10% of seniors' ED visits related to falls

Doctors can help patients improve balance by reviewing medications and prescribing exercise and strength training.

By Kevin B. O'Reilly, amednews staff. Posted Oct. 29, 2009.

Falls continue to be a serious problem for elderly patients. Seniors who hurt themselves in falls made more than 2.1 million emergency department visits in 2006, according to a report released in October by the Agency for Healthcare Research and Quality.

One in 10 visits to the ED among adults 65 and older were related to a fall, according to the report (www.hcup-us.ahrq.gov/reports/statbriefs/sb80.jsp).

Thirty percent of these patients had to be admitted to the hospital, with ED costs totaling $6.8 billion. The cost of all medical care directly related to falls is about $20 billion.

The problem appears to be getting worse, according to Ryan Mutter, PhD, an author of the study and a staff economist with AHRQ's Center for Delivery, Organization, and Markets. He said that the number of fall-related visits among seniors was up 6% from 2005.

Forty-one percent of older patients injured in falls had fractures, and four in 10 of those patients were transferred to nursing homes or other long-term-care facilities. Five percent of all fall patients had injuries to internal organs.

There are some things doctors can do to help elderly patients who have a history of falls, said another study author, William Spector, PhD. Physicians should assess patients with gait and balance problems, with one part of the assessment being a simple observation of how well they sit and then rise from the seated position.

Doctors should "encourage elderly [patients] to participate in exercise programs with balance and strength training," said Spector, a health services researcher in AHRQ's CDOM who specializes in research on long-term care and the elderly. And review medications to see if there is a way to minimize those that contribute to drowsiness or instability, he said.

Spector said other steps that have proven effective at reducing falls among the elderly include:

Muscle strengthening and balance training at home, prescribed by a physician or other trained health professional.
Tai chi exercise programs.
Home hazard assessment and modification.
Withdrawal of psychotropic medications, if possible.

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