Statement on Older Adult Falls and Falls Prevention

The American College of Surgeons (ACS) Committee on Trauma (COT), through its Subcommittee on Injury Prevention and Control, prepared the following Statement on Older Adult Falls and Falls Prevention to educate surgeons and other medical professionals on the significance of older adult falls and evidence-based prevention activities. The ACS Board of Regents approved the statement at its June 7−8, 2019, meeting in Chicago, IL.

The ACS recognizes the following facts:^1-4

• Falls are the leading cause of both fatal and nonfatal injuries for older adults.
• One out of four older adults falls each year. Of these individuals, less than half talk to their health care providers about it.
• Many people who fall, even if they are not injured, develop a fear of falling, which may cause them to limit activities, leading to reduced mobility, loss of physical fitness, and, in turn, increased risk of falling.
• A person who has fallen once is two to three times more likely to fall again within a year.

The ACS supports efforts to promote, enact, and sustain legislation and policies that encourage:

• Older adult care providers to implement comprehensive falls prevention programming, including the following:
  • Developing partnerships with community-based centers, such as senior centers, older adult living centers, and faith-based organizations.
  • Incorporating-evidenced based exercise/physical therapy fall prevention programs. Helpful information can be found on the Centers for Disease Control and Prevention (CDC) website and via other online sources.⁵
  • Partnering with home-based visiting programs to complete multifactorial risk assessments, including medication review (including the use of opioids), assessment of vision, home safety, foot pain or poor footwear, and balance and gait.
• Assessment of the risk/benefit of anticoagulation and antiplatelet therapies in older adult patients.
• Risk assessment of falls in regular medical practice to prevent the first fall. Examples are included in the (CDC’s) STEADI (Stopping Elderly Accidents, Deaths & Injuries) toolkit.⁶
• Collaboration with regional and statewide fall prevention coalitions for local networking/resources.
• The opportunity for collaboration with emergency medical services to begin the process of fall prevention in the field.⁷
• Involvement in hospital/institutional-level fall prevention and/or patient safety activities.

References

1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). Available at: www.cdc.gov/injury/wisqars/. Accessed November 8, 2018.
2. Bell AJ, Talbot-Stern JK, Hennessy A. Characteristics and outcomes of older patients presenting to the emergency department after a fall: A retrospective analysis. Med J Aust. 2000;173(4):176-177.
3. Roudsari BS, Ebel BE, Corso PS, Molinari, NM, Koepsell TD. The acute medical care costs of fall-related injuries among the U.S. older adults. Injury. 2005;36(11):1316-1322.
4. Ganz DA, Bao Y, Shekelle PG, Rubenstein LZ. Will my patient fall? JAMA. 2007;297(1):77-86.
5. Centers for Disease Control and Prevention. CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults, 3rd Edition. Available at: www.cdc.gov/homeandrecreationalsafety/Falls/compendium.html. Accessed July 23, 2019.
6. Centers for Disease Control and Prevention. STEADI: Stopping Elderly Accidents, Deaths & Injuries. Available at: www.cdc.gov/steadi/index.html. Accessed July 23, 2019.
7. Faul M, Stevens JA, Sasser SM, Allee L, Kuhls DA, Burke PA. Characteristics of older adults seen by emergency medical service providers for falls: An opportunity for fall prevention. Am J Prev Med. 2016;50(6):719-726.