Falls by the Elderly or Disabled

AuthorCharles E. Turnbow
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
§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.)

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