The mere act of falling down leads to tens of thousands of deaths among adults 65 and over every year in the U.S., and even more hospitalizations. In Baltimore, where there are many older homes and row houses with steep staircases, falls leading to an emergency room visit occur more frequently than in the rest of Maryland on average, and the city’s recently launched fall-reduction strategy aims to utilize hospital data to quickly identify neighborhoods—and even exact locations—where falls are most frequent.
Officials then will target interventions to those hot spots—such as fixing lighting in homes or installing railings that make it easier to get up and move around—with the goal of reducing the rate of falls by 20 percent over the next decade.
Falls sent nearly 5,000 older adults in Baltimore to the emergency department in 2017, costing an estimated $60 million in hospital bills, according to the city’s health department. Nationwide, Medicare and Medicaid have shouldered about 75% of the bill for nonfatal older adult falls, according to a study published in the Journal of the American Geriatrics Society.
The Baltimore initiative, which also includes public education efforts on how to prevent falls, could save $14 million in medical costs annually, “not to mention the lives saved and human impact on families,” Baltimore City Health Commissioner Dr. Leana Wen says.
Baltimore’s data surveillance system, which is updated automatically, is an extension of a project that began in 2016with $200,000 in grant funding from the Robert Wood Johnson Foundation.
The new initiative involves hospitals providing fall-related data to Maryland’s health information exchange—the Chesapeake Regional Information System for our Patients, or CRISP—which passes it along to the city health department.
The health department then strategizes with community groups about interventions to reduce the number of falls in a particular area or for certain patients. The city’s housing department, 311 service request system, social service providers and academic institutions are also involved with the project.
The health department will have access to data on falls one week to one month after they happen—as opposed to a previous lag time of 18 months or longer, due to the need for an epidemiologist to get and analyze the data hospitals would send to CRISP—which will help it prevent more falls in hot-spot areas, Mike Fried, chief information officer for the Baltimore City Health Department said.
Once an older person falls, they are twice as likely to fall again, according to the Centers for Disease Control and Prevention. Breaking a hip, meanwhile, can make it more difficult to live independently, and increases an older adult’s chance of dying in the coming months and years.
