Reducing falls and resulting hip fractures among older women

Abstract

Scope of the problem: Fall-related injuries are the leading cause of injury, deaths, and disabilities among people older than 65. The most serious fall injury is hip fracture; half of all older adults hospitalized for hip fracture never regain their former level of function. In 1996, a total of 340,000 hospitalizations for hip fracture occurred among this population, and 80% of these admissions occurred among women. From 1988 to 1996, hip fracture hospitalization rates for women older than 65 years increased 23%. Etiologic or risk factors: Risk factors for falls include increasing age, muscle weakness, functional limitations, environmental hazards, use of psychoactive medications, and a history of falls. Age also is a risk factor for hip fracture. Women older than 85 are nearly eight times more likely than women age 65 to 74 to be hospitalized for hip fracture. White women over 65 are at higher risk for hip fracture than black women. Other risk factors for hip fracture include lack of physical activity, osteoporosis, low body mass index, and a previous hip fracture. Recommendations for prevention: Because approximately 95% of hip fractures result from falls, minimizing fall risk is a practical approach to reducing these serious injuries. Research demonstrates that effective fall prevention strategies require a multifaceted approach with both behavioral and environmental components. Important elements include education and skill-building to increase knowledge about fall risk factors, exercise to improve strength and balance, home modifications to reduce fall hazards, and medication assessment to minimize side effects (eg, dizziness and grogginess). Program and research needs: Coordination needs to be improved among the diverse federal, state, and local organizations that conduct fall prevention activities. The effectiveness of existing fall prevention programs among specific groups of women (eg, those over 85 or living with functional limitations) needs careful evaluation. New primary fall prevention approaches are needed (eg, characterizing footwear that promotes stability), as well as secondary prevention strategies (eg, protective hip pads) that can prevent injuries when falls occur. Finally, efforts are needed to increase collaboration among national experts from various disciplines, reach consensus regarding priority research areas and program issues, and work toward long-term strategies for reducing falls and fall-related injuries among older adults. Conclusion: People older than 65 constitute the fastest-growing segment of the U.S. population. Without effective intervention strategies, the number of hip fractures will increase as the population ages. Fall prevention programs have reduced falls and fall-related injuries among high-risk populations using multifaceted approaches that include education, exercise, environmental modifications, and medication review. These programs need to be evaluated among older adults who are living independently in the community. In addition, secondary prevention strategies are needed to prevent hip fractures when falls occur. Effective public health strategies need to be implemented to promote behavioral changes, improve current interventions, and develop new fall prevention strategies to reduce future morbidity and mortality associated with hip fractures among older adults.