Debby and Bill were downsizing and thrilled that they were going to move into a smaller house with room for their two daughters to come home for short stays before returning to their busy lives. When developing the criteria for what they wanted in their new home, our friends were particularly interested in having everything on one floor. After all, as we all laughed during what turned out to be our last dinner together, who needs to climb up and down stairs as we toddle into our retirement years? The final night in their house was only a couple of days away, and Debby looked frazzled but beaming, anticipating this move and a future of more peace and quiet than they had experienced since before their girls were born. She and Bill were in their late 50s, healthy, and with many years ahead of them.


Then something went terribly wrong. In the middle of the night, Debby got up—perhaps on her way to the bathroom or to go to the kitchen to add one more task to her to-do list. As we all do, she probably thought she knew her house like the back of her hand and didn't need a light to find her way around. We'll never know what really happened on this last night in her two-story home because no one ever got a chance to ask her. Debby fell down the stairs in the dark. Despite Bill's frantic call to 911 and a rapid response from our community ambulance, an hour after her fall, Debby was pronounced dead at our local hospital from an acute brain injury. 


More falls have since taken their toll in people I know. One of the PA profession's leaders and a past speaker of the House of Delegates, Bill Fenn, fell off a ladder while working on his summer home, suffering a serious head injury. One of my community's most sought-after carpenters fell from a tree, sustaining multiple open femoral fractures. An older friend tripped on the concrete step into the drug store, sustaining considerable facial black and blues. Falls can happen to anyone, anywhere, at any time. 


Falls are an epidemic in this country, and older people are especially vulnerable. According to figures from the CDC, more than one-third of adults 65 years and older fall each year in the United States.1 Among this group, falls are the leading cause of injury deaths and the most common cause of nonfatal injuries and hospital admissions for trauma.1 Risk factors for falls among older adults include osteoporosis, lack of physical activity, impaired vision, medication side effects, and environmental hazards.2 In fact, at least one-third of all falls in the elderly involve environmental hazards in the home. The risk of falling increases with age and is greater for women than for men.


How many times in your clinical practice have you seen a patient at risk for a fall? Take Mrs. Cooper, for example. She is a 70-year-old woman whose husband died a year ago. She lives alone in their two-story house and has fallen several times ("I can't remember how many") in the past 6 months. She takes eight different medications prescribed by three different providers, and she complains of feeling dizzy since she began taking her "water pill." Mrs. Cooper admits to being very reluctant to drive, especially at night, because she doesn't see as well as she used to. 


PAs are perfectly positioned to make a crucial difference in the lives of patients like Mrs. Cooper by helping to prevent falls, especially in the elderly. We can do this just by evaluating patients for risk factors and educating about avoidable hazards. A huge number of resources that can help are available online. For instance, the CDC has developed several excellent (and reproducible) brochures and posters to educate older adults and those who care for them about preventing falls and the injuries that result.3 


Falls in older people have been characterized extensively in the literature, but much less information is available about falls in middle-aged and younger adults.4 Sadly, my friend Debby's accident was just that—a tragic accident—and preventing falls in people her age and younger is not as "cause-and-effect" as it is for older adults. It sounds too simplistic to tell people, "Be more careful." However, I want to believe that we can learn from this loss. I have to believe that we will. JAAPA


Sarah Zarbock, PA-C, is the editor in chief of JAAPA.

REFERENCES


1. Centers for Disease Control and Prevention. Injury falls among older adults: an overview. CDC 
Web site. http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html. Accessed 
September 3, 2010.


2. Tremblay KR Jr, Barber CE. Preventing falls in the elderly. Colorado State University Extension. http://www.ext.colostate.edu/pubs/consumer/10242.html. Updated May 12, 2010. Accessed 
September 3, 2010.


3. Center for Disease Control and Prevention. Falls among older adults: brochures and posters. CDC Web site. http://www.cdc.gov/HomeandRecreationalSafety/Falls/fallsmaterial.html. Accessed September 3, 2010.


4. Talbot LA, Musiol RJ, Witham EK, Metter EJ. Falls in young, middle-aged and older community dwelling adults: perceived cause, environmental factors and injury [published online August 18, 2005]. BMC Public Health. doi:10.1186/1471-2458-5-86.