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I'm Rob Logan, Ph.D. senior staff National Library of Medicine substituting this week for Donald Lindberg, M.D, the Director of the U.S. National of Medicine.

Here is what's new this week in MedlinePlus.

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Educational efforts to prevent Connecticut seniors from serious injuries caused by falls resulted in a significant reduction that continued even beyond a study's intervention period, reports some findings recently published in the New England Journal of Medicine.

The study compared results around Hartford (where physicians and health care providers received training to help patients prevent falls) with a region in southern Connecticut where no training occurred. The study's nine authors reported a nine percent decline in the rate of serious fall-related injuries in Hartford compared to the other region.

Interestingly, the success lasted well past the original intervention, which occurred between fall 2001 and 2004.  The study found that in 2007, three years after the intervention, the rate of serious fall-related injuries remained significantly less in the greater Hartford area.  

The use of medical services to prevent falls also was significantly higher in the Hartford area (or where the study's intervention occurred).  

The incidence of fall-related injuries and use of medical services before, during and after the study were measured through the Connecticut Health Information Management database, which is maintained by the Connecticut Hospital Association. The definition of serious fall-related injuries was not provided in the report, but was based on the Connecticut Health Information Management's standard measures.

The authors note that falls account for 10 percent of emergency room visits and six percent of hospitalizations for persons after age 65. Falls also are a trigger for nursing home placement, restricted activities, and sometimes suggest functional decline among American seniors, the authors report.  

The American Academy of Orthopaedic Surgeons' website adds that 11 million seniors fall each year, that's one of every three persons older than age 65. The treatment for injuries and complications associated with falls costs about $20.2 billion in the U.S. every year. We will add more about the American Academy of Orthopaedic Surgeons' fall prevention website in a moment.

The study's intervention was somewhat unusual because it was targeted mostly for physicians, nurses, and other providers who work with seniors in home care, outpatient rehabilitation, and senior centers in the greater Hartford area. Physicians and providers received numerous visits to clinics as well as working group sessions during the intervention period. For example, the intervention team made 69 visits to senior centers and 194 visits to rehabilitation clinics.

The training included: management of visual and foot problems, hazard reductions in homes, and promoting better balance, gait, and strength training. Participating physicians were encouraged to incorporate assessment, treatments, and referrals into their practice.

The study also included a component where information about the importance of preventing falls was promoted on local television, radio and newspapers as well as through brochures, websites, and advertising on buses. Opinion leaders were enlisted to influence colleagues.

The researchers also were careful to limit the confounding variables that might disassociate the study's success from the intervention.

As a result, the study's implication is some training in prevention (accompanied by reminders about the costs and problems associated with falls) may reduce their occurrence.

The authors do not discuss the degree the training provided in the study is scalable, or easily useful in other areas in the future.

While MedlinePlus.gov does not offer model provider training, the 'falls health topic page' provides considerable practical advice to help seniors.

For example, the American Academy of Orthopaedic Surgeons' website advises seniors to:
 

• Watch their overall health. Tips here include: annual physical and eye exams, maintain daily calcium and vitamin D, avoid excessive alcohol, and do not smoke
• Exercise, especially in programs for seniors that address agility, strength, balance, and coordination
• Dress with care, such as wear shoes with nonskid soles, replace loose slippers, use a long handled shoehorn, avoid high heels, never walk in your stocking feet
• Understand medications, especially their side effects.

The website additionally provides an array of tips that one can use in their home to prevent falls. Among the site's many suggestions, in a bedroom, place a lamp, telephone, and a flashlight near a bed, keep clutter off a bedroom floor.

In the living room and den, arrange furniture so there is a clear path between rooms. Keep appliance and phone cords out of the walkways.

In the kitchen, remove throw rugs, use nonskid floor wax, remove all food, liquids or grease spills.

On stairs and steps, put light switches at the top and bottom, use solid colors on stairs which shows the edges of steps more clearly.

In the bathroom, place a slip-resistant rug next to the bathtub for easy exit and entry. Replace glass shower enclosures with non-shattering materials.

The American Academy of Orthopaedic Surgeons helpful website is in the 'prevention/screening' section of MedlinePlus.gov's 'falls health topic page.'

The 'falls health topic page' includes: a related issues section that provides information on footwear and falls, and how to get up from a fall. It provides some of the latest research findings, and information written specifically to help children and seniors. The latter includes a website on the benefits of Tai Chi to help seniors lose their fear of falling.

To find the 'falls health topic page,' type 'falls' in the search box on MedlinePlus.gov's home page. Then, click on 'falls (National Library of Medicine).'

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