Falls can and should be prevented

 Did you know that falls remain the leading cause of injury-related hospitalizations among Canadian seniors? I was surprised to read that between 20% and 30% of seniors fall each year. Falls and associated outcomes not only harm the person that falls, but when a person falls, it also affects family, friends, care providers and the health care system. However, we do know that these personal and economic costs can be avoided through injury prevention activities.

Among Canadian seniors, falls remain the leading cause of injury-related hospitalizations, and absolute numbers are on the rise. Falls can lead to negative mental health outcomes such as fear of falling, loss of autonomy and greater isolation, confusion, immobilization and depression. In addition to the negative physical and mental health consequences of falling, there are significant associated financial costs, estimated at $2 billion annually, a value 3.7 times greater than that for younger adults.156

Results from the data analysis in the Seniors’ Falls in Canada SECOND Report indicates that:

·        self-reported injuries due to falls are increasing, specifically by 43% between 2003 and 2009/2010. The majority of falls resulted in broken or fractured bones, and over one-third of fall-related hospitalizations among seniors were associated with a hip fracture.

·        Fracture-induced physical limitations augment the need for support on the part of older adults themselves and their caregivers and increases pressure on Canadian health care systems.

·        When hospitalization data are examined, the results show that seniors who are hospitalized for a fall remain in hospital an average of nine days longer than those hospitalized for any cause. This discrepancy highlights the disproportionate health care costs of fall-related injuries in comparison to other causes of hospitalization. Even more worrying is that the number of deaths due to falls increased by 65% from 2003 to 2008.

Each older person may face a unique combination of risk factors according to his or her life circumstances, health status, health behaviours, economic situation, social supports and environment. Factors that put seniors at risk of falls include chronic and acute health conditions, balance or gait deficits, sensory factors, inadequate nutrition, social isolation, as well as factors related to the built and social environment.

Falls among seniors are preventable; however, addressing this growing public health problem is a shared responsibility. Progress in the prevention of falls and their resulting injuries requires continued collaboration, among governments, health care providers, non-government organizations, care associations and services, as well as Canadians themselves. Over the years, Canada has laid a foundation for good health and well-being across the life course. However, as our population ages, focused efforts on fall prevention will be required to maintain and improve the quality of life and well-being of seniors and to ensure that they continue to contribute and participate in society

Exercise is important

Exercise is important for your health at any age. If Americans meet five hours per week of moderate-intensity recommended physical activity guidelines, then more than 46,000 cancer cases annually in the United States could be prevented.

Published in the journal, Medicine & Science in Sports & Exercise® (MSSE®) which is the official journal of the American College of Sports Medicine and is published monthly, the data noted that three percent of all cancer cases in adults in the US aged 30 years and older during 2013 to 2016 was due to physical inactivity. Also, the proportion was higher in women compared to men.

The maximum number of cases were in the South, such as Kentucky, West Virginia, Louisiana, Tennessee, and Mississippi, whereas the lowest proportions were found in the Mountain region and northern states, such as Utah, Montana, Wyoming, Washington, and Wisconsin.

The data highlights specific cancer sites, including 16.9 percent of stomach cancers, 11.9 percent of endometrial cancers, 11.0 percent of kidney cancers, 9.3 percent of colon cancers, 8.1 percent of oesophageal cancers, 6.5 percent of female breast cancers, and 3.9 percent of urinary bladder cancers.

State-wise, the proportion of cancer cases attributable to physical inactivity ranged from 2.3 percent in Utah to 3.7 percent in Kentucky.

The research notes that these findings underscore the need to encourage physical activity as a means of cancer prevention and implement individual- and community-level interventions that address the various behavioural and socioeconomic barriers to recreational physical activity. Understanding and reducing the behavioural and socioeconomic barriers to physical activity is essential for optimizing intervention strategies targeting at-risk groups across the country.

The data highlights the importance of physical activity.

It talks about how there are many barriers to recreational physical activity, which include, lack of time due to long working hours in low-wage jobs, the cost of gym memberships or personal equipment.

The lack of access to a safe environment also contributes to the lack of physical activity. 

Boomers and Internet use in 2021

 The internet helps us stay connected, look for information, keep entertained, shop and access services. Our engagement with technology continues to evolve at a rapid pace as the capability and capacity of online technology expand.

In the past few years alone, we have seen the internet become more important, because of COVID, in our pockets via our mobile phones, streaming services exploding onto the market, and smart TVs switched on in most homes.

A report out of Australia examines how older people are adapting to the digital world, how and why they access the internet and their attitudes to doing so. This report would, I argue apply to other countries with seniors. With a specific focus on behavioural shifts over the past 4 years, it shows that while younger age groups are still leading the charge in the extent and types of online behaviours, there has been a more significant change in the online habits of those aged 65 and older.

Older people are engaging in a notably broader range of online activities across different devices and connecting to the internet more than ever before. Mobile phones and tablets are now their main gateway to the internet while the use of desktops has remained consistent.

