Fall Avoidance Dependent on Exquisitely Sophisticated Neural Control System

Brian E. Maki, PhD, PEng
Professor, Department of Surgery and
Institute of Medical Science,
University of Toronto and Senior Scientist,
Sunnybrook and Women's College Health Sciences Centre

It is well known that aging brings an elevated risk of falls and serious injuries, as well as other adverse medical and psychosocial outcomes. In recent years, exercise has been widely promoted as a potential means of reducing the risk of falling in older adults. There is no doubt that exercise and physical fitness is associated with a myriad of health benefits, and that older adults are able to improve strength, flexibility, aerobic capacity and other fitness measures as a result of exercise programs.^1-4 Even the very frail and very old have shown that they can improve their functional fitness through exercise.⁵ But what is the evidence to support the view that exercise and fitness could actually help to prevent falls and their consequences?

Certainly, there is evidence supporting an association between strength and falling risk. Severe compromise in the strength of the ankle dorsiflexors has been documented in nursing home residents with a history of falling.⁶ Other studies of less impaired individuals have also found evidence of associations between leg muscle weakness and an increase in the risk of falling.

Falls are the leading cause of injury admissions to Ontario acute care hospitals, especially for people over 65, according to figures released by the Canadian Institute for Health Information (CIHI).

Of the 68,222 injury admissions to Ontario's acute care hospitals in 1996/97, 58% were caused by falls, followed by motor vehicle collisions (14%) and intentional injuries (6%).

In 1996/97, Ontario residents spent 628,211 days in acute care hospitals due to injuries. Of these patient days, 72% were due to falls. The average length of stay in hospital was 11 days for falls compared to 9 days for all injury hospital admissions.

"Falls account for 86% of hospital admissions for people 65 years of age and older [with an injury] and the statistics are quite striking for older women. In fact, twice as many older women are admitted to hospital because of falls than men of the same age," explains CIHI spokesperson Daria Parsons.

Slipping, tripping, stumbling and falling from one level to another are the most common causes of injury admissions due to falls, in all ages and particularly for people aged 65 and older. The majority of falls occur in January, February and March. The most frequent type of injury is orthopaedic, largely bone fractures and dislocations, which are seen more often in the elderly.

CIHI's analysis shows that from 1992/93 to 1996/97, the number of injury admissions due to falls has remained relatively stable, with women representing more than half of the hospital admissions.

Causes of Injury Admissions for People Aged 65 and Older, 1996/97

In 1996/97, there were 27,650 injury admissions in people aged 65 and older, accounting for: 41% of all injury admissions 67% of hospital days due to injury 86% of admissions in people aged 65 and older were due to falls, totalling 23,689; 5% (1,439) were due to motor vehicle collisions; and other causes accounted for 9% (2,522) majority of injury admissions due to falls, for those 65 years of age and over, occur in women

These figures come from the Ontario Trauma Registry's (OTR) 1998 report on hospital injury admissions for the one-year period, April 1, 1996 to March 31, 1997. Managed by CIHI, the registry is funded by the Ontario Ministry of Health and provides current provincial and regional data on hospitalization resulting from injury in Ontario.

Information from the OTR is used by researchers and injury prevention specialists to develop and monitor injury prevention programs. The Ontario Ministry of Health has identified falls in the older population as a priority theme for injury prevention.

The Canadian Institute for Health Information

Created in 1994, CIHI is a national, not-for-profit organization with a mandate to develop and maintain Canada's integrated health information system. To this end, CIHI is responsible for providing accurate and timely information that is needed to establish sound health policies, manage the Canadian health system effectively and create public awareness of factors affecting good health.

The CIHI can be found on the world wide web at www.cihi.ca.

Sandra MacMillan, RN, BScN,
Irene Swinson, RN, BScN,
Angela Pisan, RN, BScN,
Jennifer Fuller, RN, BScN, MEd
The North York Public Health Department

Introduction

Falls are a leading cause of morbidity and mortality in seniors. In Ontario, falls cause 600 deaths annually for those over the age of 65.¹ In North York, falls are the second leading cause of hospitalization in females over the age of 65, and the fifth leading cause for males of the same age.² Hill et al. reported that one third of seniors experience one or more falls each year.³ The City of North York Public Health Department has developed and implemented a Falls Prevention Program in conjunction with community partners, designed to reduce the incidence of falls in seniors. The newest component of this program is the Fall Prevention Clinics which have been modelled after the Fall Prevention Project conducted at the Ottawa-Carleton Health Department and the Community Health Research Unit, University of Ottawa. Preliminary results from the Ottawa study suggest that it was successful in reducing the number of falls, however, a final report is pending. North York Public Health Nurses have worked closely with The Bernard Betel Centre for Creative Living, North York Seniors Centre and Taylor Place.