The National Electronic Injury Surveillance System All Injury Program, supported by the Centers for Disease Control, tracks data from a representative sample of hospital emergency departments (EDs).  This dataset was recently analyzed¹ to reveal the circumstances of injurious falls and the assistive devices that were involved, yielding estimates that:

• Each year in the US there are 47,312 nonfatal fall injury ED visits associated with the use of canes and walkers by people 65+ years of age;  60% of these happen at home.

• The injuries sustained in these falls are serious with one-third of patients requiring hospital admission for fractures, contusions, abrasions & internal injury.  Men are more likely to sustain head and neck injuries while women more commonly injure the lower trunk.

Canes are generally prescribed for a moderate level of gait instability, whereas walkers are recommended for more generalized weakness, limited weight bearing ability or poor balance.  Women are more likely to use walkers than men.  Even though there are twice as many older adult cane-users as walker-users, this analysis found that:

• Walkers are associated with 7 times as many ED fall injury visits as canes.
• Women are 2 ½ times more likely to report to the ED for these walker-fall injuries.
• Those 85+ years of age on a walker are at particularly high risk.

Clinical implications:  Assistive device use is associated with injurious falls that require medical care.  It is essential that older adults receive instruction from qualified therapists who can intervene to reduce intrinsic risk factors (poor balance) as well as maximize the likelihood of  proper fit and safe use of assistive devices.  Particular attention should be given to those helping those aged 85+ master the physical and cognitive skills required for safe walker use.

1.  Stevens JA, PhD, Thomas K, The L, ABJ, and Greenspan AI. (2009). Unintentional fall injuries associated with walkers and canes in older adults treated in US emergency departments.  JAGS 57:1464–1469.

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The Agency for Healthcare Research and Quality (AHRQ) reports results from analyses of the Healthcare Cost and Utilization Project-Nationwide Emergency Department Sample regarding ED visits among elderly adults who were coded as sustaining both a fall and an injury.  Starting from the vantage point of the ED these analyses highlight the importance of our efforts to reduce falls and illuminate how injurious falls contribute to human suffering, ED overcrowding, hospital costs, admission to long term care facilities as well as private and government health care spending.  Having sustained a fall injury requiring a trip to the ED could trigger efforts to identify, track, assess and intervene with these high risk individuals in order to reduce the risk of sustaining another fall. Having fallen is one of the strongest predictors that one will fall again.

In the United States in calendar year 2006:

Injurious falls accounted for 10.5% of all ED visits among adults aged 65+, totaling over 2.1 million visits.

• The rate was 57.4 ED visits for injurious fall injury per 1000 people 65+ years of age.

• Females accounted for 70.2% of the ED visits.  Those aged 75-84 had the highest number of visits (40.3%), followed by those 85+ (32.4%) and finally those 65-74 (27.3%).  Nearly 1 in 7 women and 1 in 10 men aged 85+ had an ED visit for an injurious fall.

• The most common injuries resulting in an ED visit were fractures (41%); superficial contusions (22.6%); open wounds (21.4%), sprains and strains (10%); internal organ injuries (4.6%) and dislocations (1.5%).

• Hip fractures accounted for about 1 in 8 ED visits among adults aged 65+.

• Nearly 30% of the injurious falls treated in the ED resulted in hospital admissions and these admissions (while not longer) had a higher average cost ($10,800) relative to older adults admitted from the ED for other reasons ($9,900).

• The aggregate national cost of hospital care for older adults who came in through the ED for an injurious fall was $6.8 billion.

• The elderly who were treated in the ED for an injurious fall and then hospitalized were more likely to be discharged to long term care (65.7%) than elderly ED patients hospitalized for other reasons (28.4%). Fractures or internal injuries were most likely to require hospital discharge to a long term care facility.

Owens PL, Russo CA, Spector W and Mutter R. Emergency department visits for injurious falls among the elderly, 2006.

HCUP Statistical Brief #80.  October 2009.  Agency for Healthcare Research and Quality, Rockville, Maryland.

http://www.hcup-us.ahrq.gov/reports/statbriefs/sb80.pdf

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If you are poor or old or both and on a Government Funded Healthcare plan typically you will be receiving inferior care from doctors.  The doctors you see are getting paid at levels that border on volunteer work since the premiums and reimbursements the government pay is so low.  In fact, the system is so antiquated that doctors (i.e. internists) many times forgo prescribing additional help for the elderly in order to steer clear of having to deal with the paperwork, regulations, and consistent rejections of recommended care.

