Introduction
Falls are one of the most severe threats to the older population as they can cause serious injuries or even be fatal. The most common consequences are hip fractures or head damage which lead to diminishing functional independence and an overall decrease in a life’s quality. The category of the population most susceptible to falls in older people, especially those over 65, due to their weakness, balance and cognitive problems, side effects of taking medications, and other reasons (Jin, 2018). In 2019 alone, falls among this group of people reached 3 million, including only recorded cases, with more than 34 thousand resulting in death, making the problem the leading cause of injury among the elderly. Therefore, it is vital to assess the risks and explore the possible methods of health education interventions in order to reduce the morbidity and mortality rates for the target population. This paper will provide an overview of the problem in the USA in general and in Miami, Florida, specifically, and review the statistics and data on the injury and death rate. Then, it will present the HP2020 report and describe the different strategies for fall prevention as well as health education interventions.
Main body
In the USA, fall-related problems are extremely acute among adults aged 65 or older. The data from the Centers for Disease Control and Prevention (CDC) (2017) demonstrates a rise in the fall death rate of 30 percent between 2007 and 2016. In Florida, though, the situation is not the most extreme. According to CDC (2018), the percentage of falls reported there is 25,4%, which is equal to the national. The number of deaths in the state is identical to the national as well and makes 66 fatal falls per 100 thousand people in the same year. As for Miami, fall injury hospitalizations from 2007 to 2009, which were taken due to the lack of more relevant reports, most often happened in the community of Kendall and the sections of Homestead (FloridaHealth, 2014). There were 944 and 474 fall-related injuries, respectively, during that period. Hence, even though not being critical, the situation still needs to be addressed in order to prevent the constant observed increase in the cases.
The risks of falls or fall-related damage increase with age, and thus, a higher percentage of injured is esteemed to be among people over 85 – 33.8% (Moreland et al., 2020). Such factors as chronic health conditions, the use of medications, and overall functional decline contribute to that. At the same time, according to Moreland et al. (2020), gender is not an important factor; whites tend to report falls more often – 23.5% – whereas fall-related injuries are more common among American Indians and Alaska Natives – 28.3%. Another factor significantly influencing the rate was the previously performed physical activity: those who led an athletic lifestyle reported falls less often – 24.9% compared to 33.1% among the less active population (Moreland et al., 2020). This view is consistent with the findings from the CDC (2017), including vitamin D deficiency, use of medicines, and vision problems as other factors contributing to the increase in risks. Therefore, having analyzed the risks and the related data, it is now reasonable to proceed to the possible recommendations for fall prevention.
Healthy People 2020 is an initiative aimed at improving the health of Americans providing 10-year objectives for the program implementation. Older Adults were one of the new HP2020 topics with the goal of enhancing the quality of life for this category of the population. This issue became more essential with the aging of the population and increasing the risks of the development of many chronic diseases causing deaths. The falls, being the leading injury cause, as was mentioned above, deserve special attention in terms of the HP2020 as well. Therefore, the main objectives are: to increase the use of Welcome to Medicare among the elderly, to increase the proportion of geriatric certified healthcare workers, and to reduce the proportion of adults with limitations (HealthyPeople, 2020). Moreover, some recommendations are given based on the most common risk factors. Firstly, particularly falls prevention programs are to implement through aging services. Then, the provision of relevant educational materials can help healthcare workers recognize the risk factors earlier and, consequently, prevent them more effectively. Lastly, some evidence-based interventions are tested to be further used by the personnel of the healthcare facilities.
As for population-level prevention and health promotion, the main recommendation of the U.S. Preventive Services Task Force (USPSTF), according to Guirguis-Blake et al. (2018), is exercise. The evidence from the same source demonstrates that exercise intervention helps decrease the risk of falls to a moderate extent for older adults. The multifactorial interventions are disputable, while the widespread belief in the positive influence of vitamin D is opposed (Guirguis-Blake et al., 2018). The frequency of the exercise in the research was no less than three times per week, most commonly including the balance, gait, and functional training performed throughout the year. Although this recommendation does not contribute to the decline in deaths resulting from falls, it is crucial for the overall improvement of the fall-related situation as it leads to a decrease in fall reports of participants by 3.8% (Guirguis-Blake et al., 2018). The intervention effect on morbidity presented a median decrease of 0.35 injurious falls per person-year (Guirguis-Blake et al., 2018). Thus, the evidence proves the effectiveness of exercises in the prevention of falls.
Other recommendations include the removal of environmental hazards and making homes safer places. As CDC (2017) states, the risks of falling are lower when there are no potentially disturbing things and better lighting. Finally, scheduled doctor’s checks and visits can be effective for the prevention of falls as it ensures timely risk assessments and the respective measures undertaken by the healthcare workforce. Therefore, all the recommendations aimed at health promotion and interventions, including the improvement in the education of health workers, should reduce the number of falls and fall-related injuries if appropriately followed.
Conclusion
To conclude, due to the global and the U.S. specifical trend of the aging population, it is essential to take into account the problems that the elderly face and address them. Falls, being the most frequent cause of injuries and deaths among the population older than 65, require immediate action. With the help of the HP2020 initiative, aimed at the improvement of life of this population category, the main objectives and recommendations for intervention and prevention of falls were outlined. The most common view on evidence-based intervention for older adults is the exercises, primarily focused on balance. The role of special aging services and programs, as well as the education and certification of the workforce dealing with ‘fall care’ should not be underestimated as well.
References
CDC. (2017). Important Facts about Falls. Web.
CDC. (2018). Older Adult Falls Reported by State. Web.
FloridaHealth. (2014). Unintentional Fall Injury Rates, Age 65+, 2007‐2009 Injury Deaths, Hospitalizations & ED Visits. Web.
Guirguis-Blake, J. M., Michael, Y. L., Perdue, L. A., Coppola, E. L., & Beil, T. L. (2018). Interventions to prevent falls in older adults: updated evidence report and systematic review for the US Preventive Services Task Force. Jama, 319(16), 1705-1716.
Jin, J. (2018). Prevention of falls in older adults. Jama, 319(16), 1734-1734.
Moreland, B., Kakara, R., Henry, A. (2020). Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years — United States, 2012–2018. Weekly, 69(27), 875–881.