Emergency room visits (ED) and deaths from falls among older Canadians are on the rise, the data show. The hospitalization rate is generally stable, but is increasing among Canadians over the age of 65.
Most falls occurred at home and while the person was walking. “This information provides guidelines for prioritizing prevention efforts, such as targeting women, those aged 80 and over, and older people living alone or on low incomes,” the authors said.
The data was published online on June 8 in a report by the Public Health Agency of Canada (PHAC).
Social factors are critical
The report is a continuation of an analysis published in 2014, said Anna Madison, a PHAC spokeswoman Medscape Medical News.
The present authors analyzed self-reported data from the 2017-2018 Canadian Community Health Statistics Survey (CCHS), hospitalization statistics from the Canadian Institute of Health Information (CIHI) abstract discharge database for 2008-2009 to 2019- 2020, statistics for visits for 2019-2020 from the CIHI National Outpatient Care Reporting System for 2010-2011 to 2019-2020 and mortality data from the Canadian Statistics Canada death database for vital statistics for 2001 to 2019
In 2017-2018, 5.8% of people over 65 who lived in a household reported a decline in the previous year. Women are more likely than men to suffer a fall-related injury (6.5% vs. 5.0%), and fall-related injuries are more common among people over 80 than those aged 65 to 79 years. About 61% of falls occurred while walking.
The absolute number of hospitalizations related to falls increased by 47% between 2008-2009 and 2019-2020, but the standardized age levels are similar – about 15 per 1,000 people. The increase in hospitalizations associated with falls is partly due to an aging population, but other factors may also be contributing. Autumn-related ED visits, deaths and hospitalizations also increased, despite the age adjustment.
One of the possible contributing factors is chronic conditions such as Parkinson’s disease, diabetes, arthritis, cardiovascular disease, chronic obstructive pulmonary disease and stroke, according to Madison. People are living longer with these conditions, as well as acute illness, imbalance and gait deficit, “all of which can lead to physical limitations affecting a person’s mobility, gait and balance,” she added.
About 52% of the falls that led to hospitalization occurred at home. Approximately 17% occurred in the accommodation.
Fall-related mortality increased over time, with the age-standardized fall mortality rate increasing by 111% from 41.0 to 86.4 per 100,000 people between 2001 and 2019. Mortality rates increased among -adult age groups, especially for those over 90 years. More women died from falls, but men had higher standardized mortality.
Doctors can play a role in reducing falls, Madison said. The report “can help them understand the factors that put people at higher risk of falling injuries”, including women, people over 80 and living alone or low income. “This can help adapt advice on prevention and management practices. Prescribing exercises for strength, balance and improving gait is never too late and should be a regular practice. Decreased muscle strength and endurance occur as people age, and muscle weakness increases the risk of falling, so prescribing safe exercise that increases balance and mobility is important, ”said Madison.
Social factors also affect the risk of falling. “Older people with higher life satisfaction, engagement in social activities and positive relationships (such as support from family, peers and the community) are less likely to report a fall or permanent disability,” Madison said.
Fighting “phalophobia”
The Canadian government is investing in making cities and communities more accessible to adults by improving transport and parking and assessing the physical environment. But individual factors such as drug adherence and access to home care face more barriers to investment, especially during a pandemic, and these factors need to be addressed, Chris Frank, MD, family doctor and clinical manager of specialist geriatrics in Providence Care in Kingston, Ontario, Canada, said Medscape.
Frank called for more investment in community-based exercise programs that offer a structure and social component without professional input. “These things were a challenge before the pandemic and are a bigger challenge now. “These are things that don’t necessarily get a lot of funding to happen, but they’re great for preventing falls,” Frank said.
Sometimes the neglected consequence of falls is what Frank calls “phalophobia” when patients who fall lose confidence in their ability to move safely. This reaction promotes reduced activity and erosion of physical abilities. “The next time they have to do something like getting up to go to the toilet, they will be weaker and more likely to fall. “It’s a vicious circle,” Frank said.
He actively asks patients about falls because they may be reluctant to report them if they have not resulted in injury or hospitalization. “They somehow imagine, ‘If I fall, someone will try to get me out of my house.’ It’s just a fear that people have, “Frank said. He regularly checks the patient’s posture, vision and medication and asks about the home environment.
Madison is a PHAC employee. Frank did not reveal any financial conflicts.
Jim Kling is a science and medical writer in Bellingham, Washington.
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