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Failing to Plan Means Planning to FALL

Headshot and quote from Dr. Frank Molnar - fall prevention expert.

In 2014/15, more than 250,000 older Ontarians made an emergency department visit due to a fall, 60,000 of these people were hospitalized according to data from Parachute Canada.

In 2010, Ontarians spent more than $2-billion on the direct cost of fall-related injuries. As the Ontario Ministry of Finance projections in “Ontario Population Projections Update 2017-2041” indicate a doubling of the number of older adults over the age of 65 and the quadrupling of the number of older adults over 85-years-of-age in the coming years, these costs are expected escalate dramatically.

Why is this happening when we have a large body of evidence to indicate that fall prevention programs and services can contribute to significant reductions in fall-related injuries, hospitalizations and associated health care costs?

“If a business ran in this wasteful a manner it would go bankrupt!”

At present, the collective impact of fall prevention efforts in Ontario is hampered by a fragmented system of delivery that reflects the low priority of fall prevention in the health system. As a society we are willing to pay billions of dollars to fix the result of falls (e.g. surgery, lengthy rehabilitation, admission to nursing homes) but we are not willing to balance that investment with greater emphasis on fall prevention (an approach that would have a far greater return on investment). The costs noted above and, to a certain extent, hospital over-crowding reflect the effect of that lack of coordinated planning for fall prevention.

The multi-faceted contributions to falls prevention by Geriatric Medicine and its interprofessional teams need to be integrated into that planning. The GERIATRIC 5Ms provide a planning context:

  • Mind (cognitive impairment due to dementia and delirium that increases the frequency of falls),
  • Mobility (more traditional causes of falls addressed in conjunction with Physiotherapy and Occupational Therapy),
  • Medications (many of which contribute to falls),
  • Multi-complexity (multiple interacting conditions such as Heart Failure, Diabetes, Stroke, Parkinson’s, Postural Hypotension etc. that contribute to falls),
  • Matters Most (Goals of Care).

If we want to address falls in a cost-savings manner to decrease hospital over-crowding (“Hallway Medicine”) then we need to: [1] better integrate Geriatric Medicine and its interprofessional teams (e.g. Geriatric Outreach, Geriatric Day Hospitals, Geriatric Emergency Management programs); and [2] invest in a central provincial coordinating structure to insure full geographic coverage across the health continuum and maximum cost-effectiveness.

If we do not start to address falls in Ontario as seriously as we do cancer and cardiovascular diseases, then we will continue to waste public resources with avoidable expensive and lengthy admissions to hospital not to mention the social costs to older adults and their families.

Dr. Frank Molnar
Associate Professor of Medicine, University of Ottawa
Division of Geriatric Medicine, The Ottawa Hospital

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