Q&A: PCPs can help ensure injuries are not a ‘normal part of aging’

More than 2.4 million ED visits and 700,000 hospitalizations among adults aged 65 years and older were caused by injuries from falls, motor vehicle accidents, opioid overdoses and self-harm in 2018, according to data in MMWR.

The data further showed that unintentional falls represented more than 90% of these visits and hospital stays.

The report coincided with the launch of a new CDC campaign, “Still Going Strong,” which aims to help older adults engage in activities in a way that prevents many of the falls, motor vehicle crashes and traumatic brain injuries that “disproportionately” affect them, according to an agency press release.

“Experiencing injuries doesn’t have to be a normal part of aging,” Debra Houry, MD, MPH, director of CDC’s National Center for Injury Prevention and Control, said in the release.

Healio Primary Care asked Robin Lee, PhD, MPH, who leads the Safety Promotion Team in the Division of Injury Prevention within CDC’s Injury Center and co-authored the MMWR paper, to provide more details on the Still Going Strong campaign and to offer strategies to prevent falls, motor vehicle crashes and TBI.

Healio Primary Care: What does Still Going Strong entail?

Lee: CDC’s Still Going Strong campaign speaks directly to older adults, aged 65 and older, and their caregivers. We want to raise awareness about preventable injuries among older adults.

This campaign has two goals: Educate about common risk factors for falls and motor vehicle crashes, as well as [TBIs] that happen from falls and motor vehicle crashes [and] empower older adults and their caregivers to take simple steps that will help them maintain their independence and age without injury.

Healio Primary Care: Why did CDC initiate this campaign?

Lee: CDC launched Still Going Strong to inform older adults and those who care for them that common injuries can be prevented as they age. Our campaign’s cornerstone positive message for older adults is that growing older does not mean they need to give up the activities they have always enjoyed, and they can take specific steps to reduce their risk of injury. CDC is focused on preventing falls and motor vehicle crashes and preventing, recognizing and responding to concussion or other [TBI].

Healio Primary Care: How is the program being implemented?

Lee: The website includes information for older adults, caregivers and health care providers on how to prevent common injuries among older adults.

The campaign includes radio spots and direct mailers in states with a high incidence of older adult injuries (Maine, Oklahoma, Oregon and Wisconsin). Nationwide print ads will appear in Reader’s Digest Large Print and Reminisce magazines. We will also have digital and video ads featured on websites frequented by older adults on a national level, including AARP. We have also shared the campaign with partner organizations and have encouraged them to share with their local and national networks.

Healio Primary Care: What are the most important things that primary care physicians should tell older patients and their families or other caregivers to prevent falls? Prevent motor vehicle accidents? Prevent TBI?

Lee: Primary care physicians should talk to their older patients and their loved ones about preventing injuries, especially from falls and car crashes.

Falls are the leading cause of both fatal and nonfatal injuries in people ages 65 and older, and falls can lead to significant functional decline and extensive medical costs. More than one in four older adults fall each year and falling once increases their chances of falling again. Health care providers can use CDC’s STEADI (Stopping Elderly Accidents, Deaths and Incidents) algorithm to screen older patients for fall risk, assess for modifiable fall risk factors and intervene to reduce identified fall risk by using effective clinical and community strategies.

There are many modifiable fall risk factors such as gait and balance, vision impairment, vitamin D deficiency and the use of certain medications or polypharmacy. The STEADI algorithm also outlines how to assess these risk factors and how to intervene to reduce risk using evidence-based strategies and also offers education material for older patients, caregivers and health care providers.

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. More than 8,000 older adults died in traffic crashes and nearly 252,000 were treated in EDs for crash injuries in 2019. This means that 22 older adults die and almost 700 sustain an injury every day in motor vehicle crashes. Health care providers can screen and assess older patients for potential driving concerns, review prescription and over-the-counter medicines for adverse effects and encourage alternative transportation options such as rideshares or having a friend or family member pick them up. The CDC’s MyMobility Plan tool can help older adults plan for how they can remain mobile if driving is not an option later in life.

A TBI can occur in several ways but falls and motor vehicle crashes are two of the most common causes, especially in adults ages 65 and older. In fact, 81% of TBI-related ED visits in older adults are caused by falls. Older adults are more likely to have a hospital stay and die from a TBI compared to other age groups. Talk to your patients about steps they can take to prevent falls and car crashes — these will also help prevent a TBI.

Healio Primary Care: How prevalent are injuries from these causes in older adults? What do recent trends suggest?

Lee: Every day, more than 10,000 people in the U.S. turn 65. The number of injuries will increase as the population of older adults grow.

Fall death rates have increased about 30% in the last 10 years. Every second, an older adult falls and every year there are about 36 million falls, 8 million fall injuries, 3 million ED visits, 950,000 hospitalizations and 32,000 deaths among older adults.

Older adults represent one out of every five drivers — which is an increase of 60% in the past decade. Every day, 22 older adults die in a motor vehicle crash and every year there are 1.6 million crashes, 250,000 ED visits, 68,000 hospitalizations and 8,000 deaths among older adults.

Falls and motor vehicle crashes are common causes of TBI among older adults. TBI death rates have increased about 30% in the last 10 years.

Healio Primary Care: Are there any other ‘red flags’ that physicians should look for when reviewing older patients’ over‐the‐counter and prescription medications? If so, what?

Lee: Health care providers should review older patients’ prescription and over-the-counter medicines at least once a year. Some medicines could cause dizziness, drowsiness or slow reaction time — which can increase the risk of a fall or car crash. CDC’s STEADI resources include information on how stopping, switching or reducing the dose of medications can optimize older adult’s health and reduce their risk of future injury.

If an older adult has fallen or been in a car crash, check them for signs and symptoms of TBI. Patients on blood thinners, such as anticoagulants (including warfarin, rivaroxaban and apixaban) or antiplatelet medications (including clopidogrel, ticagrelor and acetylsalicylic acid) may increase the risk for bleeding in the brain following a TBI. Bleeding in the brain after a TBI may put a person at risk for more severe injury or death.

Older adults can use tools in the MyMobility Plan — such as CDC’s Personal Medicines List and the Personal Action Plan — to keep track of their medicines and to help guide their conversations with their health care providers.

References:

CDC. New CDC campaign highlights steps to prevent injury in adults ages 65 and over. https://www.cdc.gov/media/releases/2021/p0506-prevent-injury.html. Accessed July 6, 2021.

CDC. Still Going Strong. https://www.cdc.gov/stillgoingstrong/index.html. Accessed July 6, 2021.

Moreland B, Lee R, MMWR. 2021;doi:10.15585/mmwr.mm7018a1.