Older people increased their online activities during the COVID-19 pandemic, particularly for communication and entertainment. They were more likely to have started or increased video conferencing and consuming video online.

Interestingly, while their behaviours have changed considerably, older people’s views of the digital world remain circumspect. The majority continue to feel overwhelmed by technological change, and may be largely unmotivated to find out more. Their engagement in online environments appears to have been prompted by perceived (or actual) necessity, rather than by seeing benefits in ‘going online’ or feeling confident about doing so.

This research suggests that older people may be feeling somewhat ‘forced’ online, a situation that may have been accelerated by the pandemic, but also by the increasing digitization of life in general. This highlights the importance of supporting older people’s digital literacy and providing them with the skills to navigate what can be confusing and potentially risky environments.

In this way, not only will they use the internet, but they can engage with the digital world safely and confidently.

There are notable changes in the way older people engage with the online world over the previous 4 years. While they remain likely to access the internet at home, most also used a mobile phone to go online when out. Their adoption of other digital devices is also on the rise. This coincides with increases in the range of activities that older people now undertake online, with the majority of those aged 65 and over banking and paying bills, viewing video content and buying goods and services.

While the most commonplace for older people to go online was at home (80%) in 2020. (up from 71% in 2017), more older people are now using mobile phones to access the internet. Since 2017, there have also been increases in the number of older people with internet access at home. 93% of older people had internet access in their homes in June 2020, up from 68% in 2017.

Four years ago, older people used fewer apps and fewer types of devices. On average, a quarter (26%) of older people used 5 or more types of devices to go online in the 6 months to June 2020, compared to 6% in 2017.

Compared to previous years, more older people are using social networking sites and apps to communicate. They are engaging with a greater number of apps, and their use of apps to make video calls, voice calls or send messages has increased substantially.

55% of older people used an app to communicate in the previous 6 months to June 2020, compared to 33% in 2019. The proportion of older people who use apps to communicate has increased in the previous 12 months. Growth in the use of apps to make voice calls in 2020 has almost tripled since 2019.

The previous 4 years have seen a marked increase in the take-up of online entertainment among older age groups. The proportion of those using online subscription services, catch-up television, online platforms like YouTube, and free video content has risen considerably since 2017.

The proportion of older people streaming content on devices has more than doubled since 2017, with 7 in 10 (70%) streaming content in June 2020, compared with 2 in 10 (23%) in 2017.

Their use of subscription or pay-per-view services also increased in 2020, to 61% from 36% in 2017.

Factors associated with an increased risk of falling among older adults

I make fun from time to time of the commercial on TV that talks about the dangers of getting seniors up and downstairs. The solution they say, “is just don’t fall.” That is easier said than done according to Seniors’ Falls in Canada, SECOND Report published in 2014 by Health Canada. In this report, they examine in a lot of detail why seniors fall, and the costs associated with when senior’s fall, on our society Here is some of what they have to say

Most falls occur as a result of compounding factors that combine and overwhelm an older person’s ability to maintain or regain his or her balance. These factors typically represent a complex interaction of biological, behavioural, environmental and socio-economic conditions termed “risk factors”. Research has identified numerous conditions that differentiate between older persons who fall and those who do not fall. Each older person may face a unique combination of risk factors based on life circumstances, health status, health behaviours, economic situation, social supports and the environment. Understanding what puts a person at risk of falling is a critical step in reducing falls and fall-related injuries among older Canadians.

The broad set of conditions that have been demonstrated to increase the risk of falling among older persons can be categorized as biological/ intrinsic, behavioural, environmental and social/ economic. These risk factors do not exist in isolation but are instead complex and interactive.

The order in which the following risk categories are presented is not based on their relative importance but, instead, in accordance with their presentation in Scott, Dukeshire, et al., and then specific factors are addressed alphabetically.

Appendix B

 Biological/ Intrinsic

• Impaired mobility

• Balance deficit

• Gait deficit

• Muscle weakness

• Advanced age

• Chronic illness/disability:

• Cognitive impairment

• Stroke

• Parkinson’s disease

• Diabetes

• Arthritis

• Heart disease

• Incontinence

• Foot disorders

• Visual impairment

Behavioural

•      History of falls

•      Fear of falling

•      Multiple medications

•      Use of:

•      Antipsychotics

•      Sedative/hypnotics

•      Antidepressants

•      Excessive alcohol

•      Risk-taking behaviours

•      Lack of exercise

•      Inappropriate footwear/clothing

•      Inappropriate assistive devices use

•      Poor nutrition or hydration

•      Lack of sleep

Social & Economic

•      Low income

•      Lower level of education

•      Illiteracy/language barriers

•      Poor living conditions

•      Living alone

•      Lack of support networks and social interaction

•      Lack of transportation

•      Cultural/ethnicity

Environmental

•      Poor building design and/or maintenance

•      Inadequate building codes

•      Stairs

•      Home hazards

•      Lack of:

§  Handrails

§  Curb ramps

§  Rest areas

§  Grab bars

§  Good lighting or sharp contrasts

•      Slippery or uneven surfaces

•      Obstacles and tripping hazards