Preventing falls in seniors an ongoing effort

A trip on the carpet, a tumble on the stairs or a plunge from a hospital bed — all are common among the nation's seniors, and send millions to the hospital.

Yet, though the problem is well known in geriatric circles, and preventive steps such as tai chi exercises and shower grab bars seem to help some seniors, researchers still struggle with the best methods of preventing harm long-term.


Now several studies in Maryland and across the nation will examine drugs, technology and individualized plans that may help doctors keep those 65 and older upright and uninjured. Any improvement can have a big payoff, because falls are the leading cause of fatal and nonfatal injuries in seniors. A third of the people 65 and older fall in any given year, and 2.5 million seniors went to the emergency department due to falls in 2013, government data shows.

"If we can identify people at fall risk and apply some kind of program or prevention in the home or elsewhere to mitigate that risk of a future fall, maybe we will be able to keep a number out of the doctor's office, having to visit the emergency department or from dying," said Glenn V. Ostir, a researcher at the University of Maryland.

The newest study by the university's medical school will involve up to 500 patients who have come to an emergency department for any reason but have a fall risk, said Ostir, director of the Program on Aging, Trauma and Emergency Care, which is leading the work.

Researchers will take extensive histories and even go home with patients to develop individualized programs that could involve exercise, a review of medications that may cause drowsiness or dizziness, eye tests and modifications to homes to minimize hazards.

The Johns Hopkins University is also one of 10 institutions recruiting seniors for a five-year study that will test whether such individualized plans offer better prevention than generic instructions on preventing falls for those 75 years and older.

Both sets of researchers hope to develop a program that can be used in other health care systems, many of which already are taking steps to address the problem.

For example, the Maryland Patient Safety Center, created by the Maryland Hospital Association, has been promoting preventive measures in hospitals, nursing homes and communities. Some were simple: lowering patients' beds and using alarms that sound when patients get up on their own.

Robert H. Imhoff III, president and CEO of the safety center, said there has been a 52 percent decrease in falls at the hospitals from September 2009 to May 2014.


The number of serious falls also is declining. Maryland hospitals reported six deaths and 67 serious injuries in fiscal 2013, fewer than the nine deaths and 98 falls the previous year.

"Now we're focusing our attention on the long-term care community," Imhoff said. "We didn't make an impact there and we're striving to take our success in acute care hospitals and apply it."

But seniors' homes may be the hardest places to make a difference, Imhoff and other experts said. There's less supervision and seniors may lie about falling because they want to keep their independence. An elderly person who falls has a 50 percent chance of falling again sometime if circumstances aren't changed, Ostir said, adding that seniors often fare worse than younger adults in recovery and suffer long-term repercussions.

Up to 30 percent of the seniors who fall have a moderate or severe injury including cuts, fractures and traumatic brain injury, according to the U.S. Centers for Disease Control and Prevention. The data also showed that as the population ages, the number of hip fractures, for example, could double to 700,000 a year by 2030.

The CDC also has reported that falls often lead to a fear of another mishap, potentially leading seniors to limit activity, which then further increases the risk of falling.

As people age, they change their gait to adapt to their changing bodies, and that can initially make walking safer, said Thurmon Lockhart, a professor in the School of Biological and Health Systems Engineering at Arizona State University.


Lockhart, who has studied the mechanics of falling, said problems arise as the elderly become increasing frail, their senses and muscles degrade, and their ability to react to a slip is delayed enough that they can't stop themselves from falling.

Understanding the process helps inform the treatments, Lockhart said, adding that traditional interventions such as exercise and new glasses are effective. The Chinese martial art of tai chi is considered particularly helpful in improving balance and reducing falls, according to a 2012 study in the New England Journal of Medicine.

The problem is that seniors don't always stick with such programs. And because assessing ongoing risk is subjective, doctors don't always know how well interventions are working or who is mostly likely to fall.

Lockhart and others are working on an iPhone app that can cheaply and easily assess ongoing risk by using the device's sensors to test stability. Researchers also are studying drugs that can improve balance and help seniors react faster, with testing on Parkinson's patients, who tend to be rigid and unstable. Both the technology and the drugs could be available in several years.

"These could be the answer, along with training," Lockhart said. "For now we're in trouble. We really don't have a good solution for everyone."

That doesn't mean seniors aren't trying to help themselves, said Lois Bernstein, a 71-year-old who goes every Friday to tai chi class at the Myerberg Senior Center in the northwest corner of the city, not far from her Baltimore County home.

She read about tai chi's benefits in preventing falls and believes it keeps her in shape. Bernstein said the movements may seem slow, but she can feel a difference in her legs. And, she said, she likes it enough to stick with it, unlike previous experiments with walking and bike riding.

"Almost everyone who takes the class is there to improve balance," she said. "I don't have a balance problem, but I want to make sure I don't [develop] a problem."

Paul Timin takes the same tai chi class but also walks and works out in the fitness room. He hopes to avoid ending up like friends who needed knee and hip surgery.

"I've seen a vast improvement," said Timin, who also lives near the Myerberg center. "It's one of the best things I've done for my balance. I can tell walking or going up and down stairs."

But not all seniors are so proactive, and Ostir doesn't expect to have a shortage of study participants from the University of Maryland system of emergency departments. Many are likely to have already fallen.

At the university's Shock Trauma Center, which handles the state's worst cases, fall victims are second only to car crashes.

A pilot program researchers conducted at Mercy Medical Center found that in the past year about 6,500 adults 65 and older came through the emergency department and about a quarter could be at risk for falling.


Seniors in the study will go though a16- to 24-week program and be followed for a year.

"The goal is reducing the amount of risk," Ostir said. "We'll learn as we go what works and what doesn't. And if things seem to be successful we'll do this on a broader level."