Rehabilitation Nurses: Let’s Join Together to Participate in September’s National Fall Awareness Week

In her July President's Message, ARN President Dr. Patricia Quigley encourages rehabilitation nurses to begin preparing for Fall Prevention Awareness Day (September 22) and Week (September 22-28) to help raise awareness about how to prevent falls.

Colleagues, we provide specialty rehabilitation nursing care across all settings of care and to all populations. We are dedicated to promoting function and independence, minimizing complications of disability and chronic diseases, promoting social confidence and integration, and excelling in patient safety outcomes. Yet, we have been slow to make an impact on fall and fall injury prevention, especially in the community. All rehabilitation nurses know that falls among older adults are a serious concern because of the high incidence of falls and the consequences of falls—injury, fear, loss of function and independence, or even loss of life. However, it may not be as widely known that falls are a leading cause of unintentional injury deaths across all age groups—in the top 10 causes of death as reported by the Centers for Disease Control and Prevention (CDC) (CDC, 2021).

The Burden of Falls​ 

This year, the CDC updated its report of death due to unintentional injury. Analysis of 2019 data shows that unintentional injury death, which includes death due to falls, was the third leading cause of death for the entire U.S. population. By age group, unintentional injury death was the third leading cause of death in infants <1 year old and in age groups 45–54 and 55–64; the leading cause of death in age groups 1–4, 5–9, 10–14, 15–24, 25–34, and 35–44; and the seventh leading cause of death in adults >65 years old.

However, falls were the leading cause of unintentional injury deaths for older adults; out of 60,257 unintentional injury deaths, falls accounted for 56.5% for those aged 65–85. The circumstances of falls were reported as unspecified cause (46.0%), fall on same level (38.2%), fall on/from stairs and steps (5.6%), and fall involving bed (2.8%).

Rehabilitation nurses know that 95% of hip fractures are caused by falls. The CDC recently reported that falls are the cause of 90% of emergency department (ED) visits among older adults (Moreland & Lee, 2021). These statistics inform our urgent call to action to protect all persons from falls, especially older adults.

Indeed, falls are common and significant health issues for those 65 years or older (Rubenstein, 2021). According to Factora and colleagues (2021), adults ages 65 years and older are twice as likely to fall than younger adults (OR 2.84 [1.77–4.53]). Every year, approximately 3.7 million Americans turn 65. Every 11 seconds, an older person visits the ED due to a fall; every 19 minutes in the United States, an older adult dies from a fall (National Council on Aging [NCOA], 2021). Falls are a threat to the health of older adults and can reduce their ability to remain independent; therefore, we must act.

In a 2015 survey of older adults who reported falling in the past year, 52.1% reported falling once in the last year, 21.3% reported falling twice, and 24.1% reported falling three times or more (Florence et al., 2018). And yet only one-third of older adults who experience a fall will seek medical care. So, let us focus our collective efforts to prevent falls and injuries in older adults and engage in community outreach to encourage older adults to seek medical care after a fall.

My Ask of You

I am asking you to start your plans this July within your organizations—fall and injury prevention committees, nursing schools, churches and parishes—to lead and participate in Falls Prevention Awareness Day (September 22) and Week (September 22–28) (NCOA, 2021). For more than a decade, Falls Prevention Awareness Day has been held nationally the first day of the fall season. The purpose of this day is to raise awareness about how to prevent falls through national, state, and local partnerships. I am asking you, rehabilitation nurses, to lead and engage in education of older adults and their families about the consequences of falls and the interventions that can be implemented to promote safety, function, and independence.

The CDC and the National Council on Aging (NCOA) are dedicated to helping older adults manage their fall risks and maintain their independence. Their mission aligns with our mission as rehabilitation nurses to advance the independence and function of all persons. Opportunities exist now to plan your participation in Falls Prevention Awareness Day and Week. As a member of your rehabilitation program and your community, you can learn more about fall and fall injury prevention, research educational materials, and plan programs for Falls Prevention Awareness Day!

