Falls aren’t just a Camden problem. Nationally, one in three seniors falls every year and falls are the leading cause of injury death for people 65 and older, according to the Centers for Disease Control and Prevention. The costs are staggering. In 2000, direct medical costs of falls totaled more than $19 billion, said the CDC, which is encouraging groups to create programs nationwide.
Hospitals from Virtua in South Jersey to Holy Redeemer Health System in Meadowbrook have efforts to help prevent falls as does Bayada Nurses, a home health agency. Chester and Montgomery Counties both have state-funded fall prevention efforts.
But Camden providers are armed with detailed data on falls, including citywide statistics that many other regions don’t have. And local providers, including the city’s biggest hospital, are using the knowledge to battle against falls – and their costs. “It’s not only identifying risk factors for [people who have fallen],” said Kathleen Devine, Cooper University Hospital’s senior director for emergency and trauma services. “It’s actually connecting them to resources in the community.”
Most falls in older adults are caused by a combination of inherent risk factors – poor balance and gait, medication side effects, limited vision – and environmental factors, such as a wet floor or an unsecured throw rug, said Roberta Newton, a noted fall expert and a physical therapy professor at Temple University. “Most often, it’s when the older adult performs the routine activities of daily living” that falls occur, she said.
That was the case for Vera Jenkins, an 82-year-old lifelong Camden resident, who decided she’d skip the five-block drive from her home to the Macedonia AME Church one Sunday last October. “That was just one day I decided to walk,” she said, “because it was such a beautiful morning.”
Jenkins fell on the walk to church, likely tripping over a break in the sidewalk. She didn’t feel hurt and her glasses hadn’t even fallen off, so she continued on. But after Jenkins saw that her top lip had swollen up to her nose, she went to Cooper. She was treated for bruising and now wears a brace to strengthen her right leg.
But what might be worse than the ongoing physical pain is the mental trauma: Jenkins is afraid to fall again. “After it happened, I’m walking like a baby,” she said. “No matter where I’m walking outside, I really pay attention.” She hasn’t walked to church since her fall. During the winter, Jenkins skipped church and her job as a school monitor to avoid the slippery snow and ice. She sometimes walks in the street to avoid uneven sidewalks. “I think you will find most seniors are afraid of falling,” Jenkins said, “because there is so much damage that can be done.”
Falls are the leading cause of fractures in older adults and of traumatic brain injuries, according to the CDC, and fall-related injuries can increase the risk of early death. But along with physical problems, falls can also cause emotional disruptions. Like Jenkins, many first-time fall victims are afraid of falling again, said Mary Lachant, a Cooper trauma research coordinator. “It’s like a vicious cycle,” she said, resulting in the person limiting physical activity due to fear of another fall. But a sedentary lifestyle actually weakens the patient, making them more likely to fall again.
Some people who fall get back up and resume their active lifestyle, Newton said. But for others, “there is this beginning, slow decline in their physical capability,” she said. “That spiral could lead to admission into a nursing home.”
SAFER Steps, a new fall prevention program at Cooper, is trying to avoid hospital readmission among people who have fallen. After watching the hospital’s fall-related patient load increase – despite the trauma center’s community presentations on fall prevention – the hospital set out to find a better model. “If you look at the fall prevention programs that are out there,” Devine said, “it’s pretty generic vanilla education.”
Cooper teamed up with one of its doctors, Jeffrey Brenner, who runs the Camden Coalition of Healthcare Providers, and in October launched a program that combines fall education and resources with in-home visits from Cooper staff. After discharge from the hospital, the SAFER Steps team visits participating patients at home. There, a nurse, physical therapist and community advocate identify risks that could lead to future falls.
In some homes, for instance, “the flooring in the bathroom is like an ice skating rink when it gets wet,” Devine said. But often the potential hazards are less obvious, such as the patient who hadn’t had an eye exam in two decades. “A lot of these people live alone and they have multiple medical problems,” said Lachant, who works on the program. “They’re on multiple medications. There are vision problems. Trip and falls happen. In a lot of cases, they don’t realize they’re 85 years old and they can’t do what they did when they were 60 or 65.”
