A new emergency procedure for cardiac arrests aims to save more lives – here’s how it works

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As of January this year, Aotearoa New Zealand became just the second country (after Canada) to adopt a groundbreaking new procedure for patients experiencing cardiac arrest.

Known as “double sequential external defibrillation” (DSED), it will change initial emergency response strategies and potentially improve survival rates for some patients.

Surviving cardiac arrest hinges crucially on effective resuscitation. When the heart is working normally, electrical pulses travel through its muscular walls creating regular, co-ordinated contractions.

But if normal electrical rhythms are disrupted, heartbeats can become unco-ordinated and ineffective, or cease entirely, leading to cardiac arrest.

Defibrillation is a cornerstone resuscitation method. It gives the heart a powerful electric shock to terminate the abnormal electrical activity. This allows the heart to re-establish its regular rhythm.

Its success hinges on the underlying dysfunctional heart rhythm and the proper positioning of the defibrillation pads that deliver the shock. The new procedure will provide a second option when standard positioning is not effective.

Using two defibrillators

During standard defibrillation, one pad is placed on the right side of the chest just below the collarbone. A second pad is placed below the left armpit. Shocks are given every two minutes.

Early defibrillation can dramatically improve the likelihood of surviving a cardiac arrest. However, around 20% of patients whose cardiac arrest is caused by “ventricular fibrillation” or “pulseless ventricular tachycardia” do not respond to the standard defibrillation approach. Both conditions are characterised by abnormal activity in the heart ventricles.

DSED is a novel method that provides rapid sequential shocks to the heart using two defibrillators. The pads are attached in two different locations: one on the front and side of the chest, the other on the front and back.

A single operator activates the defibrillators in sequence, with one hand moving from the first to the second. According to a recent randomised trial in Canada, this approach could more than double the chances of survival for patients with ventricular fibrillation or pulseless ventricular tachycardia who are not responding to standard shocks.

The second shock is thought to improve the chances of eliminating persistent abnormal electrical activity. It delivers more total energy to the heart, travelling along a different pathway closer to the heart’s left ventricle.

Evidence of success

New Zealand ambulance data from 2020 to 2023 identified about 1,390 people who could potentially benefit from novel defibrillation methods. This group has a current survival rate of only 14%.

Recognising the potential for DSED to dramatically improve survival for these patients, the National Ambulance Sector Clinical Working Group updated the clinical procedures and guidelines for emergency medical services personnel.

The guidelines now specify that if ventricular fibrillation or pulseless ventricular tachycardia persist after two shocks with standard defibrillation, the DSED method should be administered. Two defibrillators need to be available, and staff must be trained in the new approach.

Though the existing evidence for DSED is compelling, until recently it was based on theory and a small number of potentially biased observational studies. The Canadian trial was the first to directly compare DSED to standard treatment.

From a total of 261 patients, 30.4% treated with this strategy survived, compared to 13.3% when standard resuscitation protocols were followed.

The design of the trial minimised the risk of other factors confounding results. It provides confidence that survival improvements were due to the defibrillation approach and not regional differences in resources and training.

The study also corroborates and builds on existing theoretical and clinical scientific evidence. As the trial was stopped early due to the COVID-19 pandemic, however, the researchers could recruit fewer than half of the numbers planned for the study.

Despite these and other limitations, the international group of experts that advises on best practice for resuscitation updated its recommendations in 2023 in response to the trial results. It suggested (with caution) that emergency medical services consider DSED for patients with ventricular fibrillation or pulseless ventricular tachycardia who are not responding to standard treatment.

Training and implementation

Although the evidence is still emerging, implementation of DSED by emergency services in New Zealand has implications beyond the care of patients nationally. It is also a key step in advancing knowledge about optimal resuscitation strategies globally.

There are always concerns when translating an intervention from a controlled research environment to the relative disorder of the real world. But the balance of evidence was carefully considered before making the decision to change procedures for a group of patients who have a low likelihood of survival with current treatment.

Before using DSED, emergency medical personnel undergo mandatory education, simulation and training. Implementation is closely monitored to determine its impact.

