Dr. Marita Kloseck is a professor, Director of the School of Health Studies, and Director of the Canada Foundation for Innovation (CFI) funded Aging and Community Health Research Lab at Western University in London, Ontario, Canada. Her research focuses on aging, community health and optimizing seniors’ independence. She has over 25 years academic and clinical experience. Dr. Kloseck is known for her novel work with naturally occurring retirement communities (NORCs) and engaging end users, particularly seniors, in the research process.
ElderBranch interviewed Dr. Kloseck regarding “An exploration of risk for recurrent falls in two geriatric care settings,” a study conducted by Humeira Tariq, a graduate student in the Health and Rehabilitation Sciences Program at Western University. Dr. Kloseck supervised the study. Dr. Richard Crilly of the Schulich School of Medicine at Western University, and Drs. Iris Gutmani and Maggie Gibson of Parkwood Hospital were co-investigators on the study.
Why did you decide to research the factors that increase the risk of recurrent falls in older adults? Why is this topic important?
This is a major problem. Falls in old age are a significant cause of injury. Hip fractures are one of the most significant consequences and many, perhaps most, patients who experience a hip fracture don’t return to their previous functional level. Many don’t survive.
For example, men with hip fractures experience a death rate of >30% in the following year. Falls are a reflection of frailty with advanced age but much can be done to reduce them. For example, a community-based initiative in Scotland has significantly reduced falls and fractures.
The problem is that the factors that cause and predict falls can be population specific and not all people are the same. Falls, however, are endemic in institutionalized populations, and again, depending on the nature of the population, the factors associated with falling, and especially repeat falling, can be population specific. Over 1/3 of all hip fractures occur in residents in long term care and the consequences for these people can be catastrophic.
Please describe your study. What were your in-going hypotheses?
Our hypothesis was that different populations may show different patterns of falling and associated risk factors. We were particularly interested in people who fell frequently so in our study we chose two quite different populations to see if the factors associated with recurrent falling were different. They do, indeed, seem to be so.
What were the key findings from your research?
We found that for patients in the rehabilitation setting, the older you are the more likely you are to be a recurrent faller. This is not surprising given that frailty and falling are associated with advanced age but it does raise particular problems in the rehabilitation of very old individuals where safety and independence may be at odds. These patients may require much closer observation. Remember that both these units had falls prevention programs in place. We were trying to identify those who might need more attention and in the rehabilitation unit the very old may be such a group.
On the long term care ward, however, the situation was different. Age was not a significant determinant. Time of day may be important which may reflect the level of supervision available. It is likely in such patients, who tend to be more mobile and medically more stable, that the more independent they are, the greater the likelihood of falling. However predicting the recurrent faller is difficult and it may be that the only way to predict the recurrent faller is for the individual to identify themselves at risk by falling once, despite the standard fall prevention program in place. It appeared that falling once identified you as someone likely to fall again, and luckily, most first falls did not result in serious injury.
Based on your findings, what recommendations would you make to health care providers treating older adults? Are there any additional steps they can or should take to help prevent falls?
Our emphasis was on repeat falling. Most inpatient or long term care units have already implemented programs to reduce falling risk. We were looking at patients who were recurrent fallers despite these programs. It seemed to us that it was simply a case of not all patients or units or programs being the same. Each may require a tailored approach based on the specific patients in the program. A ‘cookie cutter’ approach doesn’t work.
What are the next steps in terms of furthering research into recurrent falls? What questions still need to be answered?
One of the challenges is to collect relevant and accurate falls-related data. While it is true that not every patient population will be helped by an ‘off the shelf’ intervention because each patient population needs different risk factors to be assessed and addressed, one of the challenges is to collect good information that is recorded in the same way by all staff working on inpatient and long term care units and that, in itself, is difficult. This seemingly simple recommendation, that is collecting data good enough for analysis to provide insight into the issue, is actually extremely difficult but is an essential first step in the process.