With President Obama in office, one of his first priorities is to pump $100 billion into Medicaid and Medicare, though with no obligations, therefore the same problems will continue.  A recent study by the Journal of the American College of Cardiology found that Medicaid patients with heart problems, which tend to be over whelming seniors, were more than 50% more likely to die after a coronary artery bypass than patients with private coverage.  The people conducting this survey suggested that this result came from poorer long term and follow up care.  Another study in the journal Ethnicity and Disease showed that senior Medicaid patients with unstable angina had worse care because they were unlikely to get timely interventions or to be treated at the better hospitals.

With these studies and others showing similar results, you would think the government would be doing what it can to change the system and erase these inequities.  Unfortunately even under the new presidential administration, these issues are not being addressed.

Another interesting survey showed that approximately 40% of geriatric doctors restrict access to Medicaid patients because the reimbursement rates are so low creating an even smaller number of specialists to help solve the medical problems of senior citizens.

New funds from the Obama Administration alone won’t fix the Government’s Funded Healthcare Plan’s woes since it will simply allow states to siphon monies intended for Medicaid be redirected into other programs. Without monitoring processes in place and even with the new Administration’s good intentions, it is going to take many years and a tremendous amount of dedication to change this failing system.  The only hope one has now is not to be poor or in need of care.

Shared with permission from American Care Mgr

Home Sweet Home

People spend years building and spending their hard earned money and time on their homes.  But how many think about making an environment that is senior friendly?

As we age we are not able to perform the same tasks with the ease of our earlier years, creating many dangerous situations.  The current home may not be adequately prepared to provide the safety and convenience of the aging residents.

The rate of our aging seniors is beginning to influence the development of new appliances; stairs, homes, and electronics. Currently seniors, age 55 and above, make up 76 million people and spend $25 billion annually in the American consumer market.  As they age, seniors are going to be looking for ways in which to make their lives safer and more convenient.

A new senior friendly oven comes with an automatic door and features that shuts off the heat when not in use.  Other features include a glass cook top with a thermometer that will prevent boil over if a person forgets and easy to touch or program levers for cooking.  The oven also has a handle bar that will support a 350lb person.  All of these new features are being developed and marketed specifically for the geriatric age group by companies such as General Electric, Siemens, and Moen.

New washers and dryers geared toward seniors are also being developed.   Many of the new washer and dryers are being designed to reduce stooping when removing laundry.  They provide large knobs that make unique and louder than normal noises or melodies for each setting, and have automatic or easy to open doors.

Becoming senior friendly is not only restricted to the home but also needs to include the automobile.  In order to ensure new cars are senior friendly, Nissan Motor Co. has employees wear an “aging suit” that simulates stiff joints, poor balance and impaired vision while they test concept cars.  Ford Motor Co. has developed software to simulate the motions of an older person using a vehicle.

Companies are beginning to realize that one model does not fit all.  The geriatric market will force more research and development for alternatives for the aging individual. When you prepare your home as you age, consider some of these items when replacing old or outdated appliances and equipment.

With our current economy crisis most states across America are forecasting a large shortage in the amount of funding they typically receive from taxes and from the national government.  This means that many of the programs states were funding are being reevaluated and are either totally being cut or dramatically reduced.  One of the first programs facing large cuts across the country is support services provided for the Elderly and the disabled.

Most states are focusing on cutting programs that allowed low income seniors to remain independent and receive in-home care such as home health aids, cooking, cleaning, etc.  Many seniors depend on these services to maintain a very basic quality lifestyle as opposed to moving to a nursing home.  Many of the seniors who will have these services terminated are going to have to quickly reevaluate their living situation forcing those seniors without additional finances to leave the independent lifestyle they deserve and to which they have grown accustomed.   Many of these seniors will, of course, have to dip into their own small savings to pay for these services further straining what little money they may have left.

Currently 41 states are facing cutbacks and budget shortfalls forcing them to act to restrict the funding of non-critical services.  They are cutting funding from some of the most vulnerable.  These seniors are not able to work or take care of themselves, yet try to lead an independent lifestyle.  These cuts are going to force seniors to face the question of funding these services themselves, buy their own expensive prescription drugs, or purchase groceries to eat.

Typically, when seniors deplete their personal savings they are typically forced to move into a nursing home. Clearly, the majority of senior citizens prefer to avoid a nursing home.  To their credit, the Government, over the past 8 years, has been focused on keeping seniors at home through increased home based care in order to negate the high Medicare cost of providing care for senior citizens in nursing homes.  In anticipation that some day this proportion of spending be reallocated senior citizens may be in for a long haul and a rough time.