Hospitals and emergency departments have been informed of the protocol changes and been given opportunities to ask questions and give feedback. As part of the implementation, the St John ambulance service will perform case reviews in addition to wider monitoring to ensure patient safety is prioritised.

Ultimately, those involved are optimistic this change to cardiac arrest management in New Zealand will have a positive impact on survival for affected patients.The Conversation

Vinuli Withanarachchie, PhD candidate, College of Health, Massey University; Bridget Dicker, Associate Professor of Paramedicine, Auckland University of Technology, and Sarah Maessen, Research Associate, Auckland University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Body Language (In The Real World)

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    Forget What You Think You Know About Body Language

    …unless it’s about a specific person whose habits and mannerisms you know intimately, in which case, you probably have enough personal data stored up to actually recognize patterns à la “when my spouse does this, then…”, and probably do know what’s going on.

    For everyone else… our body language can be as unique as our idiolect

    What’s an idiolect? It’s any one given person’s way of speaking/writing, in their natural state (i.e. without having to adjust their style for some reason, for example in a public-facing role at work, where style often becomes much narrower and more consciously-chosen).

    Extreme example first

    To give an extreme example of how non-verbal communication can be very different than a person thinks, there’s an anecdote floating around the web of someone whose non-verbal autistic kid would, when he liked someone who was visiting the house, hide their shoes when they were about to leave, to cause them to stay longer. Then one day some relative visited and when she suggested that she “should be going sometime soon”, he hurried to bring her her shoes. She left, happy that the kid liked her (he did not).

    The above misunderstanding happened because the visitor had the previous life experience of “a person who brings me things is being helpful, and if they do it of their own free will, it’s because they like me”.

    In other words…

    Generalizations are often sound… In general

    …which does not help us when dealing with individuals, which as it turns out, everyone is.

    Clenched fists = tense and angry… Except when it’s just what’s comfortable for someone, or they have circulation issues, or this, or that, or the other.

    Pacing = agitated… Except when it’s just someone who finds the body in motion more comfortable

    Relaxed arms and hands = at ease and unthreatening… Unless it’s a practitioner of various martial arts for whom that is their default ready-for-action state.

    Folded arms = closed-off, cold, distant… Or it was just somewhere to put one’s hands.

    Lack of eye contact = deceitful, hiding something… Unless it’s actually for any one of a wide number of reasons, which brings us to our next section:

    A liar’s “tells”

    Again, if you know someone intimately and know what signs are associated with deceit in them, then great, that’s a thing you know. But for people in general…

    A lot of what is repeated about “how to know if someone is lying” has seeped into public consciousness from “what police use to justify their belief that someone is lying”.

    This is why many of the traditional “this person is lying” signs are based around behaviors that show up when in fact “this person is afraid, under pressure, and talking to an authority figure who has the power to ruin their life”:

    Research on Non-verbal Signs of Lies and Deceit: A Blind Alley

    But what about eye-accessing cues? They have science to them, right?

    For any unfamiliar: this is about the theory that when we are accessing different parts of our mind (such as memory or creativity, thus truthfulness or lying), our eyes move one way or another according to what faculty we’re accessing.

    Does it work? No

    But, if you carefully calibrate it for a specific person, such as by asking them questions along the lines of “describe your front door” or “describe your ideal holiday”, to see which ways they look for recall or creativity… Then also no:

    The Eyes Don’t Have It: Lie Detection and Neuro-Linguistic Programming

    How can we know what non-verbal communication means, then?

    With strangers? We can’t, simply. It’s on us to be open-minded, with a healthy balance of optimism and wariness.

    With people we know? We can build up a picture over time, learn the person’s patterns. Best of all, we can ask them. In the moment, and in general.

    For more on optimizing interpersonal communication, check out:

    Save Time With Better Communication

    …and the flipside of that:

    The Problem With Active Listening (And How To Do It Better)

    Take care!

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  • California Becomes Latest State To Try Capping Health Care Spending

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    California’s Office of Health Care Affordability faces a herculean task in its plan to slow runaway health care spending.

    The goal of the agency, established in 2022, is to make care more affordable and accessible while improving health outcomes, especially for the most disadvantaged state residents. That will require a sustained wrestling match with a sprawling, often dysfunctional health system and powerful industry players who have lots of experience fighting one another and the state.

