Unintentional injuries are a leading cause of death in older adults age 65 and older—leading to more than 60,000 deaths annually. Over half of these deaths are due to falls.1
Preventing a Fall
Falls are the leading cause of both fatal and nonfatal injuries in people age 65 and older and falls can lead to significant functional decline and extensive medical costs. More than 1 in 4 older adults fall each year and falling once increases their chances of falling again.2,3 Falls can be prevented, and you can help.
What can you do to prevent your older patients from falling?
- Screen patients for fall risk.
- Assess modifiable fall risk factors.
- Intervene to reduce identified fall risk by using effective clinical and community strategies.
Motor Vehicle Safety
As Americans live longer, there are more older adults age 65 and older driving longer. There were more than 46 million licensed older adult drivers in 2019.4
Driving helps keep older adults mobile and independent but their risk of injury or death in a motor vehicle crash increases as they get older. Over 8,000 older adults died in traffic crashes and nearly 252,000 were treated in emergency departments for crash injuries in 2019.1 This means that 22 older adults die and almost 700 sustain an injury every day in motor vehicle crashes.
What can you do to prevent motor vehicle crash deaths and injuries in your patients?
Screen and assess for potential driving concerns.
- Provide an in-office assessment to identify medical conditions, functional skills, or history of recent crashes that could affect a patient’s ability to drive safely.
- Review your patient’s prescription and over-the-counter medicines for adverse effects that could increase the risk of a car crash
- Assess whether your patient can move to a lower dosage of medicines or discontinue use.
Evaluate and treat.
- You may be able to treat the relevant medical conditions or functional limitations to address the underlying conditions.
Refer patients for driving assessments as indicated.
- Patients whose limitations are not addressed by optimal medical treatment can be referred to a driving rehabilitation specialist for additional evaluation, rehabilitation, or training.
- Talk to your patients about their modifiable risk factors such as staying active and wearing proper eyewear.
- Older adults should have their eyes checked by an eye doctor at least once a year and update their eyeglasses as needed.
Encourage transportation options.
- The chances of motor vehicle crashes resulting in injuries or death increase as we age.
- Encourage your patients to consider ride shares, public transportation, or asking friends, family members, or neighbors to drive them.
- MyMobility Planning Tool (Englishpdf icon / Spanishpdf icon)
- Clinicians Guide to Assessing and Counseling Older Driverspdf iconexternal icon
Traumatic Brain Injury
A TBI may lead to devastating health effects and is linked a substantial number of deaths and disabilities in the United States each year. A TBI can occur in several ways but falls and motor-vehicle crashes are two of the most common causes, especially in adults age 65 and older. In fact, 81% of TBI-related emergency department visits in older adults are caused by falls.5
Older adults are more likely to be have a hospital stay and die from a TBI compared to other age groups.6 Still, TBIs may be missed or misdiagnosed because symptoms of TBI overlap with other medical conditions that are common among older adults such as dementia.
Check your older patients for signs and symptoms of a TBI if they have fallen or were in a car crash. This is especially important among older adults who are taking blood thinners,7 such as:
- Anticoagulants such as warfarin (Coumadin), rivaroxaban (Xarelto), and apixaban (Eliquis)
- Antiplatelet medications such as clopidogrel (Plavix), ticagrelor (Brilinta), and acetylsalicylic acid (Aspirin)
When to initiate immediate medical intervention
Signs of deteriorating neurological function may include:
- Headache that gets worse and does not go away
- Experience weakness, numbness, decreased coordination, convulsions, or seizures
- Vomit repeatedly
- Slurred speech or unusual behavior
- One pupil larger than the other
- Cannot recognize people or places, get confused, restless, or agitated
- Lose consciousness, look very drowsy, or cannot wake up
What can you do to prevent a TBI in your patients?
Practice fall prevention.
- Advise older patients to follow the steps in how you can prevent a fall.
Increase motor vehicle safety.
- Advise your older patients to follow the steps in preventing a motor vehicle crash.
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). Atlanta, GA: CDC; Accessed 2021. Available at: cdc.gov/injury/wisqars.
- Moreland B, Kakara R, Henry A. Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years—United States, 2012–2018. MMWR Morb Mortal Wkly Rep 2020;69:875–881.
- Pohl P, Nordin E, Lundquist A, Bergström U, Lundin-Olsson L. Community-dwelling older people with an injurious fall are likely to sustain new injurious falls within 5 years–a prospective long-term follow-up study. BMC Geriatr. 2014 Nov 18;14:120.
- U.S. Department of Transportation, Federal Highway Administration. Distribution of Licensed Drivers—2019. Accessed 2021. Available at: https://www.fhwa.dot.gov/policyinformation/statistics/2019/dl20.cfmexternal icon
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Surveillance Report of Traumatic Brain Injury-related Emergency Department Visits, Hospitalizations, and Deaths—United States, 2014. (2019). Available at: https://www.cdc.gov/traumaticbraininjury/pdf/TBI-Surveillance-Report-FINAL_508.pdfpdf icon
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Surveillance Report of Traumatic Brain Injury-related Hospitalizations and Deaths by Age Group, Sex, and Mechanism of Injury—United States, 2016 and 2017. (2021) Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.
- Maegele M, Schöchl H, Menovsky T, Maréchal H, Marklund N, Buki A, Stanworth S. Coagulopathy and haemorrhagic progression in traumatic brain injury: advances in mechanisms, diagnosis, and management. Lancet Neurol. 2017 Aug;16(8):630-647.