Why falls and fractures in the elderly can be a trigger for hospice care
Millions of elderly people (age 65 and older) experience falls. Further statistics show that; one out of five falls result in a serious injury, according to the Centers for Disease Control and Prevention (CDC). More than 300,000 elderly people are hospitalized each year for hip fractures, with 95 percent of hip fractures resulting from a fall. With the advancements in medicine and increasing life expectancy, it is predicted that the incidence of hip fractures of this nature will increase by 12 percent by 2030 (National Council on Aging).
This is a problem — and a growing problem at that.
Falling may result in broken bones, brain injuries, loss of independence, fear of future falls, and even death. Approximately 9,500 deaths in older adults are associated with falls annually. According to the American Family Physician, one fourth of elderly persons who sustain a hip fracture will die within six months of the injury, more than 50 percent of older adults who survive a hip fracture are discharged to nursing homes, and nearly half of that population will still reside in a nursing home a year later.
For those who survive a serious fall resulting in a significant injury, the impact on an elderly patient’s quality of life can be devastating. Falls have physical impacts but also psychological ones. Patients often become fearful of falling again, which in turn results in restriction of activities, decreased mobility and function, and loss of independence. Overall, there can be a substantial negative impact to someone’s quality of life. With declining independence comes the need for caregivers, community resources, and subsequently, financial concerns.
I can recall caring for an elderly woman a few years ago. She had entered the hospice program with advanced dementia, a diagnosis highly linked to falling. Her dementia had gotten to the point that she moved into an assisted living facility. Her hospice services continued in that setting. The patient was still ambulatory and enjoyed interacting with others. Unfortunately, a few months later she sustained a fall and fractured her hip. She was admitted to the hospital for evaluation. Hospice continued to visit her in the hospital. The patient was not a surgical candidate because of her advanced dementia and history of cardiac disease. The decision was made to seek palliative care at the Hospice of the Panhandle Inpatient Facility. She passed away a few weeks later — peacefully.†
What can be done to help? While there are interventions that can help decrease the risk of falling for an elderly person, there will always be incidence of falls and subsequent injuries and quality of life impacts. Once a frail elderly person falls and experiences a serious injury, patients, families and medical providers should consider a hospice referral. As mentioned above the morbidity and mortality for this patient population is high.
How can hospice help?
When a patient is admitted to hospice services, he or she gets an additional level of support that is aimed at improving quality of life. Physical, psychological, social, financial, and spiritual needs can be addressed by the hospice team. Hospice is an interdisciplinary service made up of:
- physicians (who can make house calls and are experts in pain and symptom management);
- nurses (who make weekly visits, coordinate the patient’s care with his or her physician, can help organize the patient’s medications);
- social workers (who can address emotional, financial and legal concerns);
- certified nursing assistants (who can provide baths, do light housekeeping, offer instruction on how to provide personal care);
- chaplains (who can provide spiritual support);
- volunteers (who can provide friendly visits, run errands, offer haircuts);
- nutritionists (who can offer dietary counseling);
- physical, occupational, speech and massage therapists; and
- bereavement counselors.
These services can be provided in patients’ homes, assisted living facilities, and nursing homes. Hospice of the Panhandle also has an inpatient facility, which can serve as an alternative to hospitalization when symptoms need more aggressive management. Our inpatient facility also offers a place of respite when caregivers need to take a much-needed break or are traveling out of town.
Falls often cannot be avoided in the frail elderly. But with the grave impact these have on quality of life, an early referral to hospice can result in better pain management, increased support and advocacy from multiple disciplines, family and caregiver support, instruction on living with physical limitations, and a focus on comfort and quality.
Dr. Sarah Phillips has been medical director at Hospice of the Panhandle for six years. She holds a certification as a hospice medical director. Hospice is a not-for-profit agency that has cared for patients and families with life-limiting illnesses in Berkeley, Morgan, Hampshire and Jefferson counties since 1980. For more information on how hospice helps residents of the four-county area live more fully, call 304-264-0406, or visit on-line at www.hospiceotp.org