Faces of the Fallen

Andrea Carlson Gielen

What do Hillary Clinton, Pope Benedict XVI, Barbara Mikulski and Sonia Sotomayor have in common? Falls. (And no, this is not a joke). In fact, falls are far from a laughing matter. Approximately 20,000 Americans die each year from falls (Katharine Graham, the former publisher of the Washington Post who died from a fall in 2001, is one notable example).

While the falls of these high-profile leaders made headlines, the bigger picture- falls as a public health problem- went largely unnoticed. It’s estimated that seven million people are treated for fall-related injuries each year in our nation’s emergency rooms, and the cost to our healthcare system is nearly twenty billion dollars annually.

If these numbers don’t grab your attention, take a minute and think about what’s going to happen as a result of our aging population. One in three adults 65 and older falls each year and every 35 minutes someone in this population dies as a result of their injuries, making falls the major reason for injury-related death, injury and hospital admission for older adults. A public health crisis of this magnitude won’t come cheap: by 2020, the annual direct and indirect cost of fall injuries is expected to reach $54.9 billion.

Contrary to popular belief, “slips, trips and falls” are not unavoidable. Because of the disproportionate burden of falls among those 65 and older, a large body of research has been devoted to developing and evaluating fall prevention interventions. As a result, we now know that older adults who exercise regularly, have their vision checked, undergo medication management, and who have access to home hazard assessment are less likely to fall in their homes. Moreover, studies have uniformly indicated that falls-prevention services result in a net cost savings for older adults at high risk of falls.

Unfortunately, falls prevention currently receives little attention in clinical practice. In fact, it’s easier to cite what Medicare doesn’t cover than what it does. Falls screening is not part of the Medicare Part B Preventive Services package, nor is it included in the “Welcome to Medicare” exam upon enrollment. Participation in strength and balance programs and home modification assessments for those at high risk are also sadly left out.

Much focus has (rightly) been directed at how healthcare reform can lead to better prevention of chronic diseases like diabetes and cancer, however the lack of attention to falls and other injuries is alarming. By neglecting injury prevention strategies, opportunities to contain costs and improve outcomes- two key goals of healthcare reform- are missed.

We wish full and speedy recoveries to these distinguished leaders. Let us use their experiences as a call to action to help the millions of others who suffer needlessly every year by incorporating falls and other injury prevention strategies into healthcare reform.

It would be a huge misstep to let this critical issue fall through the cracks.

Alicia Samuels, MPH, is the director of communications for the Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health. Ms Samuels has nearly a decade of public health communications and research experience, including six years at the national home office of the American Cancer Society in Atlanta, GA.

Andrea Carlson Gielen, Sc.D., Sc.M., is professor and director of the Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health. Dr. Gielen has almost three decades of public health experience, including as a public health practitioner and an academic researcher directing federally funded studies of health behaviors and behavior change interventions. She is the author of more than 120 articles on health behavior, health education, and the prevention of injuries and violence. In 2002 Dr. Gielen was awarded with a Distinguished Career Award from the American Public Health Association’s Public Health Education and Health Promotion Section.

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Bob Hammel, A&S '60
Guest

Approaching 71 and pretty active, I have taken a couple of good spills in the last few months. (20 years in the Army taught me how to fall best but they still hurt). Results: I was sore for more than a few days (not like 40-50 years ago) and apparently scar tissue from one of them may have resulted in bone scan looking like metastasis of prior prostate cancer. We just have to move with more thought then when younger.

Bob Hammel, A&S '60
Guest

Approaching 71 and pretty active, I have taken a couple of good spills in the last few months. (20 years in the Army taught me how to fall best but they still hurt). Results: I was sore for more than a few days (not like 40-50 years ago) and apparently scar tissue from one of them may have resulted in bone scan looking like metastasis of prior prostate cancer. We just have to move with more thought then when younger.

Bob Hammel, A&S '60
Guest

Approaching 71 and pretty active, I have taken a couple of good spills in the last few months. (20 years in the Army taught me how to fall best but they still hurt). Results: I was sore for more than a few days (not like 40-50 years ago) and apparently scar tissue from one of them may have resulted in bone scan looking like metastasis of prior prostate cancer. We just have to move with more thought then when younger.

