Multi-directional nature of falls among older adults: A rationale for prevention and management

Abstract

The global aging population is larger than ever before (1), and it is estimated that 155 countries will have an aging society by the year 2050 (2). In the United States alone, there are more than 50 million adults ages 65 years and older, with this sub-population projected to exceed more than 80 million by 2040 (3). The growing aging population reflects longer life expectancies largely attributed to a combination of medical advancements, accessible healthcare, and supportive and inclusive physical and social environments (4). While there is much variability in the aging process (5), the expansive older adult population brings with it increased prevalence rates of chronic conditions and other health issues (e.g., injurious falls, cognitive decline, malnutrition, mental illness, and social disconnectedness) that will further strain the already over-burdened healthcare system. While there are many pressing and costly geriatric conditions deserving of increased and immediate attention, we will focus on older adult falls as an example of a globally-recognized, age-related condition with a host of negative, but potentially preventable, sequelae (6, 7). Too often falls are narrowly viewed as a natural and inevitable part of aging, which cannot be prevented or managed. The complex and multi-factorial circumstances resulting in a fall require a more holistic view of the event (i.e., causes, facilitators, and contributors) and the older adults' physical, mental, environmental, and medical context. We contend that falls is among the most germane health issues facing older adults because a fall can represent a constellation of interwoven health events and may be centric to multi-level solutions spanning research, healthcare practice, community programming, and policy. This article aims to expand the lens through which we view falls as a public health issue by: (a) offering insights about the upstream indicators and downstream ramifications associated with falls; and (b) highlighting opportunities for interdisciplinary and cross-sectorial solutions to predict, prevent, and manage falls among older adults.Falls in the United States are the leading cause of unintentional injuries among older adults age 65 years and older (8). The incidence of falls is substantial, with one-in-four older adults falling each year (9). Older adults who fall have an increased risk for injury, reduced physical function, loss of independence, institutionalization, and death (9, 10). The estimated annual direct medical costs of falls exceed $50 billion USD (11), which does not account for the associated costs for rehabilitation, caregiving, skilled nursing, or other resulting health issues (physical or mental). The ramifications of a fall dramatically impact the older adult, but when considered collectively, these negative consequences impose extreme duress on their families, social structures, and the clinical and community-based organizations that serve them. Although the likelihood of falling increases with age, it is not a natural part of aging. F...

The Association of Skeletal Muscle Energetics With Recurrent Falls in Older Adults Within the Study of Muscle, Mobility and Aging

“…However, covariates accounted for the increased risk. Falls in the older population are a leading cause of morbidity and mortality and represent a worldwide public health concern [1][2][3][4] . Falls have consequences beyond physical injury in the older population as they have been associated with reduced quality of life, fear of falling, loss of independence, and institutionalization 5 .…”

Functional Lower Extremity Strength Influences Stepping Strategy in Community-Dwelling Older Adults During Single and Dual-Task Walking

“…Functional lower extremity strength plays a critical role in preserving mobility but inevitably declines with advanced age, resulting in a nearly three-fold increase in fall risks in older adults and costing over $50 billion in annual geriatric injury expenditures from government programs such as Medicare 6,7 . Quantifying decrements to functional lower extremity strength before outright mobility-disability occurs is critical but requires direct assessments linking functional lower extremity strength to gait safety.…”

Functional lower extremity strength influences stepping strategy in community-dwelling older adults during single and dual-task walking

“…Functional lower extremity strength plays a critical role in preserving mobility but inevitably declines with advanced age, resulting in a nearly three-fold increase in fall risks in older adults and costing over $50 billion in annual geriatric injury expenditures from government programs such as Medicare 6 , 7 . Quantifying decrements to functional lower extremity strength before outright mobility-disability occurs is critical but requires direct assessments linking functional lower extremity strength to gait safety.…”