Falls among elderly are avoidable, Auburn University finds key in prevention education

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Editor’s note: This article first appeared in Auburn Research magazine. More stories are available on the publication's website.

As adults are living longer, the number of Americans ages 65 and older is expected to reach 80 million by 2040. The number of adults ages 85 and older—the group most often needing help with basic personal care—will nearly quadruple by 2040.

Falls are the leading cause of fatal and nonfatal injury among older adults. In 2018, one in four reported a fall and one in 10 reported an injurious fall, making falls among the aging population a public health concern. A simple incident can be life-changing, like tripping on a rug or slipping on a wet floor and, possibly, breaking a bone.

Broken bones and fractures can be the start of more serious problems, such as a trip to the hospital, additional injuries or even a subsequent disability. According to health care specialists, most falls are preventable and do not have to be an inevitable part of aging.

“Falls are more common and pricier as one ages,” said Tiffani Chidume, an assistant clinical professor in the Auburn University School of Nursing. “Medical care costs from fall injuries are high. The impact of these medical costs often continues for at least one year after the fall.

“According to the Centers for Disease Control and Prevention, each year about $50 billion is spent on medical costs related to non-fatal injuries and $754 million is spent related to fatal falls. As the number of Americans aged 65 and older grows, we can expect higher health care costs, if measures are not taken to prevent falls.”

According to Chidume, there is a need to design and develop a health awareness program to prevent problems that cause a great deal of suffering for the elderly. Given the substantial health burden of falls for older adults, offering interventions that reduce harm from falls is imperative.

Nurses have a greater role and responsibility to care for the aging population. Her research on promoting older adult fall prevention and awareness in a community setting through a nurse-led intervention was an evidence-based effort to underscore an important aspect of nursing the elderly.

“Falls in any population can affect a person’s mobility and quality of life. They may precipitate adverse physical, medical, psychological, social and economic consequences. In the older adult, once a fall occurs, there is an increased likelihood that another (fall) will ensue. Our objective was to work on injury prevention and to reduce the number of older adults falling,” Chidume added.

The purpose of her research was to implement a fall prevention toolkit, or FPT, for adults aged 65 and older who attended mobile interprofessional education, or IPE, community clinics.

Auburn University’s School of Nursing, Harrison School of Pharmacy, the social work program in the College of Liberal Arts and nutrition program in the College of Human Sciences conduct mobile IPE community clinics visits at various sites. IPE community clinics are a means for older adults in the community to gain some form of access to health care through free screenings and health care collaborations.

The clinics provide patient-centered care to those who attend, mostly older adults, and many are already at high risk for falls. For the aging adults with possibly declining functions, Chidume said fall prevention and awareness should be assessed frequently to decrease and prevent falls.

“There were no fall prevention assessments or education being provided in conjunction with nutrition, health and social assessments by the IPE team. Literature demonstrates that fall prevention interventions and programs are effective, but underutilized. Our intent was to bring awareness and improve the health outcomes of the older adults in the community,” she said.

The study utilized two validated fall risk assessment tools, the Missouri Alliance for Home Care’s MAHC-10 and the Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths and Injuries, or STEADI.

“Fall risks were assessed by interviewing community members aged 65 and older at the IPE community clinic sites. The evidence-based research project involved the development and implementation of FPT,” said Chidume. “After assessing initial baseline fall risk and fall education score at the mobile IPE clinics, follow-up assessments occurred a month after the initial assessment and compared to the initial fall risk assessment and fall education scores.

“There was an additional open-ended participant survey included in the follow-up. Key in the success and enhancing this type of project were continued follow-ups, reinforcement of fall prevention education, or FPE, and resource availability, that were part of both fall assessment tools.”

The follow-up phone conversations in the subsequent month emphasized the following notion to the participants: Someone cared and was proactive in attempts to help decrease falls while increasing fall risk awareness and education in their aging population.

“Older adults comprise a part of the community who require more attention and special care. I had to teach some of them to be mindful of how they walked. I told them it was a lot like dancing: Take a step, count to three and take another step and so on,” explained Chidume. “After the consultation, we learned that one participant, who had been falling every day, successfully negotiated the immediate environment to prevent falls and had not fallen again at the time of the follow-up.

“This study has far-reaching implications for nursing education, patient care and simulation. Research has shown that there is a clear association between risk of fall and environmental factors, and that older adults in the community setting that have received FPE have the propensity to maintain independence and safer living conditions. It is essential that nursing education programs include care of the elderly, as nurses will have a greater role and responsibility to care for, screen and teach fall prevention methods to the aging population.

The Auburn University IPE program observed the benefit of the FPE and are considering implementing their own fall prevention initiative, using the implications from this project. Pharmacy, social work and nutrition components of the IPE will be able to tailor their programs to include FPE in their protocols and other interprofessional experiences.

Pao-Feng Tsai, associate dean for research in the School of Nursing, called fall prevention an important aspect of elder care.

“Dr. Chidume’s work demonstrates the possibility of integrating an evidence-based fall prevention intervention program into nursing education in providing care to a geriatric population,” she said. “Bringing the IPE team together to provide care for the elderly will allow providers to evaluate patients and treat them holistically.”

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