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Falls Could Signal Serious Health Issues that Patients, Providers Often Miss

Cheryl Clark, for HealthLeaders Media, May 14, 2010

Health providers should be more aggressive about telling seniors to come in for an exam if they've had a fall, not just because they may have unseen injuries, but because their accident may be a predictor of a more serious problem.

That's the conclusion in a new report from the UCLA Center for Health Policy Research.

"Falling down is hazardous to a senior citizen's health. Yet fewer than half of all seniors see a doctor after a fall," says the report. Those who don't are much less likely to engage in six recommended activities to prevent a more serious mishap.

Those six activities include:

  1. Review of medications to see if dosage and drug prescriptions are appropriate.
  2. Use of a cane or a walker.
  3. Modifications in the home to reduce hazards, such as building ramps to replace steps or installation of railings.
  4. Exercise or physical therapy to increase muscle tone and balance.
  5. Change of daily routine to avoid risk of falling.
  6. Talk with health professionals about ways to avoid falls, such as wearing appropriate shoes.

The report suggests that communities should be more proactive in training first responders or emergency medical services personnel to encourage seniors to seek medical attention after a fall, even if there appears to be no injury.

"Additional training and continuing education of practitioners about evidence-based, falls-prevention strategies are needed," the report says.

"Healthcare professionals can be motivated to engage in evaluation and counseling of seniors who fall by increasing their awareness of relatively new billing codes (ICD-9 diagnosis code V15.88 and CPT-II treatment code 1100F) that can be used when a patient has more than two falls in a year or one fall with injuries."

In addition, the California report said, "physicians who participate in Medicare's Physician Quality Reporting Initiative can earn a 1.5% quality of care bonus if they report specified quality measures that include a falls screening."

According to the report, 14.5% of Californians over age 65 fell to the ground more than once and for people age 85 or older, 21.3% fell more than once. People with disabilities and people who are classified as low-income had somewhat higher rates of repeat falls.

Yet according to the report, only half of seniors who had endured multiple falls engaged in two or more of the above activities.

"In contrast to those who get medical care for a fall, those with multiple falls who do not obtain medical care for their falls are substantially less likely to undertake any actions to prevent future falls," the report said.

However, those who had higher incomes, were in an HMO, or who visited a doctor more than five times per year for any reason were more likely to engage in preventive activities.

In California, the Fall Prevention Center of Excellence works to create coalitions in counties to expand efforts that reduce falls among seniors, an effort that not only improves their quality of life, but reduces medical care costs as well.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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