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It Often Starts with a Fall

woman outside

An avid gardener, the 79-year-old woman was watering her gladiolas in the backyard one moment and on the ground yelling for help the next. She was loaded into an ambulance, hospitalized with a broken hip, and then transferred to a long-term care facility. Within a year, she was dead.

A growing number of older adults are dying after experiencing a fall. There were 30,000 deaths due to falling among adults age 65 and older in 2016, up from roughly 18,000 in 2007. That increase was seen among both men and women and across most racial groups. The CDC says such falls are often preventable and that doctors should discuss the risks with older adults during their annual physical exams.

As an Emory research gerontologist, Assistant Professor of Medicine Ann Vandenberg works toward solutions to improve care for older adults. Much of Vandenberg’s research intersects with one central problem that besets the older population: falling.

A study published in Geriatric Nursing by Vandenberg and associates in 2017 assessed the use of fall prevention technology with patients in Dutch and U.S. nursing homes at high risk of falling. According to nursing staff, a commonly installed technology designed to prevent falls—position monitors—can potentially agitate residents and, in fact, put them at higher risk of falling. It was found that a mobile fall-prevention sensor that was integrated with the nurses’ communication system worked much better.

Vandenberg is involved in an ongoing program, EQUIPPED, that uses education and computer-decision support tools to encourage providers to avoid prescribing potentially inappropriate medications for older adults being discharged from the emergency department. The program’s intent is to decrease complications in older adults, including the risk of falls.

Vandenberg is also co-investigator of the INFORMED project to conduct and discuss brief functional assessment in dialysis clinics, including falls history. Interviews with dialysis providers showed the clear value of falls questions in eliciting rich and useful details that providers can use in helping patients—suggesting ways to make patient homes safer, bolster their social support, or refer them to physical therapy to improve balance and strength.

All too frequently, a fall can be the start of a downward spiral. “How someone comes to assisted living or a nursing home is often a fall—that’s the beginning,” Vandenberg says. “It shrinks your world. You don’t want to leave your house, you don’t get as much exercise, which makes you more unsteady on your feet and more likely to fall again.”   

Leigh Partington

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