Falls Prevention Supports Seniors' Health and Independence

She might say she slipped, tripped or fell. He might say he lost his balance, had a mishap or took a spill. The end result is the same: bruises, broken bones, long hospital stays, rehabilitation, loss of autonomy, personal, societal and economic costs, pain, suffering and, quite possibly, death.

If there’s one area of seniors’ health in Canada that presents a compelling bad news-good news picture, it’s the area of falls prevention.

The bad news is that falls are the leading cause of fatal injury among Canadians over 65 years of age. The good news is that many of these injuries can be prevented with proper falls prevention strategies.

With this knowledge in mind, Health Canada and Veterans Affairs Canada have teamed up to develop an innovative Falls Prevention Initiative designed to identify community-based strategies for preventing falls among seniors and veterans.

Under the Initiative which was announced in August 2000, Veterans Affairs Canada will invest $10 million over four years to develop falls prevention pilot projects in Atlantic Canada, Ontario and British Columbia, with funding being distributed through Health Canada’s Population Health Fund. Key results from the Initiative will be shared with all interested and involved parties in every region across Canada and it is hoped that communities will continue to build identified effective prevention strategies.

“Our focus is on reducing or eliminating risk factors that lead to falls, such as social isolation, reduced physical activity or risk-taking behaviours,” explains Nancy Garrard, Director of Health Canada’s Division of Aging and Seniors. “With its strong emphasis on community involvement, this initiative has the potential to make a difference for seniors and veterans right in their own homes and neighbourhoods.”

Garrard says the Initiative’s pilot project staff works closely with community volunteer groups and non-profit organizations and with seniors and veterans organizations, seeking their advice and support to develop practical responses to local risk factors. “With this input, we are developing useful falls prevention information for seniors and veterans and for their families and caregivers,” notes Garrard. “This information is designed to help Canadian seniors maintain their long-term health and independence.”

Jeannita Bernard, Director of Veterans Affairs Canada’s Health Promotion and Rehabilitation Directorate, says the Initiative is particularly important to Veterans Affairs Canada because many of the department’s veteran clients are at high risk of falls. “Every year, more than one in three veterans suffer a fall that can have a debilitating impact on their independence and well-being,” notes Bernard.

Among the Initiative’s anticipated benefits, she says, will be the postponement or prevention of diseases linked to falls and the improvement of the overall quality of life for veterans and seniors in their homes, neighbourhoods and communities.

Both Bernard and Garrard emphasize that the initiative is unique not only because of its interdepartmental cooperation but also because it has received a great deal of support from provincial falls prevention authorities, veterans and seniors organizations, not-for-profit community groups and voluntary organizations in communities across the country. “With this kind of local support, the Initiative has all the makings of a great grass-roots success story,” says Bernard.

Community Involvement a Priority for Victoria Falls Prevention Project

A key goal of the Falls Prevention Project in Victoria, B.C. is to increase local capacity to respond to falls prevention issues, says project Coordinator Laurie Brady-Mueller. As the Falls Prevention Project sponsor and co-participant, the Vancouver Island Health Authority prepared the project funding proposal and is currently providing project leadership and staff resources.

“This project is part of the Health Authority’s commitment to community development,” says Brady-Mueller. “Our objective is not only to create a coalition and a project but to create long-term sustainability in falls prevention.”

With this objective in mind, the sponsor has brought together a project inquiry group of some 20 volunteers from diverse project partner organizations across the community. The group meets monthly to learn more about falls and falls prevention and to design and test possible strategies for reducing falls among seniors and veterans in the community.

“We expect this group to form the core of a broad community coalition on falls prevention,” says Brady-Mueller. “Over time, this coalition will develop information and practical resources for use by seniors, their caregivers and families right here at the grass-roots level.”

As a retirement community with a higher number of seniors and veterans than many other Canadian communities, Victoria is an ideal location for the Falls Prevention Project. People aged 65 and older make up close to 18 percent of the region’s population, compared to the provincial average of just under 13 percent.

In its efforts to reach out to seniors, the project inquiry group is being assisted by University of Victoria community psychologist Jennifer Mullett, who is training group members in the use of an innovative collaborative research process. Dr. Mullett explains that the process builds expertise in the community to engage in research that is aimed at problem-solving.

The research process echoes the capacity building intent of the project. It is aimed at developing strategies to prevent falls by taking falls prevention issues directly to seniors and veterans and working with them as partners. “The principle behind this process is that solutions must be based on the knowledge and experiences of seniors and veterans,” emphasizes Dr. Mullett.

This knowledge from seniors and veterans is complemented by input from project partner organizations such as the Canadian Peacekeeping Veterans Association, the Royal Canadian Legion and the School of Nursing and Centre on Aging at the University of Victoria, and from a special project advisory group made up of health and social service professionals who offer their perspective on the causes of falls in the community and suggestions for prevention.

