-term independence, which can also impact caregivers and other family members. Even when falls are not fatal, they can have serious and far-reaching consequences. For example, at least 20% of older people who fall in the United States suffer moderate to severe injuries such as bruises, hip fractures, or head trauma. Over 95% of hip fractures, which can have serious long-term negative effects, are caused by falls. Those who experience a fall are 2–3 times more likely to have another fall (CDC, 2021, 2023a; WHO, 2021b).

For older adults living in facilities, the risks are still higher. Worldwide, it is estimated that nursing home residents experience 1.6 falls per bed per year on average, with almost half of residents experiencing multiple falls per year. Those who require low-to-middle levels of care experience more falls than those requiring either a high level of care or no care (WHO, 2021b).

The financial burden of treating falls is profound. Annual direct medical costs of treating nonfatal fall-related injuries in the United States exceed $50 billion, with $754 million spent on costs related to fatal falls, which places a significant burden on both Medicare and Medicaid, as well as on private insurers and individuals. These medical costs include hospital and nursing home care, healthcare provider and other professional services, rehabilitation, community-based services, rental or purchase of durable medical equipment, prescription drugs, and insurance claims processing (CDC, 2020b). As reported by the National Council on Aging in 2021, the average hospital cost of a fall-related injury exceeds $30,000 (NCOA, 2021).

As a person’s age increases, so too does the average cost of treating a fall-related injury. Indirect costs resulting from falls may include long-term effects such as disability, loss of personal independence, time lost from work and household duties, diminished social and/or community engagement, and overall reduction in quality of life (CDC, 2020b). When falls occurs, fear of falling again may cause older people to limit their household or social activities. Both fear of falling (with or without an accompanying fall event) and actual falls have been independently associated with decreased perceived quality of life (NCOA, 2021; Schoene et al., 2019).

The consequences of falls are not limited solely to the individual who experiences the fall. Loss of independence following a fall event may lead an individual to depend more on caregivers. Research indicates that caregivers may feel increased burden of care, fear of recurrent falls, and potentially increased risk of caregiver depression following the care recipient’s first fall. When surveyed, 1 in 5 caregivers reported increased physical strain as a result of caregiving, while over 40% of caregivers reported a need for more information on how to keep care recipients safe in the home setting (NCOA, 2021).

When preventable falls occur in a facility setting as a result of errors or oversights, both patient welfare and a facility’s finances and reputation may be adversely affected. In 2008, the Centers for Medicare and Medicaid Services stopped reimbursing hospitals for costs related to patient falls, leaving facilities and staff with increased responsibility for making fall prevention a high priority and crucial component of patient care (Fehlberg et al., 2017).

However, for such a serious public health problem, falls are also among the most preventable. Research has shown that injury prevention programs related to falls can significantly decrease the incidence and reoccurrence of balance-related falls for those at risk. Adopting clear and consistent safety guidelines and providing comprehensive education for patients, caregivers, and clinicians may help facilities reduce their risk of patient falls and related injuries, allowing them to provide better care for at-risk patients.