Emergency department (ED) visits and mortality from falls among older Canadians are trending upwards, data indicate. Hospitalization rates have held generally steady, but they are increasing among Canadians older than 65 years.
Most falls occurred in the home and while the person was walking. “This information provides guideposts for prioritizing prevention efforts, such as targeting women, those aged 80 or older, and older people who live alone or have low income,” according to the authors.
The data were published online June 8 in a report from the Public Health Agency of Canada (PHAC).
Social Factors Critical
The report is a follow-up to an analysis published in 2014, Anna Maddison, a spokesperson for PHAC, told Medscape Medical News.
The current authors analyzed self-reported data from Statistics Canada’s Canadian Community Health Survey (CCHS) for 2017-2018, hospitalization statistics from the Canadian Institute for Health Information’s (CIHI) Discharge Abstract Database for 2008-2009 to 2019-2020, ED visit statistics from CIHI’s National Ambulatory Care Reporting System for 2010-2011 to 2019-2020, and mortality data from Statistics Canada’s Canadian Vital Statistics Death Database for 2001 to 2019.
In 2017-2018, 5.8% of people older than 65 who lived in a household reported a fall in the previous year. Women were more likely than men to have a fall-related injury (6.5% vs 5.0%), and fall-related injuries were more common among people over age 80 than those aged 65 to 79. About 61% of falls occurred while walking.
The absolute number of fall-related hospitalizations rose by 47% between 2008-2009 and 2019-2020, but age-standardized rates were similar at about 15 per 1000 people. The increase in fall-related hospitalizations is partly attributable to the aging population, but other factors may contribute, too. Fall-related ED visits, deaths, and hospitalizations also rose, despite adjustment for age.
One possible contributing factor is chronic conditions like Parkinson’s disease, diabetes, arthritis, cardiovascular disease, chronic obstructive pulmonary disease, and stroke, according to Maddison. People are living longer with these conditions, as well as acute illness, balance impairment, and gait deficits, “all of which can result in physical limitations affecting one’s mobility, gait, and balance,” she added.
About 52% of falls that led to hospitalization happened at home. Approximately 17% occurred in a residential care facility.
Fall-related mortality increased over time, with the age-standardized fall-mortality rate increasing by 111% from 41.0 to 86.4 per 100,000 people between 2001 and 2019. Mortality rates increased among older age groups, especially for those over 90. More women died from falls, but men had higher age-standardized mortality.
Physicians can play a role in fall reduction, said Maddison. The report “can help them understand factors that put individuals at higher risk of fall-related injuries,” including female sex, being age 80 or higher, and living alone or having low income. “This can help to tailor advice regarding preventive and management practices. Prescribing strength, balance, and gait improvement exercises is never too late and should be a regular practice. Decrease in muscle strength and endurance occurs as people age, and muscle weakness increases the risk of falling, so prescribing safe physical exercise that increases balance and mobility is important,” said Maddison.
Social factors, too, affect fall risk. “Older adults with higher life satisfaction, engagement in social activities, and positive relationships (such as family, peer, and community support) were less likely to report a fall or sustained disability,” said Maddison.
Confronting "Fallophobia"
The Canadian government has invested in making cities and communities more senior-friendly by improving transportation and parking and assessing physical environments. But individual factors like medication adherence and access to homecare have faced more barriers to investment, especially during the pandemic, and these factors need to be addressed, Chris Frank, MD, a family physician and clinical lead of specialized geriatrics at Providence Care in Kingston, Ontario, Canada, told Medscape.
Frank called for more investment in community-based exercise programs that offer structure and a social component without professional input. “Those things were a challenge before the pandemic, and they are a bigger challenge now. Those are things that don't necessarily receive a lot of funding to make them happen, but they're super relevant for fall prevention,” said Frank.
A sometimes-overlooked consequence of falls is what Frank calls “fallophobia,” where patients who have fallen lose confidence in their ability to move safely. This reaction promotes reduced activity and erosion of physical capability. “The next time they have to do something like get up to go to the bathroom, they’ll be weaker, and they're more likely to have a fall. It’s a vicious cycle,” said Frank.
He actively asks patients about falls, because they can be reluctant to report them if they didn’t lead to injury or a hospitalization. “They kind of figure, ‘If I'm falling, somebody is going to try to take me out of my home.’ That’s just a fear that people have,” said Frank. He routinely checks the patient’s posture, vision, and medications and asks about the home environment.
Maddison is an employee of PHAC. Frank disclosed no relevant financial conflicts.
Jim Kling is a science and medical writer in Bellingham, Washington.
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Fall-Related Mortality Rising Among Older Canadians - Medscape
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