In late January, a 97-year-old woman fell in her home and broke her left hip, necessitating a hip replacement. Although the Queen Mother's plight made headlines around the world, her experience is familiar to many seniors in Canada, where their falls are relayed in alarming statistics, rather than news headlines.
Nearly one third of seniors have one or more falls a year. A frequent cause of hospital admission particularly when the result is a fracture, falls are also the most common cause of accidental or traumatic death in the elderly. Falls lead to impaired movement, curtailed independence, and costly medical care. They are one of the biggest and most costly issues in seniors' health care, often necessitating hospital admissions, surgery, and long recovery periods. Moreover, the number of falls experienced by the elderly will only increase as baby boomers age.
Many seniors who have suffered falls, and their concerned families, might be interested in research currently conducted by Dr. David Hogan, a U of C geriatrician and Health Research Fund recipient. Dr. Hogan maintains, "There is a sense that fall prevention isn't as well managed as it should be. That's why we're looking into it."
He cites research in the United States and in Europe that take different approaches to fall management. In the States, research on an individualized evaluation of an older person who has fallen underscores the importance of identifying risk factors for each person's fall. Rectifying those risks helped reduce hospital admissions and future falls. In Europe, more of a community health approach has been taken, with the focus on making the environment safer (for example, by doing in-home assessments of risks for falls) and providing easy access to exercise programs.
Dr. Hogan's research team focuses on in-home, personal, and environmental assessments for fall risk in volunteer seniors. "We have made the study as inclusive as possible. Research volunteers have to have experienced a fall, but without any lower limb fractures. They also have to be over 65 years old and living independently."
The team's research is being conducted as a randomized control study; that is, volunteers are randomly assigned to either the research intervention or the usual care given a senior who has fallen. Those volunteers assigned to the research intervention experience a thorough assessment of both their state of health and their environment, conducted by one of the team members. Dr. Hogan's research team, consisting of clinical nurse specialists including co-principal investigator Frank MacDonald, a physiotherapist, an occupational therapist, and a recreational therapist, meets regularly and reviews these assessments. Such information as the type of medications taken, footwear worn, location of scatter rugs, the number of steps in a house all contribute to a risk profile for that person.
The team then taps into existing resources to try and reduce the risks. Rather than suggest radical changes to someone's lifestyle, they work closely with the individual's physician and often with support services such as home care to integrate significant but non-disruptive changes that will have the greatest impact on reducing future falls. Team members have developed a special exercise program administered through Calgary's Day hospital, located at the Glenmore Auxiliary Hospital and the Fanning Centre. The team will also do follow-up visits for about one year to see if recommendations are being followed by volunteers. Finally, rates of hospital admissions, emergency room visits and subsequent falls will be studied over the two-year project to note changes.
Given the seriousness and prevalence of falls in seniors, the research team ensures that all project volunteers receive care. Dr. Hogan says, "The volunteers who are randomly assigned to usual care in the research project are tested by a research assistant, and the resulting information is forwarded to their physicians and any other health caregiver involved in their care, so everyone benefits from participation."
The fall prevention research began last summer and by project end in 1999, the team hopes to have assessed 200 volunteers. If the program shows a reduction in falls in volunteers and a corresponding cost reduction in medical services, many seniors in Alberta will enjoy safer lives.
Dr. David Hogan is a geriatrician and Professor of Geriatric Medicine at the University of Calgary. Mr. Frank MacDonald is a clinical nurse specialist at the Foothills Medical Centre, Calgary Regional Health Authority. The seniors' fall prevention study is supported by the Health Research Fund, administrated by AHFMR on behalf of Alberta Health.
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