Slips, Trips and Falls: A Costly Public Health Concern

Author: David Paquette  -  PHM Volunteer

I have authored articles in the past to be included in the Public Health Museum Newsletter. They gave more background and stories about some of our exhibits (i.e., the jet injector, the 1910 typhoid epidemic in Lowell). I also had the honor of doing a Zoom presentation heard in real time and later posted to YouTube. That presentation, on the story of the elimination of smallpox, I had the honor of presenting with Dr. Al DeMaria, past Board Chair, and Dr. Jason Weisfeld, who was key to the elimination of smallpox in the 1970’s.

This time I bring up a subject that I have much personal and professional knowledge and experience. My last position before retirement was with Cigna Medical Group in Phoenix, where I was (among a few other things) the health and safety officer for our 15 clinics. My responsibilities included assessing and minimizing risks for slips, trips, and falls for patients and staff. Preventing slips, trips, and falls is sometimes not considered to be a public health discipline, but the prevention of injury and morbidity, it clearly is.

I should have applied the knowledge better to my personal life. I week ago, I took a proper fall in my residence and fractured 2 ribs. (I am fine, just hurts a bit). I became that statistic of folks over 65 who disproportionally injure themselves in slips, trips, and falls.

Falls in adults 65 years of age and over have been recognized as an urgent national public health crisis. The Centers for Disease Control and Prevention (CDC) responded by creating a national initiative aimed at preventing falls among community-dwelling adults 65 years and over. Falls are the leading cause of injury-related deaths among those 65 years and over, and lead to premature mortality, loss of independence, and placement in assisted-living facilities.
The numbers are staggering. According to the CDC, in 2018 (most recent data) 27.5% (35.6 million) of adults 65 years of age and older reported at least one fall in the past year, and 10.2% (8.4 million) reported a fall-related injury. Well, begrudgingly count me in.

It gets worse. Each year falls result in more than 32,000 deaths, with 3 million older adults requiring emergency room treatment. Falls are one of the leading causes of traumatic brain injuries in this population, and fall-related hip fractures account for at least 300,000 hospital admissions.

Most falls are preventable, but a substantial increase in education among both patients and providers is required. What are some reasons for falls? Are some older people more prone to falls and injury than others? Noted in the literature:
-Medications related to falls. Increase medication use equals increased risk of falls. These are both prescription medications as well as many over-the-counter medicines. They can cause dizziness, confusion, and blurred vision in addition to other side effects correlated with increased risk of falls.

-Physical inactivity. Physically inactive adults 65 years of age and older are more likely to experience falls and be seriously injured than physically active adults.
- Other conditions. Including dementia, metabolic disorders such as diabetes, gait and balance disorders, foot deformity, lower extremity amputations, vision impairment, and nutritional status.
-Our environment (our built environment) is one of our final factors to consider, accounting for enablers and barriers to maintaining a safe home environment.
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So, look around your home or office for things that may cause you to fall, hit your head, or otherwise hurt you. Put grips under throw rugs, close cabinet doors, improve lighting, check stairway hand rails for security and stability. I wish I had.

Statistics Source: American Public Health Association, Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services