    Can the new agency get insurers, hospitals, and medical groups to collaborate on containing costs even as they jockey for position in the state’s $405 billion health care economy? Can the system be transformed so that financial rewards are tied more to providing quality care than to charging, often exorbitantly, for a seemingly limitless number of services and procedures?

    The jury is out, and it could be for many years.

    California is the ninth state — after Connecticut, Delaware, Massachusetts, Nevada, New Jersey, Oregon, Rhode Island, and Washington — to set annual health spending targets.

    Massachusetts, which started annual spending targets in 2013, was the first state to do so. It’s the only one old enough to have a substantial pre-pandemic track record, and its results are mixed: The annual health spending increases were below the target in three of the first five years and dropped beneath the national average. But more recently, health spending has greatly increased.

    In 2022, growth in health care expenditures exceeded Massachusetts’ target by a wide margin. The Health Policy Commission, the state agency established to oversee the spending control efforts, warned that “there are many alarming trends which, if unaddressed, will result in a health care system that is unaffordable.”

    Neighboring Rhode Island, despite a preexisting policy of limiting hospital price increases, exceeded its overall health care spending growth target in 2019, the year it took effect. In 2020 and 2021, spending was largely skewed by the pandemic. In 2022, the spending increase came in at half the state’s target rate. Connecticut and Delaware, by contrast, both overshot their 2022 targets.

    It’s all a work in progress, and California’s agency will, to some extent, be playing it by ear in the face of state policies and demographic realities that require more spending on health care.

    And it will inevitably face pushback from the industry as it confronts unreasonably high prices, unnecessary medical treatments, overuse of high-cost care, administrative waste, and the inflationary concentration of a growing number of hospitals in a small number of hands.

    “If you’re telling an industry we need to slow down spending growth, you’re telling them we need to slow down your revenue growth,” says Michael Bailit, president of Bailit Health, a Massachusetts-based consulting group, who has consulted for various states, including California. “And maybe that’s going to be heard as ‘we have to restrain your margins.’ These are very difficult conversations.”

    Some of California’s most significant health care sectors have voiced disagreement with the fledgling affordability agency, even as they avoid overtly opposing its goals.

    In April, when the affordability office was considering an annual per capita spending growth target of 3%, the California Hospital Association sent it a letter saying hospitals “stand ready to work with” the agency. But the proposed number was far too low, the association argued, because it failed to account for California’s aging population, new investments in Medi-Cal, and other cost pressures.

    The hospital group suggested a spending increase target averaging 5.3% over five years, 2025-29. That’s slightly higher than the 5.2% average annual increase in per capita health spending over the five years from 2015 to 2020.

    Five days after the hospital association sent its letter, the affordability board approved a slightly less aggressive target that starts at 3.5% in 2025 and drops to 3% by 2029. Carmela Coyle, the association’s chief executive, said in a statement that the board’s decision still failed to account for an aging population, the growing need for mental health and addiction treatment, and a labor shortage.

    The California Medical Association, which represents the state’s doctors, expressed similar concerns. The new phased-in target, it said, was “less unreasonable” than the original plan, but the group would “continue to advocate against an artificially low spending target that will have real-life negative impacts on patient access and quality of care.”

    But let’s give the state some credit here. The mission on which it is embarking is very ambitious, and it’s hard to argue with the motivation behind it: to interject some financial reason and provide relief for millions of Californians who forgo needed medical care or nix other important household expenses to afford it.

    Sushmita Morris, a 38-year-old Pasadena resident, was shocked by a bill she received for an outpatient procedure last July at the University of Southern California’s Keck Hospital, following a miscarriage. The procedure lasted all of 30 minutes, Morris says, and when she received a bill from the doctor for slightly over $700, she paid it. But then a bill from the hospital arrived, totaling nearly $9,000, and her share was over $4,600.

    Morris called the Keck billing office multiple times asking for an itemization of the charges but got nowhere. “I got a robotic answer, ‘You have a high-deductible plan,’” she says. “But I should still receive a bill within reason for what was done.” She has refused to pay that bill and expects to hear soon from a collection agency.

