Citation

Howland J, Peterson EW. Front. Public Health 2024; 12: e1377972.

Copyright

(Copyright © 2024, Frontiers Editorial Office)

DOI

10.3389/fpubh.2024.1377972

PMID

38544734

PMCID

PMC10965610

Abstract

Among older adults, falls are common and the leading cause of fatal and non-fatal injuries (1). In the United States, one in four older adults ages 65 and older reports falling each year (2). On average, 100 older adults died every day because of falls in 2021 (2) and estimates of medical costs of fatal and non-fatal older adult falls are ~$50 billion annually (3). About 20% of falls require medical attention (4). Falls leading to injuries can affect levels of activity, psychosocial status, and quality of life. Even when falls do not require medical attention, the experience of falling can result in fear of falling (5). While a reasonable level of concern can prevent engagement in risky activities, fear of falling that is disproportionate with functional abilities can prevent engagement in activities necessary to maintain health and wellbeing. Fear of falling is associated with depressive symptomatology (6), impacts gait (7), leads to activity curtailment (8-10), and increased fall risk (5, 8).

Trends

Between 2001 and 2021, the number of Americans dying from unintentional falls increased from 15,000 to over 44,000 as the crude death rate rose from 5.3 (per 100,000 population) to 13.5 (1). No demographic is unaffected. Among racial and ethnic groups, White older adults have the highest death rate from falls, and the biggest increase, however death rates are rising among Black seniors, Hispanic seniors, Asian seniors, and Native American seniors alike (11). While this trend is not completely understood, there may be several contributors. Some of the increase in fall mortality may be due to innovations in medical record keeping that document causes and circumstances of injuries (12), demographic trends and pharmacological factors are also at play. Older adults are living longer. Globally, the number of persons aged 60 years or over is expected to more than double, from 841 million people in 2013 to more than 2 billion in 2050 (13) and many are or will be living with frailty, co-morbidities and chronic health conditions that could increase fall risk (14, 15). Fourteen medication classes, most of which are psychotropic medications, have been identified as fall-risk increasing drugs (FRID) (16). Although falls are widely recognized as common and preventable adverse drug events (17), healthcare professionals must make decisions about deprescribing FRID that consider patient preferences and the trade-offs between competing health conditions...

Language: en

Keywords

*Accidental Falls/prevention & control; *Primary Health Care; Aged; community-based programs; falls; falls prevention; Humans; older adults; primary care