Emergency department (ED) visits and fall mortality among older Canadians have an upward trend, the data show. Hospitalization rates have generally remained stable, but are rising among Canadians over the age of 65.
Most of the falls occurred at home and while the person was walking. “This information provides guidelines for prioritizing prevention efforts, such as targeting women, people 80 and older, and the elderly living alone or on low incomes,” according to the authors.
The data was released online on June 8 in a report by the Public Health Agency of Canada (PHAC).
Critical social factors
The report is a follow-up to an analysis published in 2014, said Anna Maddison, a spokeswoman for PHAC. Medscape medical news.
Current authors analyzed self-reported data from the Canadian Community Health Survey (CCHS) of Statistics Canada for 2017-2018, hospitalization statistics from the Institute’s High Abstract Database Canadian Health Information System (CIHI) for 2008-2009 to 2019-2020, statistics on visits to the EDIS of the ICIS National Ambulatory Care Reporting System for the period 2010-2011 to 2019-2020, and mortality data from the Statistics of Canada Vital Statistics Canada Deaths Database for the period 2001-2019.
In 2017-2018, 5.8% of people over the age of 65 living in a household reported a drop in the previous year. Women were more likely than men to have a fall-related injury (6.5% versus 5.0%), and fall-related injuries were more common among people over the age of 80 than those over the age of 65. at 79 years old. About 61% of falls occurred while walking.
The absolute number of fall-related hospitalizations increased by 47% between 2008-2009 and 2019-2020, but age-standardized rates were similar at about 15 per 1,000 people. The increase in hospitalizations related to the fall is partly attributable to the aging population, but other factors may also contribute. Visits, deaths, and hospitalizations related to the fall 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 Maddison. People live longer with these conditions, as well as acute illness, impaired balance and gait deficits, “all of which can lead to physical limitations that affect mobility, gait and balance,” he added.
About 52% of the falls that led to hospitalization happened at home. Approximately 17% occurred in a residential care facility.
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 increased among age groups, especially among those over 90 years of age. of falls, but men had a higher age-standardized mortality.
Doctors can play a role in reducing falls, Maddison said. The report “can help them understand the factors that put people most at risk for falls-related injuries,” such as women, being 80 or older and living alone or having a low income. “This can help personalize advice on preventative and management practices. Prescribing strength, balance and gait exercises is never too late and should be a common practice. Decreased muscle strength and endurance occurs as people get older, and muscle weakness increases their risk of falling, so it’s important to prescribe safe exercise that will increase balance and mobility, ”Maddison said.
Social factors also affect the risk of falling. “Older adults with higher life satisfaction, participation in social activities, and positive relationships (such as peer support, peer support, and the community) were less likely to report a sustained fall or disability.” said Maddison.
Facing “Fallophobia”
The Canadian government has invested in making cities and communities more friendly to the elderly by improving transportation and parking and assessing physical environments. But individual factors such as medication adherence and access to home care have faced more barriers to investment, especially during the pandemic, and these factors need to be addressed, Chris Frank, MD, Family physician and clinical geriatrics leader at Providence Care in Kingston, Ontario, Canada, said Medscape.
Frank called for more investment in community-based exercise programs that offer a social structure and component without professional intervention. “These things were a challenge before the pandemic, and now they’re a bigger challenge. These are things that don’t necessarily get a lot of funding to make them happen, but they’re very relevant to crash prevention,” Frank said.
A sometimes overlooked consequence of falls is what Frank calls “phallophobia,” where patients who have fallen out lose confidence in their ability to move safely. This reaction favors the reduction of activity and the erosion of physical capacity. “The next time they have to do something like get up to go to the bathroom, 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 caused an injury or hospitalization. “They think, ‘If I fall, someone will try to get me out of my house.’ That’s just a fear people have,” Frank said. Regularly check the patient’s posture, vision, and medication and ask questions about the home environment.
Maddison is a PHAC employee. Frank did not disclose any relevant financial disputes.
Jim Kling is a scientific and medical writer in Bellingham, Washington.
For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.