“Globally, falls are a major public health problem…Prevention strategies should emphasize education, training, creating safer environments, prioritizing fall-related research and establishing effective policies to reduce risk.”

– (World Health Organization, 2021)

INTRODUCTION

An often overlooked, yet important, topic in public health is the issue of fall prevention. This is perhaps understandable, because falls are such a common life occurrence that we, as a society, are often inclined to dismiss them as a mundane phenomenon unworthy of serious professional attention.

To ignore the need for fall prevention, however, is to leave a significant segment of our population at risk of potentially fatal physical endangerment. This would be immensely detrimental to our collective well-being, and unacceptably burdensome on our healthcare infrastructure.

Today, the PHI team will discuss the causes and risk factors behind falls, their impact on our socio-economic fabric, and possible solutions to this often neglected (but serious) public health problem.

Table of Contents

1. Who falls and why?
2. Why it matters that people fall
3. Promoting safety: the way forward

Who falls and why?

Although individuals experience falls at every stage of life, not all age groups are equally vulnerable. Particularly susceptible are elderly individuals and young children, the former because of a myriad of physiological, sensory, cognitive changes due to aging and the latter because of “risk-taking” behaviours associated with evolving development and curiosity. Falls among seniors are especially concerning as they are less likely, compared with the general population, to remain functionally independent and recover to their pre-fall state.

Multiple risk factors increase the likelihood of falls, which most commonly occur in homes but can also arise in public spaces and institutions such as schools, hospitals, and long-term care centres. Underlying medical conditions can debilitate an individual’s neurological, cardiac, or muscle systems and result in an impairment in motor function. Certain medications can produce side effects that impact one’s mobility and sense of balance. Working in certain occupations such as construction and emergency response can expose individuals to a particularly acute risk of falls due to elevated heights. Finally, the burden of low socioeconomic status (SES) and poor housing conditions can exacerbate the risk of injury among children in particular.

While both genders are at risk of falls, this risk manifests itself somewhat differently in males and females. While women more commonly suffer from debilitating, but non-fatal, falls, men are more likely to die from a fall. This may be explained by the higher prevalence of risk-taking behaviour and a high concentration of dangerous occupational work among males.

Interestingly, fall incidents are not distributed equally among the world’s countries. According to the World Health Organization (2021), over 80% of fall-related fatalities occur in low- and middle-income countries, with the Western Pacific and Southeast Asia accounting for most of these deaths. This disparity might be traced to the paucity of effective surveillance and public education infrastructure in nations with limited socio-economic resources, in addition to widespread practices of underreporting.

Why it matters that people fall

The immediate ramifications of falls are well known. Broken bones, sprains, bruises, blisters, and a myriad of other physical injuries send individuals into often lengthy periods of hospitalization. This consumes valuable healthcare resources and often results in a loss of independence of individuals who must now rely on family members and/or other caregivers to carry out basic activities of daily living.

There are, however, other implications that are far less direct but equally, if not more, impactful on an individual’s life and his/her societal milieu. A restricted quality of life can exact a heavy psychological toll on sufferers of falls, who may come to experience extreme fear and anxiety. In addition, these individuals may exhibit sentiments of guilt for their “burdensome” effects on caregivers and the healthcare system. An inability to participate in everyday activities can also result in chronic loneliness and social isolation.

The effect of falls on a nation’s financial integrity cannot be overstated. According to the Winnipeg Regional Health Authority (2018), falls among Canadians of all ages accounted for $6.7 billion, or nearly half of direct costs related to injury in 2010. These costs can be compounded by long hospitalizations, surgeries, and knee replacements that often accompany fall incidents.

On a global level, the statistics surrounding falls paint a troubling picture. According to the World Health Organization (2021), falls are the second leading cause of unintentional injuries worldwide, behind only road traffic incidents. Approximately 37.3 million falls worldwide are severe enough to require medical attention annually, resulting in a net loss of 38 million disability-adjusted life-years (DALYs).

Promoting safety: the way forward

In light of these concerning developments, many public health interventions aimed at enhancing measures to promote individual and public safety have been implemented, with more being proposed.

Because homes are among the most common settings in which falls occur, it has been suggested that a home assessment and modification program might benefit individuals with a history of falls. By inspecting home environments for potential hazard sources including handrails, stairs, lighting, and elevation changes, occupational therapists or public health agencies can assist individuals in creating physically secure living environments.

In long-term care centres, programs designed to promote motor function development through exercises can help residents avoid fall incidents. These exercises can assist individuals in improving muscle strength and coordination, and can be combined with education initiatives promoting preventative practices.

On a more biomedical level, the use of assistive devices such as hip protectors, which can substantially reduce the risk of fracture, can help individuals cope effectively with physical and sensory impairments. It must be emphasized, however, that prescribing these devices alone will likely be insufficient in preventing falls, and will have to be incorporated into a more holistic, multifactorial approach aimed at promoting physical safety.

Finally, public health professionals can work collaboratively with clinician stakeholders such as physicians to identify risk factors in vulnerable individuals and foster preventative practices. Seniors, for example, can benefit from routine screening or diagnostic tests that combine gait and balance assessments with analyses of physiological and biochemical risk factors such as vitamin deficiencies, low blood pressure, and visual impairments.

In any case, it is clear that more needs to be done to reduce fall incidents in Canada and throughout the world. While other public health issues may occupy a larger space in the public imagination, the ramifications of fall incidents are serious enough that this issue merits dedicated attention within all sectors of our society.

Written by: Shenbei Fan BMSc, MPH (c)