Once the dangers are highlighted, the team connects the patient with resources to fix them – everything from a referral for an eye exam to a new walker and a tutorial with a physical therapist on how to use it. For Jenkins, one of the program’s first patients, the problems were inside her home. Through a partnership with St. Joseph’s Carpenter Society, in which Cooper buys supplies and the society donates labor, Jenkins will have carpeting put down in her bathroom and two small ramps built in her doorways.
The team follows patients over several months, monitoring whether their suggestions were taken and, most importantly, if the patient has fallen again. So far, none have. There is no charge to patients or their insurance providers. Once the program hits the one-year mark, the Cooper team plans to look for grant funding to expand.
A 2008 report by the CDC encouraged the creation of such community-based fall prevention programs for older adults. The report emphasized the need for education about risk factors and prevention, exercise classes, medication review by a health professional, vision assessment and correction and a home safety assessment, including modifications if necessary.
Bayada Nurses, a Moorestown-based home health care company, also focuses on falls – even for patients who have never taken a tumble. Fall prevention has always been a staple of patient assessment for Bayada, staff members said. But its importance has increased as hospital stays have grown shorter, they said, leaving some discharged patients weaker and less educated about their own home care.
Paul Martin Jr., 70, suffered a stroke a decade ago that weakened the right side of his body, yet he still navigated the stairs and hallways of his longtime Camden home. But after a recent bout with ulcerative colitis confined him to a hospital bed for three weeks, Martin’s strength deteriorated. Despite two weeks of rehabilitation, his endurance was low and he couldn’t walk without support, said Abayomi Ramos, Martin’s physical therapist from Bayada. Martin was classified as a high fall risk.
After an initial assessment in December, Ramos worked with Martin on walking up and down the stairs and getting up from his favorite chair with a single attempt. Martin saw physical improvement – he answers the door much faster now – but he also became educated about how a fall could endanger his active lifestyle. “If you’re independent and you have that drive,” he said, “you’ll try not to do things that are going to harm you.”
It’s no surprise that hospital readmissions are a major focus of fall prevention efforts, considering how quickly the costs related to fall hospitalizations add up. When Newton studied fall-related hospitalizations among North Philadelphia residents about five years ago, she found that an average hospital stay for a fall injury cost $23,000. Another 2005 study found that the average hospitalization cost for a fall injury is $17,500.
In recent years, Philadelphia hospitals have increased their focus on falls occurring within hospital walls. The ECRI Institute, a nonprofit that researches approaches to improving patient care, in 2007 gathered representatives from 15 Philadelphia-area hospitals to discuss fall prevention tactics.
Following the seven-month program, several hospitals launched medication review procedures to identify patients at high fall risk, said ECRI’s Kathryn Pelczarski. For those patients, hospitals added increased precautions, such as bed exit alarms, to prevent falls. Hospitals also developed a list of medications that could compound fall risk -- for example, certain antidepressants can cause dizziness and blurred vision – and distributed it to nurses.
Elsewhere around the country, researchers are devising ways to reduce fall hospitalization costs – especially as Baby Boomers start to hit senior status.
Last year at the Gerontological Society of America conference, a University of South Florida doctoral student presented research indicating that gardening, which has the potential to improve or maintain balance and gait speed, might indirectly prevent or reduce falls. The researcher, Tuo-Yu Chen, said that as one of the most common physical activities among older adults, gardening might be a beneficial addition to fall prevention programs. The psychic benefits of gardening would be a bonus.
Contact freelancer Christina Hernandez at christinamh@gmail.com. She wrote this article as part of her MetLife Foundation Journalists on Aging Fellowship in partnership with New America Media and the Gerontological Society of America.
