Continence Coach: Borrowing from Our Neighbors: Falls Prevention as We Age

     I am no stranger to the cause of falls prevention. When he was 79 years old, my father, a stroke survivor, fell in the bathroom of an assisted-living facility attempting to urinate without assistance during the night. He died several days later from severe head trauma sustained in the accident. Although incontinence did not appear on his death certificate, my daddy died from an incontinence-related fall.

     Elderly men with moderate or severe lower urinary tract symptoms (urinary urgency, urinary frequency, and the need to strain to initiate urination) are at a significantly greater risk for falls, a risk that increases dramatically as symptoms worsen.¹ From survey data, the National Association For Continence (NAFC) has found that among men and women ages 30 to 70 years who awaken during the night to use the bathroom, more than one third do so twice or more nightly to urinate, fitting the clinical diagnosis of nocturia. Of these adults, one in eight say they sometimes lose urine, experiencing urge incontinence, on the way to the bathroom, placing them at risk of slipping and falling.² More than one third of adults age 65 years and older fall each year^3,4; falls are the leading cause of injury death in this age group.⁵

     My preoccupation with falls prevention is not just emotional — it’s also an economic reality confronting our nation. In 2000, direct medical costs for nonfatal fall injuries in older persons totaled $19.3 billion.⁶ Without a doubt, the tab has escalated over the past decade. Our country’s demographics — aging baby boomers and the population living longer than a generation ago — place more people at risk for falling. This is especially true with more people living alone as they age, unable to afford the luxury of assisted living or to qualify for a state-funded Medicaid bed in a nursing home. According to recent research,⁷ people living alone report a higher percentage of falls than persons living with others. Because job demands and personal circumstances often keep families geographically apart, it is difficult to help safeguard frail elderly relatives from falls and injury. As a result, professional healthcare providers — eg, home health aides, first-line caregivers in assisted living, or nursing assistants in nursing homes — must assume the burden of care.

     Sadly, our nation is ill-equipped to adequately provide the caregiver the educational tools to prevent falls. We need to take note of how our neighbor Canada is addressing problem as it confronts similar trend data. A new course, the Canadian Falls Prevention Curriculum (CFPC), offers evidence-based approaches for the design, implementation, and evaluation of falls prevention programs for older adults in community, residential, and acute care settings. The curriculum has been developed and pilot-tested for healthcare professionals, community service providers, and policy and program personnel to integrate into their falls and injury prevention practices and services. The workshop is coordinated through the British Columbia Injury Research and Prevention Unit in Vancouver within Canada. Persons close to the Canadian border can access the training program for concepts that can lessen the stress of responsibility for falls and lower the likelihood of caregiver injury incurred in retrieving a fallen resident. The course also is offered online internationally. To find out more or enroll, visit: www.injuryresearch.bc.ca.

    Meanwhile, efforts to tackle falls prevention are underway in the US. At the forefront are endeavors of the National Safety Council (www.nsc.org) and the National Council on Aging (www.ncoa.org), who together with the NAFC (www.nafc.org/blog/incontinence-blog/nighttime-toileting-and-osteoporosis/) and other organizations and agencies are working to secure funding to underwrite programs similar to those in Canada. Until our own public health agenda is strengthened, let’s borrow what we need from our neighbors and become better prepared to prevent more falls.

The National Association For Continence is a national, private, non-profit organization dedicated to improving the quality of life of people with incontinence. The NAFC’s purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence.

This article was not subject to the Ostomy Wound Management peer-review process.

1. Parsons JK, Mougey J, Lambert L, Wilt J, Fink H, Garzotto M, et al. Lower urinary tract symptoms and risk of falls in older men. J Urol. 2008;179(suppl):140.

2. Muller N. What Americans understand and how they are affected by bladder control problems: highlights of recent nationwide consumer research. Urol Nurs. 2005;25(2):109–115.

3. Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. Preventing falls among community-dwelling older persons: results from a randomized trial. Gerontologist. 1994;34(1):16–23.

4. Hausdorff JM, Rios DA, Edelber HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil. 2001;82(8):1050–1056.

5. Web-based Injury Statistics Query and Reporting System (WISQARS) [database online]. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Available at: www.cdc.gov/injury/wisqars/index.html. Accessed December 21, 2009.

6. Stevens JA. Falls among older adults — risk factors and prevention strategies. J Safety Res. 2005;36(4):409–411.

7. Elliott S, Painter J, Hudson, S. Living alone and fall risk factors in community-dwelling middle age and older adults. J Community Health. 2009;34(4):301–310.