Prevention of Unintentional Injuries Among Seniors

Workshop on Healthy Aging:
November 28-30, 2001

Compelling Evidence Linked to Healthy Aging

Injured seniors often face an irreversible decline in function, which can lead to institutionalization and death. In particular, falls have a grave impact on seniors and their independence, and are responsible for about 84% of injury-related hospital admissions and 40% of admissions to nursing homes.

The health care cost of injuries is extremely high. In fact, injuries among all ages rank third behind cardiovascular and musculoskeletal disease in terms of total burden of illness, accounting for 11% of the total direct and indirect cost of all illness.

The physical nature of seniors, especially in the older age groups, means that falls often result in more serious fractures and longer periods of recovery and, hence, longer use of health care resources. According to one study, a reduction of 20% of hospitalizations due to falls among seniors could potentially result in over 7,500 fewer hospitalizations and some 1,800 fewer people over the age of 65 with permanent disabilities. The net savings from this target reduction are estimated at $138 million annually. Reduction in injuries would also have dramatic implications for seniors themselves by extending their independence, decreasing the likelihood of needing long-term care and thereby having an impact on their quality of life.

Effectiveness of Interventions

Note: The federal, provincial, and territorial Ministers Responsible for Seniors have provided support for an inventory of Canadian falls prevention initiatives and a systematic review of literature to assess the evidence of the effectiveness of interventions to reduce falls and fallrelated injuries among community-dwelling seniors. The results of this study form the basis of a best practices guide. These documents are available online through the Seniors Policies and Programs Database at http://www.sppd.gc.ca.

Research shows that many injury risk factors can be modified when appropriate interventions are put in place. However, many interventions are implemented in time-limited programs with limited resources. As a result, few rigorous evaluation studies have been completed to determine the effectiveness of interventions, particularly those that adopt a multifaceted approach.

Interventions that have shown promising results in falls prevention among seniors include the effects of Tai Chi exercises. After adjustment for fall risk prior to entering a study on falls prevention, the results demonstrated that Tai Chi training (a form of Chinese martial arts) completed two times per week for 15 weeks served to reduce falls by 47.5% among seniors 70 years of age or older compared to a discussion only group.

Environmental modifications to the home have been shown to reduce falls requiring medical attention by 55% over 24 months. Clinical interventions by emergency room nurses and physicians for senior patients with a primary diagnosis of a fall-related injury, followed by home interventions under the direction of an occupational therapist, were found to significantly reduce falls over one year, with 32% of intervention participants versus 52% of control group participants reporting at least one fall.

A community-wide, multi-strategy intervention in Australia showed a 20% lower, agestandardized rate for fall-related hospital admissions in the intervention area relative to the control area. A similar multi-strategy approach in Norway showed a significant 26.3% reduction in fractures due to falls over five years.

Multifaceted strategies that target a variety of risk factors hold great promise for reducing falls and are considered to be a good investment in injury prevention. However, the impact of these strategies needs to be further evaluated. Examples of interventions that could be combined include exercise and balance promotion programs, vision checks, medication management and environmental modifications.

More research is also needed to better understand the cost-effectiveness of injury prevention strategies. A study that examined the cost savings attributed to a multi-strategy falls prevention program showed that for an average investment of $906, there was a cost saving of $3,695 due to a reduction in fall injuries. Cost-effectiveness was also measured as part of a New Zealand study using an exercise program delivered by visiting nurses to seniors 80 years of age or older. The findings showed that there was a cost saving of NZ$1,563 per injurious fall prevented, after accounting for program costs and averted hospital costs.

Specific strategies targeted at fracture prevention have also been shown to save health care dollars. One study shows that an investment of $8,000 for hip protectors per 40 nursing home residents will translate into the prevention of one hip fracture. This is a considerable savings, given that one hip fracture costs the health system approximately $25,000.

To maximize the effectiveness of injury prevention programs, it must be recognized that injuries result from a combination of factors. It is, therefore, important that sectors associated with these factors, such as transportation, housing and local government, are included as partners in the implementation and evaluation of prevention strategies.

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