“What we’re doing is building a whole body of practical knowledge to go along with established research on falls prevention,” says Dr. Mullett. “This combined knowledge will enable us to come up with new educational products and new strategies for falls prevention. These products should prove useful to seniors and veterans because they are being built, in large part, by seniors and veterans themselves.”

For project volunteer Harold Leduc, National President of the Canadian Peacekeeping Veterans Association, participation in the project is a unique learning opportunity which he hopes to translate into positive outcomes for association members.

“I represent veterans who range in age from 19 to 95 years of age,” says Leduc. “Many of them, young and old, are prime candidates for falls-related injuries. I hope to gain a better understanding of ways to prevent and manage falls so that I can pass on information to as many veterans and their families as possible.”

Fellow veteran Larry Gollner, a volunteer with the Alzheimer Society of British Columbia, says he was motivated to get involved by the possibility of acquiring information that would help caregivers prevent falls among those suffering from Alzheimer’s disease. Gollner, who is prone to falls himself as a result of a leg injury incurred during military service, adds that the project’s emphasis on prevention and education makes it a sound social investment.

“We know that, as a society, we must find better ways and means to reduce or at least stabilize the growing financial burden of health care,” notes Gollner. “Equally, we know that our society is aging. This means that the numbers involved with falls will grow. If a well conceived and executed Falls Prevention Initiative can help reduce individual suffering, ease stress on family caregivers, and, as a bonus, take pressure off the health care system, than I am all for it.”

Facts About Falls

• Approximately 30 percent of community-dwelling Canadian seniors experience at least one fall each year.
• Seniors’ falls result in a loss of independence. In 1998/99, there were 68,897 injury admissions in the senior population accounting for 35 percent of all injury admissions. Seniors are more likely to be admitted to hospital from an injury as a result of a fall than any other age group. In fact, over half (56%) of all admissions due to falls occurred in persons 65 years of age or over.
• Veterans Affairs Canada research shows that in the one-year period from June 1996 to June 1997, 37 percent of veterans experienced one or more than one fall. Seventy-five percent of veterans age 75 or older experienced an injury related to a fall. As for the oldest group, they tend to indicate more severe injuries such as loss of consciousness, sprains and fractures.
• In 1997, falls accounted for 20 percent of all injury deaths among adults age 65 or over.
• Injury death rates rise steeply with age. In 1997, the injury death rates among those 65-74 were 51.6/100,000 and 455.6/100,000 among those over age 85.
• About 40 percent of falls among seniors which result in a hospital stay are attributable to hip fractures. These are the most common type of fall injury among seniors and it is expected that the number of annual hip fractures among seniors will increase from 23,375 in 1993 to 88,214 by the year 2041.

The Causes of Falling

• Studies show that many falls result from a combination of personal factors (such as health status and personal heath practices) and lifestyle factors (such as social isolation, reduced physical activity and risk-taking attitudes).
• These factors may also work in conjunction with environmental factors, which may include indoor hazards such as poor lighting, throw rugs, unstable furniture, waxed floors, steep stairways and slippery tubs or outdoor hazards such as poor ice and snow removal and bad weather.
• Nearly half of all injuries among seniors take place at home. Constructional features of a house or building such as floors, stairs and steps are identified more often in an injury than any household product.

The Cost of Seniors’ Falls in Canada

The annual direct health care cost of falls is $2.4 billion. Caring for seniors injured from a fall represents 41 percent of these costs or $1 billion.

Canada’s Aging Population

Statistics Canada estimates that Canada’s senior population will grow to five million by 2011 and to over ten million by the year 2041, or close to 23 percent of the total population. As Canada=s population continues to age, the development of effective falls prevention strategies will take on added importance.

Addressing Risk Factors and Building Evidence

Studies suggest that falls are often preventable and that health promotion interventions can reduce or eliminate high-risk behaviours and risk factors that lead to falls. However, for the majority of factors found to be associated with falls, the current state of research is only beginning to uncover sufficient evidence of the impact of risk factor reduction on the incidence of falls and fallsrelated injuries for community-dwelling seniors. While some knowledge and experience exist on falls prevention in Canada, it is not enough. The Falls Prevention Initiative will deepen existing knowledge by addressing the range of risk factors and by identifying what practices, program models and community settings are best able to effectively reach veterans and seniors living in the community.

You Can Prevent Falls!

Various resources and information materials are available to help increase knowledge and strategies for falls prevention. The You Can Prevent Falls! kit developed by the Initiative will be of interest to seniors, veterans, caregivers and professionals alike. It includes:

• Eight Fact Sheets with tips, practical advice, statistics, resources listings, and program information.
• One Compact Disk compatible with either the PC or MAC environment, the CD offers many federal government resources, including prevention guides and policy tools, national data sources, lifestyle choice and injury prevention publications.

For more information on the Fall Prevention Initiative or to obtain a copy of the kit, call (613) 952-7606, fax (613) 957-9938 or e-mail seniors@hc-sc.gc.ca. To download from the Web, visit http://www.hc-sc.gc.ca/seniors-aines.