Fatal falls soar among the elderly in Mass.
'06 increase puzzles public health officials
The number of senior citizens dying from falls in Massachusetts rose dramatically in 2006, a finding so alarming to public health authorities that they have begun reviewing hundreds of death certificates for clues that might explain the increase.
That year, 341 people ages 65 and older died from falls in the state, an increase of nearly two-thirds from the year before and the highest total on record. Falls kill nearly as many people in Massachusetts as vehicular accidents, and reducing their incidence has become a major focus of hospitals, nursing homes, and health agencies in recent years.
The steep one-year rise, which is detailed in a state report being released this morning, left specialists in aging and public health deeply concerned.
"We're scratching our heads with the size of the jump," said Alice Bonner, executive director of the Massachusetts Long Term Care Foundation, the research arm of the state's nursing home trade group.
Yesterday, state investigators and advocates for the elderly pointed to a broad range of potential reasons for the rise in fatal falls, touching on everything from medication to weather. As people age, their medicine cabinets bulge with more and more prescription drugs that can dangerously interact, spawning problems with balance. Falls can increase during winter months when ice makes walking outdoors hazardous.
The investigation by the state Department of Public Health will mine death certificates for any telling details that, taken together, might sketch a narrative for the increase. The reviewers want to know where the senior citizens died. They want to know about their age, gender, race, ethnicity, and underlying medical problems.
John Auerbach, the state's public health commissioner, acknowledged that heightened awareness about falls may have yielded more vigilant reporting of them on death certificates, although investigators have found no evidence of that so far.
"The bottom line is that the numbers tell us that we need to do more to educate people about the dangers associated with falls and what can be done to prevent them," Auerbach said.
Those efforts have turned more urgent with the aging of the US population; between 1999 and 2005, the rate of falls among Massachusetts residents 85 and over nearly doubled.
"We've done a good job of helping people live with chronic conditions," said Judy Stevens, an epidemiologist with the federal government's National Center for Injury Prevention and Control. "As they age with all these other conditions, it tends to make for an older, more frail population. If they do fall, they're less able to survive the injury."
More than one-third of American seniors fall each year, according to the US Centers for Disease Control and Prevention, making falls the leading cause of injuries among those 65 and older. Most deaths from falls are a result of brain trauma and injuries to the hips, legs, and feet.
Those who survive often need hospital treatment - 1.8 million older people were treated in emergency rooms for survivable falls in 2005, according to the CDC. And for many, the fear of another fall becomes so paralyzing that it cripples their lives.
In Massachusetts and across the nation, hospitals, nursing homes, and governmental regulators have embraced an array of campaigns to reduce falls. Often that means evaluating patients for the likelihood of suffering a fall as soon as they check in to a hospital.
When Patricia Noga's mother was admitted recently to a Massachusetts hospital, she was designated a "falling star," meaning nurses, orderlies, and other hospital workers should be especially watchful.
"It's a concern to everyone," said Noga, senior director for clinical affairs at the Massachusetts Hospital Association. If a patient does fall, hospital staff members quickly "huddle to do a root-cause analysis to determine why this happened and what we can do to prevent this from happening again."
The issue is receiving attention from lawmakers, too. State Senator Richard T. Moore of Uxbridge, chairman of the Joint Committee on Health Care Financing, has legislation proposing a commission on fall prevention.
Falls, Moore said, "are a very expensive and personally draining experience and if we could prevent them or reduce the number, we would save some lives."
Karen Devereaux Melillo believes her father died of a preventable fall. At 83, he suffered from dementia and complications of hip replacement surgery. The family placed him in a nursing home in the Greater Boston area, but one afternoon a year ago, the staff called to say he had fallen to the floor between his bed and the adjacent chair.
In the emergency room, he was diagnosed with a fractured skull. He died 36 hours later, said Melillo, chairwoman of the nursing department at the University of Massachusetts at Lowell.
A state investigation did not place any blame.
Melillo, a geriatric specialist, said such fatal falls highlight the importance of training staff to help frail seniors. "Falls are not a normal part of aging," she said.