    The road to more affordable health care will be long and chock-full of big challenges and unforeseen events that could alter the landscape and require considerable flexibility.

    Some flexibility is built in. For one thing, the state cap on spending increases may not apply to health care institutions, industry segments, or geographic regions that can show their circumstances justify higher spending — for example, older, sicker patients or sharp increases in the cost of labor.

    For those that exceed the limit without such justification, the first step will be a performance improvement plan. If that doesn’t work, at some point — yet to be determined — the affordability office can levy financial penalties up to the full amount by which an organization exceeds the target. But that is unlikely to happen until at least 2030, given the time lag of data collection, followed by conversations with those who exceed the target, and potential improvement plans.

    In California, officials, consumer advocates, and health care experts say engagement among all the players, informed by robust and institution-specific data on cost trends, will yield greater transparency and, ultimately, accountability.

    Richard Kronick, a public health professor at the University of California-San Diego and a member of the affordability board, notes there is scant public data about cost trends at specific health care institutions. However, “we will know that in the future,” he says, “and I think that knowing it and having that information in the public will put some pressure on those organizations.”

    This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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  • Why Some People Get Sick More (And How To Not Be One Of Them)

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    Some people have never yet had COVID (so far so good, this writer included); others are on their third bout already; others have not been so lucky and are no longer with us to share their stories.

    Obviously, even the healthiest and/or most careful person can get sick, and it would be folly to be complacent and think “I’m not a person who gets sick; that happens to other people”.

    Nor is COVID the only thing out there to worry about; there’s always the latest outbreak-du-jour of something, and there are always the perennials such as cold and flu—which are also not to be underestimated, because both weaken us to other things, and flu has killed very many, from the 50,000,000+ in the 1918 pandemic, to the 700,000ish that it kills each year nowadays.

    And then there are the combination viruses:

    Move over, COVID and Flu! We Have “Hybrid Viruses” To Contend With Now

    So, why are some people more susceptible?

    Firstly, some people are simply immunocompromised. This means for example that:

    • perhaps they have an inflammatory/autoimmune disease of some kind (e.g. lupus, rheumatoid arthritis, type 1 diabetes), or…
    • perhaps they are taking immunosuppressants for some reason (e.g. because they had an organ transplant), or…
    • perhaps they have a primary infection that leaves them vulnerable to secondary infections. Most infections will do this to some degree or another, but some are worse for it than others; untreated HIV is a clear example. The HIV itself may not kill people, but (if untreated) the resultant AIDS will leave a person open to being killed by almost any passing opportunistic pathogen. Pneumonia of various kinds being high on the list, but it could even be something as simple as the common cold, without a working immune system to fight it.

    See also: How To Prevent (Or Reduce) Inflammation

    And for that matter, since pneumonia is a very common last-nail-in-the-coffin secondary infection (especially: older people going into hospital with one thing, getting a secondary infection and ultimately dying as a result), it’s particularly important to avoid that, so…

    See also: Pneumonia: What We Can & Can’t Do About It

    Secondly, some people are not immunocompromised per the usual definition of the word, but their immune system is, arguably, compromised.

    Cortisol, the stress hormone, is an immunosuppressant. We need cortisol to live, but we only need it in small bursts here and there (such as when we are waking up the morning). When high cortisol levels become chronic, so too does cortisol’s immunosuppressant effect.

    Top things that cause elevated cortisol levels include:

    • Stress
    • Alcohol
    • Smoking

    Thus, the keys here are to 1) not smoke 2) not drink, ideally, or at least keep consumption low, but honestly even one drink will elevate cortisol levels, so it’s better not to, and 3) manage stress.

    See also: Lower Your Cortisol! (Here’s Why & How)

    Other modifiable factors

    Being aware of infection risk and taking steps to reduce it (e.g. avoiding being with many people in confined indoor places, masking as appropriate, handwashing frequently) is a good preventative strategy, along with of course getting any recommended vaccines as they come available.

    What if they fail? How can we boost the immune system?

    We talked about not sabotaging the immune system, but what about actively boosting it? The answer is yes, we certainly can (barring serious medical reasons why not), as there are some very important lifestyle factors too:

    Beyond Supplements: The Real Immune-Boosters!

