Reducing Falls and Resulting Hip Fractures Among Older Women

Older adults constitute the fastest growing portion of the US population. In 1990, 13% of the population was 65 or older; by 2050, this proportion will be 23%. By the year 2040 there will be 68.1 million people in the US aged 65 and older. Falls are the leading cause of injury, deaths and disabilities among older people. In the US, one of every three older adults falls each year. Women are nearly three times more likely than men to be hospitalized for a fall-related injury.

The most prevalent fall-related injuries are fractures of the hip; spine; upper arm; forearm; and bones of the pelvis, hand, and ankle. Most serious is hip fracture, 95% of which are the result of a fall. Hip fractures are expensive. A recent study documented that the cost of a hip fracture was $16,300-$18,700 during the first year following the injury.

Even more important is the injury's impact on a person's life in the form of loss of independence and decreased quality of life. Only 50% of older adults hospitalized for hip fracture are able to return home or live independently after the injury. Without effective intervention strategies, the number of hip fractures will increase as the US population ages.

What factors put people at risk for falling?

• Advancing age -- especially for white women, in whom the greater prevalence and severity of osteoporosis increases bone fragility and probability of hip fracture.
• Lack of current or previous physical activity.
• Muscle weakness or balance problems.
• Functional limitations -- difficulty with dressing or bathing.
• Cognitive impairment or dementia.
  
• Psychoactive medications like tranquilizers or antidepressants.
• Tripping hazards in the home and elsewhere.
• Having fallen previously or having had a stroke.
• Having more than one chronic disease.
• Parkinson's disease or other neuromuscular disease.
• Vision problems.
• Shoes with thick, soft soles that can affect balance or become a tripping hazard by catching in carpeting.

How to Help Prevent Falls Effective fall prevention strategies require a multifaceted approach with both behavioral and environmental components. Important elements include:

• Physical Activity. Activities that improve strength, balance, flexibility and coordination (Tai Chi, for example) reduce the risk for falls among healthy and frail persons. Studies have demonstrated a 40%-60% reduction in hip fracture risk with increasing levels of physical activity.
• Modifications to the home. More than half of all falls among older adults occur at home. Eliminate potential tripping hazards such as clutter and throw rugs. Other helpful improvements include stair railings, improved lighting, non-slip floor surfaces, grab bars in bathrooms.
• Medications. Assess medications to minimize side effects like dizziness and grogginess that increase the risk of falling.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.