Preventing Falls and Associated Hip Fractures

It is estimated that one in three older adults falls each year. Because injuries from falls are the leading cause of death and disabilities among women and men aged 65 or older, the Centers for Disease Control and Prevention (CDCP) has published a report that addresses the problem and offers suggestions on how to prevent falls and resulting hip fractures (approximately 95% of hip fractures are caused by falls).

According to Judy A. Stevens, PhD and Sarah Olson, M.S. of the CDCP’s National Center for Injury Prevention and Control’s Division of Unintentional Injury Prevention who wrote a report on hip fractures and falls, approximately 340,000 hip fractures occur each year, and 50% of all older adults who are hospitalized for hip fractures are not able to return home or live independently after a hip fracture. Approximately 80% of patients hospitalized for hip fractures are women, and the hospitalization rate for female hip fractures has increased 40% from 1988 to 1996. This increase in the hospitalization rate for hip fractures is largely due to the fact that the elderly population has increased, in part because less older adults are dying from coronary heart disease, stroke, and cancer than in the past.

Risk factors for hip fractures include:

• Increasing age
• Osteoporosis (significant loss of bone mineral density)
• Muscle weakness
• Functional limitations
• Environmental hazards
• Use of pyschoactive medications
• History of falls
• Lack of physical activity
• Low body mass index

Because of the severe consequences hip fractures pose to older adults, preventing falls can help older women and men maintain a higher quality of life. The CDCP recommends fall prevention programs to help educate older adults on methods to reduce falls. These methods include increased physical activity, environmental modifications, medical assessments, and hip protectors.

• Increased physical activity can help improve balance, strength, and coordination, thereby reducing the risk of falls and injuries from falls. Studies have shown that increased physical activity helps reduce the risk of osteoporosis and can decrease the risk of hip fractures by 40% to 60%.
• Environmental modifications can help eliminate hazards in private homes or nursing homes that may pose risks. For example, eliminating tripping hazards such as throw rugs or clutter, adding stair railings, improving lighting, adding nonslip floor surfaces, and installing grab bars in bathrooms may reduce the risk of falls in private homes. In nursing homes, the addition of wheel locks for beds, modifying floor plans, installing raised toilets, etc. may decrease the number of falls. The CDCP recommends that communities implement fall prevention programs, which would include the distribution of educational materials and checklists to reduce the risk of falls among older adults.
• Medical assessments may help in minimizing certain side effects of drugs, such as dizziness or grogginess, which can contribute to an increased risk of falls.
• Hip protectors are pads designed to be worn on the hips to help shunt energy away from the point of impact. In a 1993 Copenhagen study, researchers found that hip protectors reduced the risk for hip fracture by approximately 50%.

Because older adults (aged 65 and older) are the fastest-growing age group in the United States, additional research and awareness is needed to help prevent an increase in hip fractures from falls. In 2000, 12.4% of the U.S. population was aged 65 or older. By 2050, 23% of the U.S. population (over double the number from 1990) will be 65 years of age or older. This rate is expected to increase even faster among people 85 years of age or older. Therefore, the CDCP’s National Center for Injury Prevention and Control has funded the National Resource Center on Aging and Injury at San Diego State University to further research and increase the awareness of preventing unintentional injuries.

Osteoporosis, a degenerative bone disease that affects primarily post-menopausal women, can significantly increase the risk of bone fractures. According to the National Osteoporosis Foundation, by the time a woman reaches 60 years of age, she has a one in four chance of breaking a bone from osteoporosis. Maintaining a balanced diet rich in calcium and vitamin D, performing regular weight-bearing exercises (such as walking or aerobics), limiting alcohol intake, not smoking, and considering hormone replacement therapy or other drug therapies may help prevent the risk of osteoporotic fractures.

Additional Resources and References

• The CDCP National Center for Injury Prevention and Control report by Judy A. Stevens, PhD and Sarah Olson, MS, "Reducing Falls and Resulting Hip Fractures Among Older Women," is available at http://www.cdc.gov/mmwr//preview/mmwrhtml/rr4902a2.htm
• The National Resource Center for Injury Prevention and Control provides information and resources for older adults and their families at http://www.olderadultinjury.org/
• To learn more about osteoporosis, please visit http://www.imaginis.com/osteoporosis/

Updated: April 7, 2008