State Programs Show that Falls Prevention is a Wise Investment: Falls Come at a Cost of $19 Billion a Year

Michele Late


Nations Health. 2010;40(2) 

When it comes to preventing falls, Ilene Silver, MPH, of the Washington State Department of Health, has heard it all: Falls are a natural part of aging. All older people fall. And falls cannot really be prevented anyway.

Luckily, Silver — who is a program development specialist with the health department's Senior Fall Prevention Program — and her colleagues in Washington state know better. Recognizing the enormous impact that falls have on seniors and the state health system, health workers in Washington have been making falls prevention a priority. Through community partnerships, education, training and outreach programs, Washington injury prevention advocates are spreading the message that falls do not have to be the norm for people as they age and that health workers can play an important role in preventing them.

With older adults the fastest growing segment of Washington's population, falls are an increasing concern for the state, Silver said. Already, falls are the leading cause of injury-related hospitalization for older adults in Washington, outnumbering the number of total residents hospitalized for motor vehicle crashes by a ratio of 5-to-1. About two-thirds of those hospitalized for falls in Washington are sent to nursing facilities for rehabilitation or care, Silver noted.

"This is an enormously costly issue, both for individuals and society," Silver said. "We are going to be using a lot of health care dollars on falls if we don't prevent them, which means those dollars will not be available for other issues and populations."

Nationwide, falls are a "tremendous problem" that cost $19 billion a year in direct costs alone, according to "Bonita" Lynn Beattie, vice president for injury prevention at the National Council on Aging. One-third of people ages 65 and older fall a year, and with the U.S. population aging, "we've got a growing problem," she told The Nation's Health.

Through its Falls Free Coalition, a group of more than 70 organizations, the National Council on Aging is working with partners to coordinate falls prevention activities around a national plan. Released in 2005, the National Action Plan highlights 36 strategies that can be used to prevent falls in the community, centered on measures such as home safety, medication management and activity.

"The premise is that everybody has a role to play — city planners, health care providers, aging services providers," Beattie told The Nation's Health. "You have to have these community partnerships."

At the state level, cross-collaborative coalitions are leading the way on falls prevention, with coalitions operating or being developed in almost 30 states, Beattie said. Among the states that have benefited from such coalitions is Wisconsin, where a Falls Prevention Initiative brought together partners from state and local health and aging departments, universities, hospitals, long-term care facilities and other sectors to develop community-based programs and promote healthy fall-free lifestyles among seniors.

Since 1999, Wisconsin has ranked in the top five states for falls, said Jane Mahoney, MD, an associate professor at the University of Wisconsin School of Medicine and Public Health, during a session on falls prevention at APHA's Annual Meeting in Philadelphia in November. To take on the issue, Wisconsin turned to two prevention programs for seniors.

The first program, Stepping On, is a group-based activity for seniors who are able to attend classes, while the second, Sure Step, is an individualized program that is appropriate for those who are homebound, frail or have cognitive impairments. The programs are evidence-based and their results have been measured, said Mahoney, noting that "our dollars are scarce, so we need to use what we know will be effective."

Such programs can have an enormous impact, according to Amy Harris, MPA, acting deputy director of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention, who also spoke at the APHA-sponsored Annual Meeting session. Comprehensive prevention programs can reduce falls by 35 percent to 55 percent, Harris said, noting that proven programs return up to $2.50 for every dollar invested.

According to the U.S. Agency for Healthcare Research and Quality, hospital emergency departments treated more than 2 million seniors for broken bones, head wounds, cuts and other injuries from falls in 2006. Many times after such injuries, seniors can become afraid of falling again and limit their activities, thereby reducing their physical fitness and raising their risk of falling, according to CDC.

"Falls prevention is an issue that is right for public health policy and program intervention," Harris said.

One program that is making a measurable difference is a Minnesota initiative that is tackling falls prevention in one particular setting: hospitals.

Launched in May 2007, the Minnesota Hospital Association's Safe from Falls campaign involves more than 100 hospitals throughout the state. The program incorporates measures such as safety coordination, reporting, risk assessment, interventions, and staff and patient education. When a hospital becomes involved in the campaign, an advisory group visits the facility to do a baseline survey and look at best practices and barriers. Later, a kick-off event is held to launch the program.

Hospitals have been "very open" to the campaign, according to Julie Apold, patient safety manager for the Minnesota Hospital Association, with participants suggesting ideas and sharing information with one another.

In January, the Minnesota Department of Health credited the program for helping to achieve a 20 percent decrease in falls that occurred in the state's hospitals and surgical centers in 2009, noting that best practices for preventing falls increased from 60 percent to 90 percent in hospitals involved in Safe from Falls.

"We are pleased with the success we've had, but we want to make sure that success gets locked in," said Lawrence Massa, president and CEO of the Minnesota Hospital Association.

Back in Washington state, injury prevention advocates are also working to continue their success on falls prevention, creating partnerships and promoting Washington's Stay Active and Independent for Life program. The program, which is taught to seniors throughout the state by trained physical therapists and other workers, incorporates strengthening, aerobics, balance training and home safety. The program includes a guide for seniors to help them develop an individualized "fall-free plan."

"For seniors, falls are a negative, and they are seen as the beginning of the end," Silver said. "(But) there are things you can do to reduce and prevent fall-related injuries."