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  • Older-Adult Deaths From Falls Have Increased; Intervention May Help Decrease Falls in the Future

    Researchers analyzing health statistics have uncovered some disturbing news: in 2016, adults 75 and older were dying from falls-related injuries at more than double the rate they were in 2000. And while authors of a recent JAMA editorial on the numbers say the reason for the dramatic increase "is not fully understood," a separate study in the same issue of the journal points to a physical therapist (PT)-led falls prevention program as a potentially effective way to counteract the trend.

    Using data from the National Vital Statistics System, authors of "Mortality from falls among US adults aged 75 years or older, 2000-2016" found that, in adults over age 75, the number of deaths from falls increased from 8,613 in the year 2000 to a staggering 25,189 in 2016. The age-adjusted mortality rates in 2016 was 42.1 per 100,000 people for those aged 75–79 and 590.7 for individuals aged 95 or older.

    Mortality rates increased for both men and women. The age-adjusted mortality rate for men rose from 60.7 deaths per 100,000 people in 2000 to 116.4 in 2016. Likewise, among women, rate of death from falls went from 46.3 per 100,000 people to 105.9 in 2016.

    Authors of the editorial say the reason for the increase in deaths resulting from falls "is not fully understood." Still, they write, while older adults clearly have the highest risk for falls, they also have the highest potential for cost-effective interventions that make a difference.

    One such promising intervention for secondary fall prevention in community-dwelling older adults is the Otago home-based exercise program. In a study (abstract only available for free) published in the same issue of JAMA that includes the falls editorial, researchers including APTA member Teresa Liu-Ambrose, PT, PhD, write that the program "may have been effective because it reduced the number of falls among individuals who fell repeatedly."

    Researchers for the recently published JAMA study designed a randomized controlled trial to specifically examine whether the Otago exercise program could do so for adults over age 70 who previously had experienced a fall. Upon seeing a physician after a fall, patients were randomly assigned to receive 12 months of "usual care" or usual care plus the home-based strength and balance retraining program. Usual care included fall risk and medical assessment; treatment by a geriatrician, including lifestyle recommendations; and referral to other providers as necessary.

    In the Otago program, a PT delivers balance, strength, and walking exercises that increase in difficulty over time. Participants in the JAMA study were instructed to repeat the exercises 3 times a week and walk for 30 minutes each week. The PT returned every other week to adjust the exercises, and individuals were evaluated by a physician at 6 and 12 months.

    Authors found that falls were significantly reduced among those who completed the Otago program (236 falls) compared with those who only received usual care (366 falls). While a majority of participants experienced additional falls, the rate was 1.4 per person-year for the Otago group compared with 2.1 for the usual care group.

    However, consistent with previous research, there were no significant differences between groups in fall risk, general balance, and mobility. "It is possible to observe a significant reduction in falls without significant improvements in physical performance," authors conclude. APTA provides extensive resources on falls prevention at its Balance and Falls webpage. Offerings include consumer-focused information, online courses, and links to other sources of information, including the CDC and the National Council on Aging. In addition, APTA's PTNow evidence-based practice resource offers a unilateral vestibular hypofunction clinical summary, a summary on falls risk in community-dwelling elders, an osteoporosis clinical summary, and tests and measures such as a fracture risk assessment, a clinical test of sensory interaction and balance, and a self-paced walk test. The association's scientific journal, PTJ (Physical Therapy) has published a clinical guidance statement from the APTA Academy of Geriatric Physical Therapy on management of falls in community-dwelling older adults.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

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