Bob Hammel, A&S '60
Guest

Approaching 71 and pretty active, I have taken a couple of good spills in the last few months. (20 years in the Army taught me how to fall best but they still hurt). Results: I was sore for more than a few days (not like 40-50 years ago) and apparently scar tissue from one of them may have resulted in bone scan looking like metastasis of prior prostate cancer. We just have to move with more thought then when younger.

Bob Hammel, A&S '60
Guest

Approaching 71 and pretty active, I have taken a couple of good spills in the last few months. (20 years in the Army taught me how to fall best but they still hurt). Results: I was sore for more than a few days (not like 40-50 years ago) and apparently scar tissue from one of them may have resulted in bone scan looking like metastasis of prior prostate cancer. We just have to move with more thought then when younger.

Bob Hammel, A&S '60
Guest

Approaching 71 and pretty active, I have taken a couple of good spills in the last few months. (20 years in the Army taught me how to fall best but they still hurt). Results: I was sore for more than a few days (not like 40-50 years ago) and apparently scar tissue from one of them may have resulted in bone scan looking like metastasis of prior prostate cancer. We just have to move with more thought then when younger.

Bob Hammel, A&S '60
Guest

Approaching 71 and pretty active, I have taken a couple of good spills in the last few months. (20 years in the Army taught me how to fall best but they still hurt). Results: I was sore for more than a few days (not like 40-50 years ago) and apparently scar tissue from one of them may have resulted in bone scan looking like metastasis of prior prostate cancer. We just have to move with more thought then when younger.

Bob Hammel, A&S '60
Guest

Approaching 71 and pretty active, I have taken a couple of good spills in the last few months. (20 years in the Army taught me how to fall best but they still hurt). Results: I was sore for more than a few days (not like 40-50 years ago) and apparently scar tissue from one of them may have resulted in bone scan looking like metastasis of prior prostate cancer. We just have to move with more thought then when younger.

Bob Hammel, A&S '60
Guest

Approaching 71 and pretty active, I have taken a couple of good spills in the last few months. (20 years in the Army taught me how to fall best but they still hurt). Results: I was sore for more than a few days (not like 40-50 years ago) and apparently scar tissue from one of them may have resulted in bone scan looking like metastasis of prior prostate cancer. We just have to move with more thought then when younger.

Bob Hammel, A&S '60
Guest

Approaching 71 and pretty active, I have taken a couple of good spills in the last few months. (20 years in the Army taught me how to fall best but they still hurt). Results: I was sore for more than a few days (not like 40-50 years ago) and apparently scar tissue from one of them may have resulted in bone scan looking like metastasis of prior prostate cancer. We just have to move with more thought then when younger.

Bob Hammel, A&S '60
Guest

Approaching 71 and pretty active, I have taken a couple of good spills in the last few months. (20 years in the Army taught me how to fall best but they still hurt). Results: I was sore for more than a few days (not like 40-50 years ago) and apparently scar tissue from one of them may have resulted in bone scan looking like metastasis of prior prostate cancer. We just have to move with more thought then when younger.

Bob Hammel, A&S '60
Guest

Approaching 71 and pretty active, I have taken a couple of good spills in the last few months. (20 years in the Army taught me how to fall best but they still hurt). Results: I was sore for more than a few days (not like 40-50 years ago) and apparently scar tissue from one of them may have resulted in bone scan looking like metastasis of prior prostate cancer. We just have to move with more thought then when younger.

Bob Hammel, A&S '60
Guest

Approaching 71 and pretty active, I have taken a couple of good spills in the last few months. (20 years in the Army taught me how to fall best but they still hurt). Results: I was sore for more than a few days (not like 40-50 years ago) and apparently scar tissue from one of them may have resulted in bone scan looking like metastasis of prior prostate cancer. We just have to move with more thought then when younger.

Bob Hammel, A&S '60
Guest

Approaching 71 and pretty active, I have taken a couple of good spills in the last few months. (20 years in the Army taught me how to fall best but they still hurt). Results: I was sore for more than a few days (not like 40-50 years ago) and apparently scar tissue from one of them may have resulted in bone scan looking like metastasis of prior prostate cancer. We just have to move with more thought then when younger.

Bob Hammel, A&S '60
Guest

Approaching 71 and pretty active, I have taken a couple of good spills in the last few months. (20 years in the Army taught me how to fall best but they still hurt). Results: I was sore for more than a few days (not like 40-50 years ago) and apparently scar tissue from one of them may have resulted in bone scan looking like metastasis of prior prostate cancer. We just have to move with more thought then when younger.