Community-Based Fall Prevention Resources

Rehabilitation nurses are actively engaged in community outreach to provide education on the prevention of chronic diseases, injuries, and disability. Community-based preventive interventions that reduce falls in older adults are well documented and are within the domain of rehabilitation nursing. Evidence-based interventions include medication management, gait training, and vision correction. Multifactorial interventions, often conducted in clinical practice settings, address multiple fall risk factors. These programs have been shown to reduce falls by as much as 24% (Gillespie et al., 2012). To support you and your team in your efforts to plan and participate in the 14^th annual Falls Prevention Awareness Day and Week, here are some tools, activities, and education materials.

To Reduce Fall Risk​ 

CDC STEADI Program: To help healthcare providers implement fall risk and injury assessment, the CDC's Injury Prevention and Control Center developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) program. This includes screening older adults for their fall risks, mitigating or eliminating these risks, and assessing injury history.

To Educate Patients, Families, and Caregivers​ 

Make fall and fall injury prevention brochures available to patients and caregivers:

•  CDC STEADI (cdc.gov/steadi/patient.html)

• Stay Independent
• What You Can Do to Prevent Falls
• Chair Risk Exercise
• Postural Hypotension
• Check for Safety

•  VA National Falls Toolkit/VISN 8 Patient Safety Center of Inquiry (www.patientsafety.va.gov/professionals/onthejob/falls.asp)

• Hip Protectors (video and brochure)
• Osteoporosis and Men (video)
• Wall of Education Materials
• Group Classes—How to Fall and How to Get Up

• Falls Free CheckUp
• See If You're at Risk for Falls
• Individuals' Fall Prevention Stories
• Age Well Planner

You learned in the May 13 issue of Pulse that the CDC is launching a new injury prevention campaign for older adults—Still Going Strong—to encourage them to "age without injury." This campaign is directly linked to the agency's 2019 findings regarding the leading causes of unintentional injuries and deaths among older adults. The program will launch in Maine, Oklahoma, Oregon, and Wisconsin. Be a part of their campaign: cdc.gov/stillgoingstrong/resources.html

I hope this information has been helpful, compelling your urgency to act, and has encouraged you to revitalize your fall and fall injury prevention community efforts/practices. I encourage you to join the CDC and NCOA in addressing this public health problem and focusing on the prevention of fall injuries. I also hope that you will report your efforts back to ARN and NCOA. Each year, NCOA prepares a compendium of program offerings—showcase your fall and fall injury prevention program! And be sure to share your programs on ARN's Membership Circle!

Your Participation is Essential!

Thank you for reading my message,

Patricia A. Quigley, PhD ARNP CRRN FAAN FAANP FARN
President, Association of Rehabilitation Nurses

References

Centers for Disease Control and Prevention. (2021). National Center for Injury Prevention and Control. Leading causes of death and injury, 2001-2019.

Centers for Disease Control and Prevention. (2020). STEADI (Stopping Elderly Accidents, Deaths and Injuries)—older adult fall prevention. https://www.cdc.gov/steadi/index.html

Centers for Disease Control and Prevention. (2017). Important facts about falls. https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

Factora, R., Thomas, D., & Darowshi, A. (2021). Evaluation of falls in the elderly. BMJ Best Practice. https://bestpractice.bmj.com/topics/en-us/880

Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Sherrington, C., Gates, S., Clemson, L. M., & Lamb, S. E. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database Systematic Review, 2012(9), CD007146. https://doi.org/10.1002/14651858.CD007146.pub3

Moreland B. & Lee R. (2021). Emergency department visits and hospitalizations for selected nonfatal injuries among adults aged ≥65 years—United States, 2018. Morbidity and Mortality Weekly Report, 70(18), 661–666. http://dx.doi.org/10.15585/mmwr.mm7018a1

National Council on Aging. (2021). Get the facts on falls prevention. https://www.ncoa.org/article/get-the-facts-on-falls-prevention

Rubenstein, L. Z. (2021, April). Falls in older people. Merck Manual. https://www.merckmanuals.com/professional/geriatrics/falls-in-older-people/falls-in-older-people

U.S. Department of Veterans Affairs. (2019). VHA National Center for Patient Safety. https://www.patientsafety.va.gov/professionals/onthejob/falls.asp