Falls by the Elderly or Disabled

• Author: Charles E. Turnbow
• Pages: 523-538

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CHAPTER 23

Falls by the Elderly or Disabled

§2300 Introduction

Illustration: Classification of Hip Fractures

Case 1: Fall on Spilled Food

Case 2: Fall on Ramp

Case 3: Torn Carpet in Rest Home Hallway

§2310 The Magnitude of Problem

§2311 Development of Regulations

§2311.1 Americans With Disabilities Act (ADA)

§2311.2 Special Problems

§2311.3 Recognition of Hazards

§2311.4 Avoiding the Hazard

§2311.5 Increased Duty of Property Owner

§2311.6 Duty of Care Givers

§2311.7 Neglect and Elder Abuse

§2311.8 Classification of “Care and Custody” Providers

§2320 Types of Hazard

§2321 Slipping Hazards

§2322 Tripping Hazards

§2323 Automatic and Power Assisted Doors

§2324 Elevators

§2325 Falls Due to Defective Products

§2325.1 Crutches, Canes and Walking Aids

§2325.2 Wheelchairs

Case 1: Wheelchair Falls Off Landing

Case 2: Wheelchair Tips Over Backward in Parking Lot

§2325.3 Bathtubs and Bathing Facilities

§2325.4 Grab Rails

§2326 Falls Resulting From Environmental Conditions

§2326.1 Lighting

§2326.2 Noise

§2326.3 Other Factors That Distract

§2330 Special Duty to Elderly and Handicapped

Picture: Unsafe Entryway

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 FALLS BY THE ELDERLY OR DISABLED §2300

§2300 Introduction

A Personal and Public Health Crisis

Fall accidents create a serious health problem among

older persons. This country reports a remarkable number

of such accidents each year where one out of every three

persons over age 65 will experience a fall accident each

year. (Tinetti et al., 1988 [Tinetti ME, Speechley M, Ginter

SF. Risk Factors for falls among elderly persons living in

the community. N.Engl. J Med 1989:320 (16); 1055-9].

Sattin, 1992 [Sattin RW. Falls among older persons: A

public health perspective. Annu Rev Public Health 1992:

13:48-508].) Twenty to thirty percent of these accidents

will result in individuals suffering moderate to severe

injuries causing reduced mobility and independence, and

approximately 7,700 will result in the death of the victim.

(Alexander, et al. [Alexander BH, Pivara FP, Wolf Me.

The Cost and Frequency of Hospitalization for fall-related

injuries in older adults. American Journal of Public Health

1992:82(7): 1020-1023]. National Summary of Injury

Mortality Data 1988-1984. Atlanta (GA): Center for

Disease Control and Prevention, 1996.)

The most common fall-related injuries are osteoporotic

fractures where a demineralization of the bone results

in substantial loss of the bone’s ability to resist fractur-

ing. The hip, spine and forearm are the areas of the most

common fracture sites. The medical costs associated

with these osteoporotic fractures are staggering. In 1986,

Norris reported that the overall direct medical costs were

approximately $5.15 billion (Norris RJ. Medical Costs of

Osteoporosis. Bone 1992: 13L S11-16). Barrett-Connor

estimates that the costs would exceed $10 billion by 1995

and the year 2000 would see total direct costs exceed-

ing $45.2 billion. (Barrett-Connor, E. The economic and

human costs of Osteoporotic Fractures. American Journal

of Medicine 1995: 98 (suppl 2A) 2A-3S to 2A-8S;

Chrischilles E, Shireman T, Wallace R. Costs and health

effects of Osteoporotic Fractures. Bone 1994: 15(4): 377-

386.) The direct costs are out-of-pocket expenses such as

cost for hospital and nursing home care, physician and

other professional services, rehabilitation, community-

based services, drugs and medical equipment, insurance

administration, vocational rehabilitation and home modi-

fications. (Englander F, Hodson TJ, Terregrossa RA.

Economic dimensions of slip and fall injuries. Journal of

Forensic Science 1996: 41(5): 755-746.)

This does not include the long-term consequences of these

injuries such as disabilities and reduced quality of life. The

cost to both society and to the individual requires that ade-

quate redress is available to the victim whenever possible.

Hip Fractures

The most common of all of the fall-related fractures suf-

fered by the elderly are hip fractures. These injuries are the

most serious and create the greatest heath problems as well

as the greatest number of deaths. The National Center for

Injury Prevention and Control reports that about 240,000

hip fractures occur each year among people older than 50

years (Cooper C, Campion G, Melton LJ. Hip fractures

in the elderly; a world-wide projection. Osteoporosis

International 1992: 2:285-289.) At least one-half of all

elderly adults hospitalized for hip fracture cannot return

home or live independently after the fracture. People older

than 85 years are 10 to 15 times more likely to experience

a hip fracture than are people aged 60 to 65. (Unintentional

Injury Prevention Fact Sheet on Falls and Hip Fractures.

National Center for Injury Prevention and Control, Atlanta

(GA): Centers for Disease Control and Prevention, 1996;

Norris RJ. Medical Costs of Osteoporosis. Bone 1992:

13:S11-6; Schnieder EL, Guralnick JM. The Aging of

America: impact on health care costs. Journal of the

American Medical Association (JAMA) 1990: 263(17)

2235-2340; Cooper C, Campion G, Melton LJ. Hip frac-

tures in the elderly; a world-wide projection. Osteoporosis

International 1992: 2:285-289.)

Hip fractures usually require a minimum of a two-week

hospital stay. Hip fractures alone account for more than

$3 billion in direct medical costs. Cummings estimates

that this cost may be as much as $240 billion by the year

2040. (Cummings SR, Rubin SM, Black D. The future of

hip fractures in the United States. Numbers, Costs, and

Potential Effects of Postmenopausal estrogen. Clinics of

Orthopedics and Related Research 1990; 252:163-166;

Schnieder EL, Guralnick JM. The Aging of America:

impact on health care costs. Journal of the American

Medical Association (JAMA) 1990; 263(17) 2235-2340.)