    One final last-line thing…

    Since if we do get an infection, it’s better to know sooner rather than later… A recent study shows that wearable activity trackers can (if we pay attention to the right things) help predict disease, including highlighting COVID status (positive or negative) about as accurately (88% accuracy) as rapid screening tests. Here’s a pop-science article about it:

    Wearable activity trackers show promise in detecting early signals of disease

    Take care!

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  • Insomnia Decoded – by Dr. Audrey Porter

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We’ve written about sleep books before, so what makes this one different? Its major selling point is: most of the focus isn’t on the things that everyone already knows.

    Yes, there’s a section on sleep hygiene and yes it’ll tell you to cut the caffeine and alcohol, but most of the advice here is beyond that.

    Rather, it looks at finding out (if you don’t already know for sure) what is keeping you from healthy sleep, be it environmental, directly physical, or psychological, and breaking out of the stress-sleep cycle that often emerges from such.

    The style is light and conversational, but includes plenty of science too; Dr. Porter knows her stuff.

    Bottom line: if you feel like you know what you should be doing, but somehow life keeps conspiring to stop you from doing it, then this is the book that could help you break out that cycle.

    Click here to check out Insomnia Decoded, and get regular healthy sleep!

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  • Physical Sunscreen or Chemical Sunscreen – Which is Healthier?

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    Our Verdict

    When comparing physical sunscreens to chemical sunscreens, we picked the physical sunscreens.

    Why?

    It’s easy to vote against chemical sunscreens, because it has “chemical” in the name, which tends to be offputting PR-wise no matter how healthy something is.

    But in this case, there’s actual science here too!

    Physical sunscreens physically block the UV rays.

    • On the simplest of levels, mud is a physical sunscreen, as you can see widely used by elephants, hippos, pigs, and other animals.
    • On a more sophisticated level, modern physical sunscreens often use tiny zinc particles (or similar) to block the UV rays in a way that isn’t so obvious to the naked eye—so we can still see our skin, and it looks just like we applied an oil or other moisturizer.

    Chemical sunscreens interact with the UV rays in a way that absorbs them.

    • Specifically, they usually convert it into relatively harmless thermal energy (heat)
    • However, this can cause problems if there’s too much heat!
    • Additionally, chemical sunscreens can get “used up” in a way that physical sunscreens can’t* becoming effectively deactivated once the chemical reaction has run its course and there is no more reagent left unreacted.
    • Worse, some of the reagents, when broken down by the UV rays, can potentially cause harm when absorbed by the skin.

    *That said, physical sunscreens will still need “topping up” because we are a living organism and our body can’t resist redistributing and using stuff—plus, depending on the climate and our activities, we can lose some externally too.

    Further reading

    We wrote about sunscreens (of various kinds) here:

    Who Screens The Sunscreens?

    And you can also read specifically about today’s topic in more detail, here:

    What’s The Difference Between Physical And Chemical Sunscreens?

    Take care!

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  • Accidental falls in the older adult population: What academic research shows

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    Accidental falls are among the leading causes of injury and death among adults 65 years and older worldwide. As the aging population grows, researchers expect to see an increase in the number of fall injuries and related health spending.

    Falls aren’t unique to older adults. Nealy 684,000 people die from falls each year globally. Another 37.3 million people each year require medical attention after a fall, according to the World Health Organization. But adults 65 and older account for the greatest number of falls.

    In the United States, more than 1 in 4 older adults fall each year, according to the National Institute on Aging. One in 10 report a fall injury. And the risk of falling increases with age.

    In 2022, health care spending for nonfatal falls among older adults was $80 billion, according to a 2024 study published in the journal Injury Prevention.

    Meanwhile, the fall death rate in this population increased by 41% between 2012 and 2021, according to the latest CDC data.

    “Unfortunately, fall-related deaths are increasing and we’re not sure why that is,” says Dr. Jennifer L. Vincenzo, an associate professor at the University of Arkansas for Medical Sciences in the department of physical therapy and the Center for Implementation Research. “So, we’re trying to work more on prevention.”

