Douglas S. Paauw, MD
We have wrapped up another holiday season, and I am reminded of what a risky time it is for our older patients. Falls are the primary cause of fatal injuries in adults older than age 65 years. One in four older adults falls every year, and 37% of those who fall require medical care.
Douglas S. Paauw, MDFatal falls are increasing: the age-adjusted fall death rate increased by 41% from 55.3 per 100,000 older adults in 2012 to 78.0 per 100,000 older adults in 2021. Fatal falls are more common in December and January, likely due to factors such as more ice in northern climates and the desire to get on ladders to decorate for holidays and remove decorations.
Most advice to prevent falls focuses on factors such as medication reviews, muscle strengthening, better eyeglasses, and getting rid of trip hazards. All are important but we need to actively tell our older patients to stop getting on ladders (as well as step stools).
Ackland and colleagues looked at the epidemiology and outcomes of ladder-related falls requiring ICU admission. Hospital mortality was 26%, and almost all deaths occurred in older men who had domestic falls and died as a result of traumatic brain injury. Fewer than half of survivors were living independently 1 year after the fall.
Vallmuur and colleagues studied ladder-related falls in Australia. They found that rates of ladder-related falls requiring hospitalization rose from about 20 per 100,000 for men aged 15-29 years to 78 per 100,000 for men older than 60 years. Of those who died from fall-related injuries, 82% were older than 60 years, with more than 70% dying from head injuries. Panagiotis and colleagues found that age was a major determinant in fatal falls from ladders, with a risk of death 10 times higher in patients older than 65 years compared to those younger than 15 years.
Schaffarczyk and colleagues looked at the impact of nonoccupational falls from ladders in men older than 50 years. The mean age of patients was 64 years (range, 50-85), and 27% suffered from severe trauma. There was a striking effect on long-term function in over half of the patients. The authors interviewed patients long after the falls and found that most never thought of themselves as being at risk for a fall, and after the experience of a bad fall, would never consider getting on a ladder again.
It is important for healthcare professionals to discuss the dangers of ladder use with older patients, pointing out the higher risk of falling and potential for the fall to be a life-changing or life-ending event.
Pearl: Counsel your older patients (over age 60) to never get on a ladder. This topic should be raised at the Medicare wellness exam.
