Falls

September 2015

Key facts

  • Falls are the second leading cause of unintentional injury deaths in the Region.
  • Each year an estimated 142 000 individuals die from falls in the Region.
  • Nearly two thirds of deaths due to falls occur in those aged 60 years or over.
  • Prevention strategies should emphasize education, training, creating safer environments, prioritizing fall-related research and establishing effective policies to reduce risk.

Fall-related injuries may be fatal or non-fatal though most are non-fatal. For example, of children in the People's Republic of China, for every death due to a fall, there are four cases of permanent disability, 13 cases requiring hospitalization for more than 10 days, 24 cases requiring hospitalization for 1–9 days and 690 cases seeking medical care or missing work/school.

The problem

An estimated 142 000 deaths due to falls occur annually in the Region, accounting for more than a quarter of the world's toll. Death rates are highest among adults over the age of 60 years.

Falls are responsible for over 4.6 million DALYs (disability-adjusted life years) 1 lost in the Region. The largest morbidity occurs in people aged 65 years or older, young adults aged 15–29 years and children aged 15 years or younger. In addition, those individuals who fall and suffer a disability, particularly older people, are at a major risk for subsequent long-term care and institutionalization.

The financial costs from fall-related injuries are substantial. For people aged 65 years or older, the average health system cost per fall injury in Australia is US$ 1049.

Who is at risk?

While all people who fall are at risk of injury, age, gender and health of the individual can affect the type and severity of injury.

Age

Older people have the highest risk of death or serious injury arising from a fall, and the risk increases with age. This risk level may be in part due to physical, sensory, and cognitive changes associated with ageing in combination with environments that are not adapted for an ageing population.

Childhood falls occur largely as a result of their evolving developmental stages, innate curiosity of their surroundings, and increasing levels of independence that coincide with more challenging behaviours commonly referred to as ‘risk taking’. While inadequate adult supervision is a commonly cited risk factor, the circumstances are often complex, interacting with poverty, sole parenthood and particularly hazardous environments.

Gender

Across all age groups and regions, both genders are at risk of falls. In some countries, it has been noted that males are more likely to die from a fall, while females suffer more non-fatal falls. Older women and younger children are especially prone to falls and increased injury severity. Worldwide, males consistently sustain higher death rates and DALYs lost. Possible explanations of the greater burden seen among males may include higher levels of risk-taking behaviours and hazards within occupations.

Other risk factors include:

  • occupations at elevated heights or other hazardous working conditions
  • alcohol or substance use
  • socioeconomic factors including poverty, overcrowded housing, sole parenthood, young maternal age
  • underlying medical conditions, such as neurological, cardiac or other disabling conditions
  • side effects of medication, physical inactivity and loss of balance, particularly among older people
  • poor mobility, cognition, and vision, particularly among those living in an institution, such as a nursing home or chronic care facility
  • unsafe environments, particularly for those with poor balance and limited vision

Prevention

Fall prevention strategies should be comprehensive and multifaceted. They should prioritize research and public health initiatives to further define the burden, explore variable risk factors and utilize effective prevention strategies. They should support policies that create safer environments and reduce risk factors. They should promote engineering to remove the potential for falls, the training of health care providers on evidence-based prevention strategies; and the education of individuals and communities to build risk awareness.

Effective fall prevention programmes aim to reduce the number of people who fall, the rate of falls and the severity of injury should a fall occur. For older individuals, fall prevention programmes can include a number of components to identify and modify risk, such as:

  • screening within living environments for risks for falls
  • clinical interventions to identify risk factors, such as medication review and modification, treatment of low blood pressure, Vitamin D and calcium supplementation, treatment of correctable visual impairment
  • home assessment and environmental modification for those with known risk factors or a history of falling
  • prescription of appropriate assistive devices to address physical and sensory impairments
  • muscle strengthening and balance retraining prescribed by a trained health professional
  • community-based group programmes which may incorporate fall prevention education and Tai Chi-type exercises or dynamic balance and strength training
  • use of hip protectors for those at risk of a hip fracture due to a fall

For children, effective interventions include multifaceted community programmes; engineering modifications of nursery furniture, playground equipment, and other products; and legislation for the use of window guards. Other promising prevention strategies include: use of guard rails/gates, home visitation programmes, mass public education campaigns, and training of individuals and communities in appropriate acute pediatric medical care should a fall occur.


*The disability-adjusted life year (DALY) extends the concept of potential years of life lost due to premature death to include equivalent years of “healthy” life lost by virtue of being in states of poor health or disability.

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