Trauma surgeons at Oregon Health & Science University handle the most complex and severe cases from across the region: gunshots, occupational injuries, motor vehicle crashes.
Yet, the single most common cause of traumatic injury at OHSU is ground-level falls.
“These are life-changing injuries,” said trauma surgeon Mackenzie Cook, M.D., associate professor of surgery (trauma, critical care and acute care surgery) in the OHSU School of Medicine. “I’ve seen people who have died from injuries like this.”
It may sound innocuous, but injuries caused by people simply toppling over can be life-altering and even life-threatening, especially among older adults with underlying medical conditions. Trauma surgeons are treating severe injuries like hip fractures, spinal injuries and brain injuries caused by ground-level falls. In fact, the number of injuries caused by ground-level falls has risen sharply in recent years, despite the fact that most of these falls are preventable.
This week, OHSU held its first-ever fall-prevention screening event for the public.
Organizer Sarah Gold, RN, who previously worked as an OHSU emergency medicine nurse, anticipates holding additional public screening events on an annual or semi-annual basis.
Held in the ground-floor atrium of the Center for Health & Healing Building 1 on OHSU’s South Waterfront Campus, 64 participants turned out for free screenings in balance, strength, walking gait and vision. Participants also received tips and advice about how to reduce the risk of falling and winding up in OHSU’s emergency department.
“My goal is to be out of a job because of injury prevention,” said Heather Wong, RN, administrative director of OHSU’s trauma program.
Judging from the rising number of falls treated at OHSU, her job won’t end any time soon.
OHSU treated 891 injuries caused by falls that were serious enough to require entry into the trauma system in 2022 — a 91% jump from six years before. That doesn’t even count another 1,240 falls treated in the OHSU emergency department last year that were deemed non-trauma.
Nationwide, people 65 and older account for about three quarters of traumatic fall injuries.
“This is truly becoming a public health emergency,” said geriatrician Katie Drago, M.D., associate professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine. “Older adults are one of the fastest-growing demographics in the United States. We are living longer, which is good, but it also means more of us are living longer with physical and cognitive impairments that raise the risk of falling.”
At the screening event, researchers enrolled participants in a six-month study designed to reduce the risk of falls among people 65 and older. The study relies on a falls-prevention program created by the Centers for Disease Control and Prevention. Hiroko Kiyoshi-Teo, Ph.D., RN, assistant professor in the OHSU School of Nursing, is leading the study with Bory Kea, M.D., associate professor of emergency medicine in the OHSU School of Medicine.
“Falls are a sensitive topic,” Kiyoshi-Teo said. “There’s a lot of shame, but people never really want to talk about how to prevent it from happening.”
Harry Rectenwald, 71, of Lake Oswego, attended the fall-prevention screening event with his 82-year-old sister Monica Yahr, who was visiting from Atlanta.
He was happy to enroll in the trial.
“We both have kids and they want us to take care of ourselves,” Rectenwald said. “We don’t want them to get a call in the middle of the night from someone at the hospital saying, ‘Your dad fell.’”
For those who missed the event this week, the National Council on Aging provides an online fall-prevention check-up tool.
Many people share that fear, Drago said.
“Falling is not a normal part of aging — it is not inevitable,” she said. “There are lots of things people can do to reduce the risk.”
Drago describes three broad categories of actions older people and their families can take now to reduce the risk of falling: exercise, minding medication and clearing a path.
Drago said she emphasizes the importance of physical activity with her patients, including aerobic exercise, strength training and balance through activities such as tai chi. She advises older adults to build exercise into their daily routine.
“Inertia really does kill,” she said. “Bodies in motion stay in motion.”
Drago said that ground-level falls aren’t typically due to any one factor, but could be a combination of factors. For example, medications can combine in unanticipated ways, leading to dizziness that contributes to falling.
She often works with her patients to cull lengthy lists of medications and supplements. It’s also worth discussing whether bifocals used for reading may not be ideal for moving around.
It’s imperative to visit a health care provider any time a person falls, she said.
“Usually, people aren’t going to be able to distinguish on their own whether they simply tripped, or if they might be having a major neurological or cardiac issue that needs to be dealt with,” Drago said. “If you have fallen, you should bring it up with your primary care provider.”
Drago said many cases arrive in the trauma bays as a simple result of clutter. Someone gets up in the night to use the bathroom and trips over a pile of books; or their hallway isn’t quite wide enough to use a walker without bumping into a wall; or overgrown shrubbery encroaches on walkways around the house.
Keeping a clear path enables older adults to minimize the risk of falling and to continue living independently.
“Little things like that can make a big difference for people,” Drago said.