Physicians who treat older adult patients know how devastating a fall can be to an individual?s overall health and well-being. Over 2 million people age 65 and older are treated in the emergency room (ER) for fall-related injuries each year; nearly 600,000 are admitted to the hospital.¹ The most common non-fatal fall injuries are fractures — and they are also the most costly. In addition to the direct costs of fall-related injuries, about 30 percent of patients need help with daily activities while they recover, often for an extended period of time.² Falling can also take a toll on the quality of life for older adults. Many older adult patients voluntarily limit their activities for fear of another fall and never completely regain their independence. This chain of events can lead to nursing home care and early death.¹

Falls go unreported

Despite the high rate of falls among people 65 and older (one in three falls each year), these events may not come to the primary care provider?s attention unless a patient receives hospital or ER care.³ In the 2002 Medicare Current Beneficiaries Survey (MCBS), fewer than half of the respondents reported telling their physician about a fall in the previous year.⁴ Since even minor falls can signal potentially dangerous balance problems, it is important to actively collect information from your patients about their fall history at least every 12 months.⁵

Managing fall risk

To help health insurance plans and providers identify and manage patients at high risk of fall-related injury, the Medicare Health Outcomes Survey (HOS) collects data on the percentage of plan members who have falling, walking, or balancing problems and who discussed the problem with their physician and received treatment. A health plan receives a 4-star rating from the Centers for Medicare & Medicaid Services if at least 59 percent of members seen in the last year and identified as at-risk for falling receive an intervention from their current practitioner. A positive response of 76 percent or above earns 5-stars.⁶ Keystone 65 HMO (at 68 percent) and Personal Choice 65^SM PPO (at 63 percent) both currently have a 4-star rating for this measure.

Talking to your patients about falls

Including questions from the HOS in conversations with your patients is a good starting point for identifying high-risk individuals. Specifically, the HOS survey asks:⁵ A fall is when your body goes to the ground without being pushed. In the past 12 months, did you talk with your doctor or other health provider about falling or problems with balance or walking? Did you fall in the past 12 months? Has your doctor or other health provider done anything to help prevent falls or treat problems with balance or walking? Some things he or she might do include: suggest that you use a cane or walker; check your blood pressure lying down or standing; suggest that you do an exercise or physical therapy program; suggest vision or hearing testing.

Defining falls

When talking to your patients about their fall history, it is key to arrive at a common definition of a "fall." Technically, a fall involves the body coming in contact with the ground; however, a variety of terms are used interchangeably in casual conversation. When discussing falls with your patients, be sure to also explore events such as slips, trips, missteps, or near-falls even if they did not result in contact with the ground. These problems can be warning signs of balance or gait irregularities that could lead to injury down the road.⁷

Reducing falls

The Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons (2010) suggests a ?multifactorial intervention? approach to fall prevention in community-dwelling seniors. Depending on the needs of the individual patient, components may include:⁸ lowering doses of medications that have been linked to falls; designing a customized exercise program that includes cardiovascular, strengthening, flexibility, and balance activities; correcting vision problems; managing postural hypotension; managing heart rate and rhythm abnormalities; prescribing vitamin D supplementation; treating foot problems and recommending proper footwear; modifying the home environment to reduce falling hazards; providing education on fall prevention. If you have patients who need additional support with fall prevention, consider referring them to a Health Coach. Health Coaches — health care professionals such as registered nurses — from the Connections^SM Program are available to speak with your patients about preventing falls. Plus they can provide information and support for some of the most common chronic conditions. To learn more about the health coaching services available to our members, call 1-866-866-4694 or refer to our Connections Health Management Program web page. You can also refer a patient for Health Coaching by completing the online Physician Referral Form. References:

¹ Centers for Disease Control and Prevention. Cost of Falls Among Older Adults. February 10, 2011. www.cdc.gov/homeandrecreationalsafety/falls/fallcost.html
² Centers for Disease Control and Prevention. Cost of Fall Injuries in Older Persons in the United States, 2005. February 10, 2011.
³ Centers for Disease Control and Prevention. Self-Reported Falls and Fall-Related Injuries Among Persons Aged ? 65 years ? United States, 2006. MMWR Weekly. March 7, 2008; 57(09);225-229.
⁴ Shumway-Cook A, et. al. Falls in the Medicare Population: Incidence, Associated Factors, and Impact on Health Care. Phys Ther. 2009 April:89(4):324-332.
⁵ National Quality Measures Clearing House. Measure Summary: Fall risk management: the percentage of Medicare members 65 years of age and older who had a fall or had problems with balance or walking in the past 12 months, who were seen by an MAO practitioner in the past 12 months and who received fall risk intervention from their current practitioner. Updated: October 17, 2011. http://qualitymeasures.ahrq.gov/content.aspx?id=32407
⁶ Centers for Medicare & Medicaid Services. Medicare Health & Drug Plan Quality and Performance Ratings 2012 Part C & Part D Technical Notes. October 11, 2011.
⁷ Zecevic A, et al. Defining a Fall and Reasons for Falling: Comparisons Among the Views of Seniors, Health Care Providers, and the Research Literature. The Gerontologist. 46(03):367-376.
⁸ Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons (2010). J Am Geriatr Soc 2010.