WASHINGTON — What is often preventable but costs Medicare and Medicaid $37.5 billion annually? The answer: falls and subsequent injuries to beneficiaries.
“Falls are the leading cause of fatal and non-fatal injuries for older Americans, often leading to a downward spiral with serious consequences,” Sen. Susan Collins (R-Maine), chair of the Senate Aging Committee, said Wednesday at a hearing on strategies for falls prevention. “In the United States, the total cost of fall-related injuries is approximately $50 billion annually, and that is expected to double to $100 billion by the year 2030. Seventy-five percent of these costs ($37.5 billion) are borne by the Medicare and Medicaid programs.”
“One key cause is osteoporosis, which can be especially dangerous for people who are completely unaware that they suffer from low bone density,” she continued. “While Medicare covers bone density testing, reimbursement rates have been slashed by 70% since 2006, resulting in 2.3 million fewer women being tested. As a result, it is estimated that more than 40,000 additional hip fractures occur each year, which results in nearly 10,000 additional deaths.”
Collins and Sen. Ben Cardin (D-Md.) have introduced legislation to reverse the reimbursement cuts.
The statistics on the number and cost of falls “may not even tell the whole story because many older adults don’t tell anyone when they fall,” said Sen. Bob Casey (D-Pa.), the committee’s ranking member. “We must remove the stigma associated with falling so that they can get the help they need to age in place – where they want to be – in their homes and communities.”
Interventions, Home Modifications Needed
Casey discussed a report on the issue that the committee released Tuesday. “As our report illustrates, there are steps that can be taken to make this a reality,” he continued. “I’ll start with one: Physical mobility. That is key. Staying active – walking, stretching, and strength-training – all of that is proven to reduce the risk of falls among older adults.”
Investing in developing and disseminating proven interventions is also important, as are home modifications. “Yet, to a senior on a fixed income, even installing a grab bar in the shower may be out of reach due to cost,” said Casey. “The research community also has a role to play by ensuring that older adults are part of clinical trials, so that we know the prescription drugs they may need do not come with a dose of falling.”
And last, “providers must be trained to screen patients for their fall risk and refer those in need of intervention to the appropriate service provider,” he said. “A conversation that allows a provider to assess a patient should be part of every wellness visit.”
Witnesses at the hearing discussed their efforts to help with fall prevention in their local communities and nationwide. Peggy Haynes, senior director of Healthy Aging at Maine Health, a healthcare system in Portland, talked about “A Matter of Balance,” an evidence-based, clinically led fall prevention program developed at Boston University in the mid-1990s that has been replicated nationwide. This is “a small group program where participants learn to reduce falls and to view falling as controllable,” she said.
Participants in the program’s eight 2-hour classes learn exercises to increase strength and balance, and also participate in group problem-solving. Maine Health tried to offer the program in the local community, “but the expense of using clinical staff limited our dissemination,” Haynes said. Maine Health was given a grant to develop a model using lay leaders, “and now classes are taught by lay coaches, who in turn are taught by master trainers.”
The results in Maine have been positive, including statistically significant increases in falls efficacy, management, and control for up to a 12-month period, Haynes said. In addition, “99% plan to continue to exercise, and “A Matter of Balance” was associated with a cost savings of $938 [per person] per year. More than 6,200 Mainers have benefitted from the program,” which now has master trainers in 46 states.
Need for Education
Virginia Demby, a Chester, Pennsylvania resident who advocates for older adults, has struggled with her health all her life. “I was born with some birth defects,” she explained. “many things would happen to me and doctors didn’t know what was wrong with me, and I would fall a lot. I’d find myself on the floor … Before I got a wheelchair, I many times crawled across the floor to get to the bathroom because I didn’t want to make a mess.”
Demby eventually taught herself how to keep from falling, but many older adults haven’t had fall prevention training, she said. “They end up isolated, alone, not knowing what to do.” Demby said she benefited from a program called “Healthy Steps” because “there’s the opportunity to learn how to be active, how to regain what you’ve lost.” She said she now participates in line dancing, Zumba, kickboxing, weight lifting, boxing, and extreme exercise. “I used to run — I don’t do running any more because I’m very visually impaired, so now I’m walking. But I do distance walking.”
Kathleen Cameron, senior director of the National Council on Aging’s Center for Healthy Aging, in Arlington, Virginia, said her own mother died due to consequences of a hip fracture she sustained after a fall. “This is a health issue that crosses all genders, ethnicities, and income levels,” she said. “Every hour, four older adults die from fall-related complications; this number is expected to reach seven by 2030 if we don’t take significant steps now.”
A Call for a Federal Effort
“We need a coordinated federal effort,” said Cameron. “It could be modeled after the National Alzheimer’s Model Act, and include a national awareness and action campaign.” Health providers should be incentivized to use the CDC’s “STEADI” (Stopping Elderly Accidents, Deaths, and Injuries) fall risk prevention program, she added.
“At the federal level, we recommend expanding payment for the ‘Welcome to Medicare’ and annual wellness visits to include physical therapy and occupation therapy visits … and use the Center for Medicare & Medicaid Innovation to examine innovative payment models. We must face falls in older adults head on,” Cameron said.
Sen. Mike Braun (R-Ind.) noted that “when I talk about things like wellness and prevention, the insurance industry is more interested in remediation and claims processing … so we’re on to something here.” And, because diseases like diabetes, heart disease, and cancer are much more common and visible, “falls and the prevention of them will not be high on the radar screen.”
Demby recommended starting fall prevention early. “It should probably be incorporated into physical education programs in schools,” she said. “If fall prevention is included in the school curriculum, by the time you get to be an older adult, you know something about it. You know how to fall.”
“What do I do when I know I’m going to fall? At the very instant it happens, I need to know to relax,” Demby added. “Let the fall take place. When you relax there’s less injury and sometimes no injury at all. I had to learn that, and there was no one to teach me.”