Aging Population in Europe does it mean More Death from Fall? Martin Rusnák Veronika Bučková

rusnakm@truni.sk 14. 1. 2019

An 82-year-old residential care facility for the elderly (RCFE) resident was dropped by an employee that had not been properly trained during a routine transfer from the toilet to her wheelchair. As a result, she incurred a fractured femur, and was forced to undergo surgery to repair it. Thereafter, the woman was transferred to a rehabilitation facility to receive physical therapy with hopes of making a full recovery. While at the rehabilitation facility, the patient developed pressure ulcers, which lead to infections, substantial weight loss, and fevers. She was eventually forced to undergo several surgeries to heal the progressively worsening pressure ulcers. rusnakm@truni.sk 14. 1. 2019

A 54-year-old woman went to a hair-school in North County San Diego intending to get a color and cut. During her beauty appointment, she suffered severe injury after falling upon a wet area on the flooring. Specifically, after receiving a rinse by a student hairstylist, the client slipped on a clear gel-like substance that had been left on the floor while returning to her chair. In the fall incident, she broke her hip, and had to undergo reparative surgery. During the litigation, defense counsel for the school argued that the client fell when she mis-stepped trying to get back into her chair, and not as a result of any slippery or wet substance that has been left on the floor. rusnakm@truni.sk 14. 1. 2019

We all want to protect our older family members and help them stay safe, secure, and independent. Knowing how to reduce the risk of falling, a leading cause of injury, is a step toward this goal. rusnakm@truni.sk 14. 1. 2019

Falls are prominent among the external causes of unintentional injury worldwide. The frequency of falls increases with age and frailty level. Older people who are living in nursing homes fall more often than those who are living in community. Approximately 28-35% of people aged of 65 and over fall each year.(WHO, 2007) Falls in higher age rusnakm@truni.sk 14. 1. 2019

Falls occur as a result of a complex interaction of risk factors. The main risk factors reflect the multitude of health determinants that directly or indirectly affect well-being. Those are categorized into four dimensions: biological, behavioral, environmental and socioeconomic factors. Risk factors rusnakm@truni.sk 14. 1. 2019

Age is the number one biological factor and its importance increases with population aging. Women are more likely than men to fall and sustain fracture, resulting in twice more hospitalizations and emergency department visits than men. However, fall-related mortality disproportionately affects men. (Tromp et al., 1998) Older whites are 2.7 times more likely to die from falls as their black counterparts.3 Rates also differ by ethnicity. Older non-Hispanics have higher fatal fall rates than Hispanics. Biological rusnakm@truni.sk 14. 1. 2019

People age 75 and older who fall are four to five times more likely than those age 65 to 74 to be admitted to a long-term care facility for a year or longer.13 Rates of fall-related fractures among older women are more than twice those for men.14 Over 95% of hip fractures are caused by falls.15 In 2010, there were 258,000 hip fractures and the rate for women was almost twice the rate for men.17 White women have significantly higher hip fracture rates than black women. Fall Injuries rusnakm@truni.sk 14. 1. 2019

Environment Poor lighting Ice and Snow Spilled substances and food in stores Failure to warn of a dangerous condition Broken or missing hand rails Defective steps and stairways Holes or other gaps in walking surfaces Ripped or torn carpeting Swimming pool areas Falling merchandise at a store Environment rusnakm@truni.sk 14. 1. 2019

One out of three older adults (those aged 65 or older) falls each year1 but less than half talk to their healthcare providers about it.2 Among older adults, falls are the leading cause of both fatal and nonfatal injuries.3 In 2013, 2.5 million nonfatal falls among older adults were treated in emergency departments and more than 734,000 of these patients were hospitalized.3 In 2012, the direct medical costs of falls, adjusted for inflation, were $30 billion How big is the problem? rusnakm@truni.sk 14. 1. 2019

What outcomes are linked to falls? (CDC, 2014) Twenty to thirty percent of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, and head traumas.5,6 These injuries can make it hard to get around or live independently, and increase the risk of early death. Falls are the most common cause of traumatic brain injuries (TBI). In 2000, 46% of fatal falls among older adults were due to TBI.7 Most fractures among older adults are caused by falls.8 The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand. Many people who fall, even if they are not injured, develop a fear of falling.10 This fear may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness, and in turn increases their actual risk of falling. What outcomes are linked to falls? (CDC, 2014) rusnakm@truni.sk 14. 1. 2019

Clinical interventions, such as vitamin D supplementation, exercise or physical therapy programmes, and some comprehensive multifactorial fall assessment and management interventions can reduce falls and are safe for community-dwelling older adults. Fall interventions at different settings, such as nursing homes, community, and hospitals have been developed and proven to be successful. The lack of dissemination of this knowledge into practice may explain the meagre progress that has been observed so far in falls prevention.(Alamgir et al., 2012) How to Prevent rusnakm@truni.sk 14. 1. 2019

To lower their hip fracture risk, older adults can: Older adults can stay independent and reduce their chances of falling.18,19 They can: Exercise regularly. It is important that the exercises focus on increasing leg strength and improving balance, and that they get more challenging over time. Tai Chi programs are especially good. Ask their doctor or pharmacist to review their medicines—both prescription and over-the counter—to identify medicines that may cause side effects or interactions such as dizziness or drowsiness. Have their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision. Consider getting a pair with single vision distance lenses for some activities such as walking outside. Make their homes safer by reducing tripping hazards, adding grab bars inside and outside the tub or shower and next to the toilet, adding railings on both sides of stairways, and improving the lighting in their homes. To lower their hip fracture risk, older adults can: Get adequate calcium and vitamin D—from food and/or from supplements. Do weight bearing exercise. Get screened and, if needed, treated for osteoporosis. rusnakm@truni.sk 14. 1. 2019

Study of injuries of falls trends in Europe rusnakm@truni.sk 14. 1. 2019

This paper studies the time series of deadly injuries resulting from falls in Slovakia, neighboring countries and the European Union. Using population projection it looks at prospects of the mortality from falls. Aim rusnakm@truni.sk 14. 1. 2019

Population data were downloaded from publicly available sources on demography by EUROSTAT; Population forecasts were taken from the same source; Mortality data by ICD 10 for Slovakia were obtained from the National Center for Health Information; Mortality data for Austria, Czech Republic, Hungary and Poland were downloaded from WHO mortality database; Statistical environment {R} was used to derive forecasts; Forecasts made using linear regression with CI and moving average with population prediction; PYLLs were computed using the LE0 for the last available year. Methodology rusnakm@truni.sk 14. 1. 2019

Results rusnakm@truni.sk 14. 1. 2019

SR SMR Falls by Age Groups rusnakm@truni.sk 14. 1. 2019

SMR Falls, 65+ of age rusnakm@truni.sk 14. 1. 2019

Slovakia PYLL from Falls, 65+ rusnakm@truni.sk 14. 1. 2019

While linear regression provides an optimistic forecast of continuous reduction in standardised mortality the moving average using the population forecast reveals a constant increase over coming years; The increase is more prominent in SR, HU and CZ compared to A; There is a need to focus on preventing falls by increased provision of services for aging population to reduce the PYLL from falls. Conclusions rusnakm@truni.sk 14. 1. 2019

We study injuries at our faculty with our students, focusing on head trauma, but not exclusively; We offer twinnings opportunities using first internet connections and personal meeting and exchange. If interested, email me: rusnakm@truni.sk rusnakm@truni.sk 14. 1. 2019