Older adults worried about falling typically receive general advice: Take an exercise class. Get your vision checked. Stop taking medications for sleep. Install grab bars in the bathroom.
A new study suggests that sort of advice hasn鈥檛 proved to be very effective: Nearly three times more adults age 75 and older died from falls in 2016 than in 2000, according to a in the Journal of the American Medical Association.
In 2016, 25,189 people in this age group died from falls, compared with 8,613 in 2000.聽 The rate of fatal falls for adults 75 and older more than doubled during this period, from 51.6 per 100,000 people in 2000 to 122.2 per 100,000 people in 2016, the report found.
What鈥檚 needed to check this alarming trend, experts suggest, is a more personalized approach to preventing falls, more involvement by medical practitioners and better ways to motivate older adults to take action.
Elizabeth Burns, a co-author of the report and health scientist at the U.S. Centers for Disease Control and Prevention, said it鈥檚 not yet clear why fatal falls are increasing. Older adults are probably more vulnerable because they鈥檙e living longer with conditions such as diabetes and cardiovascular disease and taking more brain-altering medications such as opioids, she noted.
By 2030, the , 49 million older adults will fall each year, resulting in 12 million injuries and more than $100 billion in health-related spending.
The steep increase in fatal falls is 鈥渄efinitely upsetting,鈥� especially given national, state and local efforts to prevent these accidents, said Kathleen Cameron, senior director of the Center for Health Aging at the National Council on Aging.
Since 2012, the CDC has tried to turn the situation around by encouraging physicians to adopt evidence-based fall prevention practices. But doctors still are not doing enough to help older patients, Burns said.
She cites evidence from two studies. In one, , researchers found that fewer than half of seniors who were considered high risk 鈥� people who鈥檇 fallen repeatedly or sought medical attention for falls 鈥� received a comprehensive fall risk assessment, as recommended by the and the .
These assessments evaluate a person鈥檚 gait, lower-body muscle strength, balance, medication use, problems with their feet, blood pressure when rising from a sitting position, vision, vitamin D levels and home environment.
In another , Burns found that physicians and nurse practitioners routinely failed to review older adults鈥� medications (about 40% didn鈥檛 do so), recommend exercise (48% didn鈥檛) or refer people to a vision specialist (about 62% didn鈥檛) when advising older patients about falls.
Physicians鈥� involvement is important because older adults tend to take their doctors鈥� advice seriously, said Emily Nabors, program manager of the Fall Prevention Center of Excellence at the University of Southern California.
Also, seniors tend to underestimate their chance of falling.
鈥淚t鈥檚 very easy for people to look at a list of things that they should be concerned about and think, 鈥楾hat doesn鈥檛 apply to me. I walk just fine. I don鈥檛 have trouble with my balance,鈥欌�� said Dorothy Baker, a research scientist at Yale School of Medicine and executive director of the Connecticut Collaboration for Fall Prevention.
What鈥檚 the alternative to giving seniors a laundry list of things to do and hope they pay attention? We asked experts around the country for suggestions:
Get a fall risk assessment. Doctors should ask older adults three questions about falls: Have you fallen in the past year? Do you feel unsteady when walking or standing? And are you afraid of falling?
If the answer is yes to any of these questions, you鈥檙e probably a good candidate for a comprehensive fall risk evaluation.
Dr. Muriel Gillick, a geriatrician at Harvard Medical School, believes older patients and their families should 鈥渃lamor鈥� for these assessments. 鈥淭ell your doctor, 鈥榃e鈥檙e really worried about falls. Can you do this kind of evaluation?鈥欌�� she said.
When you join Medicare, you become eligible for a 鈥溾�� prevention visit, during which doctors should evaluate your chance of falling. (This is a brief screen, not a thorough examination.) Subsequently, seniors are eligible each year for a Medicare , which offers another chance for a physician to assess your fall risk.
If your doctor doesn鈥檛 offer these services, ask for a referral to another medical practice, said Leslie Allison, editor-in-chief of the Journal of Geriatric Physical Therapy. Physical therapists can provide an in-depth review of walking, muscle strength and balance, she noted.
The CDC鈥檚 鈥� lists 12 fall-related considerations for those interested in doing a self-assessment. Pay attention to the last one, about depression, which alters attention, slows responses and is often overlooked in discussions about falls.
Get a personalized plan. A fall assessment should identify risk factors that are specific to you as well as ways to address them.
鈥淭he goal is to come up with personalized recommendations, which older adults are far more likely to take up than generic non-tailored approaches,鈥� said Elizabeth Phelan, a researcher of falls and associate professor of geriatric medicine at the University of Washington.
Take programs that address balance, for example. Some are designed for older adults who are frail, some for those who are active, and still others for those in between. 鈥淚f a senior goes to a program that doesn鈥檛 meet her needs, it鈥檚 not going to work out,鈥� said Mindy Renfro, associate professor of physical therapy at Touro University Nevada.
The single most important intervention is exercise 鈥� but not just any kind. Notably, simply walking 鈥� the type of exercise most older adults get 鈥� won鈥檛 help unless seniors have previously been sedentary. 鈥淚f you鈥檙e walking, by all means, don鈥檛 stop: It鈥檚 good for general health and well-being,鈥� Phelan said. 鈥淏ut to prevent falls, you need to focus on strength and balance.鈥�
Exercise such as tai chi or the Otago Exercise Program could improve strength and balance, advises Cameron of the National Council on Aging. She suggested asking an area agency on aging, senior center, YMCA or YWCA about classes. The center also has formed fall prevention coalitions in 43 states. Look for one near you .
A of resources that can help older adults make home modifications is being expanded through a led by USC鈥檚 Leonard Davis School of Gerontology. Occupational therapists can evaluate homes and suggest changes to reduce your chance of falling. Ask your physician for a referral.
Your doctor鈥檚 guidance will be needed to review medications that can contribute to falls. Using three or more psychotropic medications such as opioids, antidepressants, antipsychotics, benzodiazepines (such as Valium) and 鈥淶鈥� drugs for sleep (such as Ambien) puts seniors at substantial risk, said Dr. Donovan Maust, an assistant professor of psychiatry at the University of Michigan Medical School.
Be careful during transitions. Older adults coming home from the hospital or starting new medications should be especially careful about falling, because they may be weak, deconditioned, exhausted and disoriented.
A from researchers at the University of Michigan and Yale University highlights this risk. They looked at 1.2 million older adults readmitted to the hospital within 30 days of being discharged in 2013 and 2014. Fall-related injuries were the third most common reason for readmissions.
In other , Geoffrey Hoffman, an assistant professor at the University of Michigan School of Nursing, has asked seniors and caregivers about their experiences during discharge planning. None remembered receiving information about falls or being advised that they might be at risk.
Hospital staffers should discuss fall prevention before older patients leave the hospital, Hoffman said, calling it 鈥渁 time when it鈥檚 critical to intervene on fall risk.鈥�
Consider the message. In research studies and focus groups, older adults report they don鈥檛 like negative messages surrounding falls such as 鈥淵ou can hurt yourself badly or die if you don鈥檛 watch out.鈥�
鈥淭elling older adults what they need to do to be safe feels patronizing to many people and raises their hackles,鈥� Hoffman said.
Instead, seniors respond better to messages such as 鈥渢aking these steps is going to help you stay independent,鈥� Burns of the CDC said.
We鈥檙e eager to hear from readers about questions you鈥檇 like answered, problems you鈥檝e been having with your care and advice you need in dealing with the health care system. Visit聽kffhealthnews.org/columnists聽to submit your requests or tips.