Transcript of interview with Debra Houry, MD, MPH, director of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention
Interview conducted by Natalie McGill, reporter for The Nation’s Health newspaper.
Listen to this interview as a recording on our podcast page.
An unexpected fall can be deadly. What puts seniors at higher risk for falls and what are the long-term health consequences of an unexpected fall for seniors and their families?
Falls are associated with age-related changes and functional abilities. The chance of falling really increases with age and risk is higher with certain chronic diseases, such as those who have a history of stroke or have other conditions like arthritis, diabetes or Parkinson’s (disease). And other important risk factors include things like muscle weakness or difficulty walking. Using medications like those that are for anxiety or depression, difficulty sleeping, those can be particularly sedating…And then things like poor vision or environmental hazards.
What’s important to realize is that many people who fall suffer moderate to severe injuries, such as internal injuries or hip fractures or head injuries. These injuries can cause long-term problems that make it hard to get around, limit independent living and really affect the person's emotional well-being and increase the risks of early death. Traumatic brain injuries also can be a serious consequence of falling. About half of fall-related deaths among older adults are caused by these traumatic brain injuries.
Healthy People 2020 has an objective of preventing an increase in fall-related deaths for seniors age 65 and older. As the director of CDC's National Center for Injury Prevention and Control, how is your agency leading the way tackling this goal?
So for the past 20 years the National Center for Injury Prevention and Control at CDC has been the nation's leading public health authority on violence and injury prevention. Our overall strategy is to make falls prevention, including screening assessment treatment and referral, a routine part of medical care. Evidence shows that the majority of modifiable risk factors can be identified and addressed in health care settings, yet many health care providers often lack the tools needed to intervene. So our injury center is developing these tools such as STEADI — Stopping Elderly Accidents, Deaths and Injuries — which is a nice toolkit that really walks health care providers through assessing a patient's fall risks, educating patients, selecting interventions and following up.
What’s helpful about this is that STEADI Step 1 is a tool modified from a longer algorithm (that) really helps enhance the rapid adoption of fall screening and gives clinicians clear actions to do with patients age 65 and older. I'm an emergency physician and I found that if you have very long assessments, those are hard to implement. What I like about STEADI is it is very simple. There's three questions about screening older adults for falls. "Have you fallen in the past year?” “Do you feel unsteady when standing or walking?” “Do you worry about falling?" The other two things that are part of this study are things like recommending vitamin D supplements of at least 800 units a day with calcium. We know this can reduce falls up to 17 percent and the United States Preventive Services Task Force supports this recommendation.
And the third thing, in addition to the screening and vitamin D, is reviewing and managing medications. We know that certain medications can cause sleepiness or dizziness that can increase fall risks. So (we need) to effectively manage medications or to stop medications with these side effects when possible, switch to safer alternatives and reduce medications to the lowest effective dose. And by doing this better medication management, this can reduce falls by up to 66 percent.
You co-authored a study in August in the American Journal of Lifestyle Medicine that projects as many as 100,000 fall-related deaths by 2030 tied to $100 billion in medical care costs. In what ways does health care need to shift so these statistics don't become a reality?
So primary care providers are really in a unique position to reduce falls among their older patients. There are a number of effective fall interventions that can be incorporated in primary care settings, such as modified medications and recommending that older adults take daily vitamin D supplements.
In addition, primary care providers can address other fall risk factors by referring patients to specialists such as an ophthalmologist, podiatrist or occupational therapist. Over 90 percent of older adults see a medical provider at least once a year, which really gives clinicians the opportunity to reduce their older patients' fall risks by implementing interventions tailored to each patient. I think the focus is really on prevention, really looking at a lot of the healthy community-dwelling adults. If we can prevent falls in this population, we can significantly reduce long-term morbidity and mortality.
Research has shown that community-based fall prevention programs can go a long way in reducing falls among seniors. What are some examples of what makes them so successful?
It’s important for older adults to really have that understanding that falls are not inevitable or just bad luck or just an accident and that they can take steps to reduce their chances of falling. Effective fall prevention programs must engage older adults as well as provide skills and knowledge needed to reduce their fall risk.
Things like social interactions can also be very important and we've also found that fall prevention messages should really focus on the positive message, such as improving overall health and maintaining independence. Messages that emphasize the negative results of falls, such as hip fractures, tend to discourage older people.
What are the most important things public health workers can do to address falls in seniors?
So public health really plays an integral role to prevent falls in older adults, including serving as a resource for community-based organizations. For example, a public health department may partner with a senior services or parks and recreation organization to create a program that includes exercise and fall prevention education. Staff in the injury center here at CDC developed materials to really assist organizations in developing and implementing those programs. We have a compendium of effective fall interventions which lists 41 scientifically tested and proven fall interventions and has relevant details about these interventions so organizations can decide which ones to implement. We have a second resource, “Preventing Falls: A Guide to Implementing Effective Community-Based Fall Prevention Programs,” which is designed to be a practical and useful tool providing guidance on program planning, development, implementation and evaluation. We really hope that these resources will be useful for those in public health.
Well, Dr. Houry thank you so much for taking out the time to talk today. I really appreciate it.
Absolutely. We really appreciate the opportunity to get our message out.