Injury - Older Adult Falls Deaths

Why Is This Important?

Falls are the leading cause of unintentional (accidental) injury death among adults aged 65 years and older in the United States and in New Mexico. The majority of fall-related injury deaths among older adults involve hip fractures and traumatic brain injuries. Non-fatal injuries from a fall can limit the mobility and also result in non-independent living for many older adults. Falls among older adults are associated with an increased risk of future fall-related injury associated premature death. Many people who fall develop a fear of falling and may become more sedentary, further increasing their risk for another fall. Most falls are not a normal part the normal aging process and are preventable.

Definition

Fall-related death rate is the number of unintentional injury deaths due to falls in persons age 65 years or older, per 100,000 population age 65 years or older. Rates are age-specific death rates for ICD-9 Codes: E880-E886, E888 (1990-1998) and ICD-10 codes ICD-10 Codes: W00-W19 (1999 forward).

Data Sources

• New Mexico Death Data: Bureau of Vital Records and Health Statistics (BVRHS), Epidemiology and Response Division, New Mexico Department of Health.
  (https://www.nmhealth.org/about/erd/bvrhs/vrp/)
• U.S. data before 1999 from Web-based Injury Statistics Query and Reporting System (WISQARS), 1999 and later Centers for Disease Control and Prevention, National Center for Health Statistics, CDC WONDER Online Database
  (http://wonder.cdc.gov, https://www.cdc.gov/injury/wisqars/index.html)
• Centers for Disease Control and Prevention, National Center for Health Statistics, CDC WONDER Online Database
  (http://wonder.cdc.gov)
• New Mexico Population Estimates: University of New Mexico, Geospatial and Population Studies (GPS) Program.
  (http://gps.unm.edu/)

How the Measure is Calculated

How Are We Doing?

The fall-related death rate among adults aged 65 years and older in New Mexico increased by 16% between 2015 and 2016.

How Do We Compare With the U.S.?

In 2016, the fall-related death rate among adults aged 65 years and older was 50% higher in New Mexico compared to the United States.

What Is Being Done?

As a result of legislation that was passed in 2013 and 2014, the New Mexico Department of Health expanded its adult falls prevention program, after which it received additional funding to more comprehensively establish older adult falls primary and secondary prevention programs. The Office of Injury Prevention has prioritized the following intervention efforts pursuant to its partnership with the NM Adult Falls Prevention Coalition (for more information see http://nmstopfalls.org). Older community-dwelling adults should increase safe physical activities, have medications reviewed annually, assure appropriate levels of Vitamin D intake, and make appropriate safety modifications to their homes. o Health care providers should screen their older adult patients for fall risk factors and refer them to appropriate interventions in order to minimize their fall risk. o Caregivers and family members should be trained on fall prevention strategies. o State agencies and other organizations should increase the availability of evidence-based falls prevention and physical activity programs in community-based organizations serving older adults improve mechanisms for health care providers to screen and refer older adults who may be at risk for falls to community-based falls prevention and physical activity programs, and empower all individuals to promote falls prevention strategies in their communities. PHYSICAL ACTIVITY: Evidence-based fall prevention exercise programs are an effective means for older adults to get stronger and improve their balance and have been demonstrated to reduce the risk of adult falls. The New Mexico Department of Health currently supports four evidence-based fall prevention programs for older adults: Otago, A Matter of Balance: (MOB), Tai Ji Quan: Moving for Better Balance, and Tai Chi for Arthritis. Otago has traditionally been for home-bound adults, however, recent movements in the program have proven it to be just as effective as a group or community-based program. A Matter of Balance: Managing Concerns about Falls, Tai J Quan, and Tai Chi for Arthritis are community-based programs commonly offered through senior citizen centers throughout New Mexico. The objectives of these evidence-based fall prevention programs are to increase level of safe physical activity, reduce fear of falls, and also to improve strength, balance, mobility, and daily functioning in older adults. There are currently over 94 evidence-based falls prevention instructors in 16 New Mexico counties and 14 Native American Pueblos who are available for teaching evidence-based fall prevention programs to adults who may be at risk for falls. In 2016 and 2017, approximately 500 older adults completed one or more evidence-based fall prevention program in New Mexico. CLINICAL INTERVENTION: The New Mexico Department of Health has sponsored peer-to-peer training for healthcare providers on clinical implementation of the Center for Disease Control and Prevention's (CDC's) fall prevention toolkit, Stopping Elderly Accidents, Deaths and Injuries (STEADI), which is used to screen for multiple risk factors for falls and provides for referrals to appropriate resources, including evidence-based falls prevention programs as appropriate. Screenings for fall risk may include identifying strength and balance issues, home safety modifications, review and manage medications linked to falls, annual vision checks, and vitamin D intake recommendations. HOME SAFETY MODIFICATION: Most falls happen at home. The New Mexico Department of Health (NMDOH) encourages older adults and their caregivers to check their homes for safety and modify as appropriate to minimize potential hazards. Home safety hazards can include torn rugs or rugs that do not lie flat, stairs that are in poor repair (i.e. broken or no handrails), poor lighting, and clutter on floors or in walkways. Another environmental safety concern for older adults may be the need for appropriate safety equipment for accessibility in the bathroom such as grab bars, a walk-in shower, and adaptive equipment as needed. The NMDOH encourages local services such as Fire Departments, and Emergency Medical Services (EMS) to do provide home visits to community members aged 65 years and older who may be at risk for falls and educate them about opportunities to make their homes safer.. Individuals who qualify for Medicaid or dual enrollment (Medicaid and Medicare) may qualify for environmental modification funds through their Managed Care Organization (MCO).

Evidence-based Practices

How can older adults prevent falls*? Exercise regularly to increase strength and balance. The NMDOH currently supports four evidence-based falls prevention programs and Stopping Elderly Accidents, Deaths and Injuries (STEADI) as a clinical intervention and best practices for fall prevention. Ask a doctor or pharmacist to review medications annually, including both prescription and over-the-counter medications, to identify medications that may cause side effects, such as dizziness or drowsiness. Visit an Optometrist annually to update prescription eyeglasses and maximize vision. Reduce home hazards by removing tripping hazards, installing grab bars in the bathroom, both inside and outside the tub or shower and next to the toilet, installing railings on both sides of stairways, and improving all lighting in the home. *Source: Important Facts about Falls: What You Can Do To Prevent Falls, downloaded from http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html on November 23, 2015.

Other Objectives

New Mexico Community Health Status Indicator (CHSI)