Public Health

Fear of Falling

As people age, falls become not only more common, but more problematic. Every year 300,000 elderly Americans are hospitalized for a hip fracture, and 95% of these fractures are due to falls. Falls are the leading cause of fatal and non-fatal injuries among the U.S. elderly. What are people doing about it? Kaiser Health News has two interesting stories on the topic.

First, younger elderly individuals are moving to more “Age-proofed” housing:

For those 65 and older, it said, “the number of households with housing cost burdens has reached an all-time high. By 2050, almost one-quarter of Americans will be 65 or older, according to the Census. Surveys conducted over the past decade show that older adults overwhelmingly want to age in their homes.

Yet many houses aren’t suited to “aging in place,” said Abbe Will, associate project director of the Remodeling Futures Program at Harvard…

In a recent survey of 1,000 people age 65 and older by the California-based nonprofit SCAN (formerly the Senior Care Action Network), 80% of respondents were concerned about their ability to age in place. The driver appears to be financial: About 60% said they have less than $10,000 in savings (including investments and retirement plans).

Baby boomers want a safe place for them to live as they age. While this caution is well-placed, another KHN article argues that hospitals may be too cautious. In an effort to prevent falls, hospitals may be keeping the elderly on bedrest for too long. Kaiser Health News reports:

Hospitals face financial penalties when…[falls]…occur. Nurses and aides get blamed or reprimanded if a patient under their supervision hits the ground.
But hospitals have become so overzealous in fall prevention that they are producing an “epidemic of immobility,” experts say. To ensure that patients will never fall, hospitalized patients who could benefit from activity are told not to get up on their own — their bedbound state reinforced by bed alarms and a lack of staff to help them move.

That’s especially dangerous for older patients, often weak to begin with. After just a few days of bed rest, their muscles can deteriorate enough to bring severe long-term consequences.

Part of the reason hospitals are overly cautious is that starting in 2008, the Centers for Medicare and Medicaid Services imposed financial penalties on hospitals whenever patients fell. The penalties increased when the Affordable Care Act was passed. This created a culture where hospital staff were perhaps overly fearful of falls, as CMS only tracks fall rates, not patient mobility at discharge.

Preventing falls is important. But physicians and nurses need to be able to use their discretion to help determine to balance the risk from falls against a lack of mobility.

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