INCREASING NUMBER OF UNINTENTIONAL FALLS INDICATES URGENT NEED FOR FALL PREVENTION PROGRAMS

To the Editor: If walkers and canes are being prescribed to assist ambulation of individuals with poor balance and to prevent falls, then why are a large number of reported falls associated with the use of walkers or canes in the article, “Unintentional Fall Injuries Associated with Walkers and Canes in Older Adults Treated in U.S. Emergency Departments” by Stevens and colleagues?1 This article was particularly interesting to me, a graduate student of occupational therapy who recently completed a fieldwork placement in a rehabilitation setting where walkers and canes were often recommended for individuals with poor balance. The study examined 3,932 cases of individuals aged 65 and older who were annually treated an estimated 47,312 times for fall-related injuries between 2001 and 2006 in various U.S. emergency departments based on data from the National Electronic Injury Surveillance System All Injury Program. “Approximately 87.3% of the injuries were associated with walkers, 12.3% with canes, and 0.4% with both (although the last estimate was unstable).”1 The researchers also reported that 60% of all fall injuries occurred at home and that more women (36,326) were treated than men (10,986).1 This may be because men are more likely to have fatal falls.2 Bodily injuries varied according to sex. The majority of men were treated for injuries to the head, neck, or lower trunk, whereas women were most often treated for injuries to the lower trunk.1 Stevens and colleagues1 are the first to examine falls associated with walkers and canes on a national level. The evidence portrays the urgent need for today's healthcare system to implement effective evidence-based fall prevention programs to keep older adults safe and out of hospitals. The study suggests that individuals may not be equipped with the knowledge of how to use the devices safely, have other preliminary medical problems, or have environmental hazards that place them at risk for falling.1 A review of the literature on current fall prevention programs indicated that several programs were effective at preventing and reducing the frequency of falls. Successful programs suggest that elderly individuals need to be made aware of potential risks and participate in supervised activities to build their confidence.3,4 Home visits to reduce at-home risks, making individuals aware of fall hazards, conducting home modifications, and providing suggestions on fall prevention were all found to be effective at the 12-month follow-up in a randomized controlled trial (RCT).4 Obtaining proper eyewear and performing specific exercises to target weak leg muscles are other effective interventions.5 The literature also noted ineffective programs. Kerse and colleagues6 conducted a RCT of an intervention focused on staff and caregiver fall risk awareness by placing posters in the rooms of at-risk individuals. Alone, this technique was not found to be effective. The individuals at risk, as well as the family or staff caring for these individuals, should be informed of risk management techniques to prevent falls. A RCT of an individualized fall prevention program found pamphlets and counseling on lower limb sensation to be ineffective at preventing falls.5 Current literature pertaining to fall prevention programs supports evidence-based practice for health practitioners. In their article, Stevens and colleagues1 suggested the need for patient and caregiver education to understand risk factors contributing to falls and information on proper use of ambulation devices. The Centers for Disease Control and Prevention has put together a current international compendium of effective fall prevention programs offered free to the public and available online at http://www.cdc.gov. Multiple studies of high-quality research have been conducted to determine effective fall prevention programs, but if health professionals are not implementing these programs, the number of falls in the geriatric population may continue to rise, as evidenced in this article. The evidence is clear that the nationwide healthcare community needs to make strides toward preventing injuries to reduce healthcare costs and improve quality of life in an aging population with an ever-increasing life span. There are various possibilities for implementing this knowledge. One suggestion is to increase coverage for home care services, with greater involvement from occupational and physical therapists, emphasizing home safety for patients and caregivers. Another suggestion is for academic professors to integrate fall prevention programs into their nursing and occupational and physical therapy curricula. Last, this article provides evidence of grant funding to support and implement effective programs for community members and their families. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the author and has determined that the author has no financial or any other kind of personal conflicts with this paper. Author Contributions: Jessica Hanmer produced this letter with editing support from Professor Sandra B. Dimeo. Sponsor's Role: There was no sponsor involved in this letter.