Taken by themselves, the numbers are startling.
About 50 per cent of injury-related hospitalizations for seniors are from falls.
We spend an estimated $962 million a year dealing with the health outcomes from falls.
Falls are responsible for 95.1 per cent of all hip fractures.
One in three seniors is likely to fall at least once per year.
Six Local Health Integration Networks (LHINs) had identified falls as a priority and have already implemented comprehensive prevention programs.
Last July the LHIN Collaborative (LHINC) put out its own framework and toolkit, aiming to establish a province-wide strategy on falls.
It’s a delicate dance given the role of prevention belongs to the public health units, not to the LHINs. When the province decided which half of the health system should be integrated by the LHINs, they didn’t include the public health units. Whoops.
Worse still, the 32 public health units don’t share similar boundaries to the 14 LHINs, creating jurisdictional overlap problems.
The public health units were not identified by the provincial government for targeted funding in the spring budget despite a plea by Don Drummond, the public sector reform commissioner, to triple their funding to BC levels (while himself suggesting this take place amid deep overall funding restraint).
Everybody owns a bit of this problem, and it seems many of the decisions made by the McGuinty government appear to have exasperated the situation.
The kinds of health services that Ontario delisted – including eye examinations and physiotherapy – are just the kind of interventions needed to reduce the incidence of falls.
Recently the province decided it would not cover vitamin D testing, even though the LHINs note vitamin D deficiency is one of the significant medical factors contributing to falls. Appendix C of the LHINC report includes a preliminary literature review on falls prevention for the elderly. It specifically states “a combination of vitamin D and calcium supplementation in elderly women will help reduce the risk of falls by more than 40 per cent.”
Whereas the Community Care Access Centres once offered a range of in-home non-clinical supports, these are now delivered in an inconsistent patchwork that varies by region. Yet the home environment is another major contributor to falls.
The LHIN reports that the social determinants of health are a major factor in determining your likelihood of experiencing a fall, yet by any standard we have endured budgets that have made Ontario and Canada a less equal place. Our level of inequality is rising even faster than the United States.
Are the falls the source of the problem, or a symptom of the problem of a health system that is not functioning well?
It would be nice if there were a simple strategy to reduce falls, but the medical conditions considered risk factors are comprehensive, including addictions, anemia, arthritis, cognitive impairment, coronary artery disease, delirium, dementia, depression, diabetes, incontinence, low bone mineral density, osteoporosis, Parkinson’s, and Postural hypertension.
The evidence suggests there are few responses that work across settings. For example, exercise-based interventions reduce the rate of falls in the community and inpatient hospital settings, but results were mixed in long-term care settings.
“No literature on best practices for processes in determining the most suitable intervention was identified in this preliminary literature review,” the report states.
A big part of the LHIN plan includes comprehensive assessment, which according to them, can even be done by PSWs (Personal Support Workers) despite the need for a full medical assessment and assessment of current medications. In fact, they say it can be integrated into the current practice of typical formal caregivers, even though these same formal caregivers are under intense workload pressures and the report contains no mention of money (beyond projections of what can be saved).
Further each LHIN will have a core multi-sector committee that will meet at least quarterly on this issue. The intent is to get health care providers to work together to address these issues and to monitor the progress largely through existing data collection. These committees would in turn interface with a province-wide group.
It’s hard to oppose a strategy to reduce falls. As the report states, “a fall for a senior can mean disability, change in level of function, loss of independence, change in living arrangements or even death.”
If it is working – as Erie St. Clair LHIN claims in a recent media report – then the effort will be worthwhile. At this point it seems way too early to tell. The reduction of falls in Erie St. Clair is likely owing more to a mild winter than real progress so soon. When one identifies all the risks, it seems to fix the problem one has to address many core issues affecting our health system. In a period of extreme austerity, this may be easier said than done.
BC is recognized as the leading province in falls prevention. Then again, didn’t Drummond say public health had three times the funding?
Being 81 years old, I can speak from experience. I did not fall while I was in the hospital for three weeks because I used a walker and was very careful to put the bed in its lowest position when I was getting up and also made sure that i could hang on to something as I got to the walker. However I have fallen several times. Once trying to step around an obstacle on a sidewalk (I was in a hurry). I did not break any bones but did bruise one leg badly. Once in my kitchen unloading the dishwasher with several bowls in my hand and pivotting to put them in the cupboard. Again, I did not break any bones but have had pain in my left humerus for several months. The shoulder joint has full range of motion. I exercise three times a week at a community centre but I think I basically have strong bones. Everybody can fall. The trick is to have strong bones. If you bruise yourself that is not so bad.
“Being 81 years old, I can speak from experience…” — And we are certainly privileged to receive it. Interesting that you note exercise — it does appear to have a significant effect on reducing falls, and certainly minimizing the impact of falls when they do occur.
I can recall an eye surgeon yelling in frustration at a hospital administrator about not being able to get an elderly patient timely cataract surgery and remarking. “Perhaps when she is in here next week, because she fell and is getting her broken hip reduced ,you can let me work on the other end and fix her eyes so she doesn’t break the other one!”