    Vincenzo advises journalists to write about how accidental falls can be prevented. Remind your audiences that accidental falls are not an inevitable consequence of aging, and that while we do decline in many areas with age, there are things we can do to minimize the risk of falls, she says. And expand your coverage beyond the national Falls Prevention Awareness Week, which is always during the first week of fall — Sept. 23 to 27 this year.

    Below, we explore falls among older people from different angles, including injury costs, prevention strategies and various disparities. We have paired each angle with data and research studies to inform your reporting.

    Falls in older adults

    In 2020, 14 million older adults in the U.S. reported falling during the previous year. In 2021, more than 38,700 older adults died due to unintentional falls, according to the CDC.

    A fall could be immediately fatal for an older adult, but many times it’s the complications from a fall that lead to death.

    The majority of hip fractures in older adults are caused by falls, Vincenzo says, and “it could be that people aren’t able to recover [from the injury], losing function, maybe getting pneumonia because they’re not moving around, or getting pressure injuries,” she says.

    In addition, “sometimes people restrict their movement and activities after a fall, which they think is protective, but leads to further functional declines and increases in fall risk,” she adds.

    Factors that can cause a fall include:

    • Poor eyesight, reflexes and hearing. “If you cannot hear as well, anytime you’re doing something in your environment and there’s a noise, it will be really hard for you to focus on hearing what that noise is and what it means and also moving at the same time,” Vincenzo says.
    • Loss of strength, balance, and mobility with age, which can lessen one’s ability to prevent a fall when slipping or tripping.
    • Fear of falling, which usually indicates decreased balance.
    • Conditions such as diabetes, heart disease, or problems with nerves or feet that can affect balance.
    • Conditions like incontinence that cause rushed movement to the bathroom.
    • Cognitive impairment or certain types of dementia.
    • Unsafe footwear such as backless shoes or high heels.
    • Medications or medication interactions that can cause dizziness or confusion.
    • Safety hazards in the home or outdoors, such as poor lighting, steps and slippery surfaces.

    Related Research

    Nonfatal and Fatal Falls Among Adults Aged ≥65 Years — United States, 2020–2021
    Ramakrishna Kakara, Gwen Bergen, Elizabeth Burns and Mark Stevens. Morbidity and Mortality Weekly Report, September 2023.

    Summary: Researchers analyzed data from the 2020 Behavioral Risk Factor Surveillance System — a landline and mobile phone survey conducted each year in all 50 U.S. states and the District of Columbia — and data from the 2021 National Vital Statistics System to identify patterns of injury and death due to falls in the U.S. by sex and state for adults 65 years and older. Among the findings:

    • The percentage of women who reported falling was 28.9%, compared with 26.1% of men.
    • Death rates from falls were higher among white and American Indian or Alaska Native older adults than among older adults from other racial and ethnic groups.
    • In 2020, the percentage of older adults who reported falling during the past year ranged from 19.9% in Illinois to 38.0% in Alaska. The national estimate for 18 states was 27.6%.
    • In 2021, the unintentional fall-related death rate among older adults ranged from 30.7 per 100,000 older adults in Alabama to 176.5 in Wisconsin. The national estimate for 26 states was 78.

    “Although common, falls among older adults are preventable,” the authors write. “Health care providers can talk with patients about their fall risk and how falls can be prevented.”

    Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years — United States, 2012-2018
    Briana Moreland, Ramakrishna Kakara and Ankita Henry. Morbidity and Mortality Weekly Report, July 2020.

    Summary: Researchers compared data from the 2018 Behavioral Risk Factor Surveillance System. Among the findings:

    • The percentage of older adults reporting a fall increased from 2012 to 2016, then slightly decreased from 2016 to 2018.
    • Even with this decrease in 2018, older adults reported 35.6 million falls. Among those falls, 8.4 million resulted in an injury that limited regular activities for at least one day or resulted in a medical visit.

    “Despite no significant changes in the rate of fall-related injuries from 2012 to 2018, the number of fall-related injuries and health care costs can be expected to increase as the proportion of older adults in the United States grows,” the authors write.

    Understanding Modifiable and Unmodifiable Older Adult Fall Risk Factors to Create Effective Prevention Strategies
    Gwen Bergen, et al. American Journal of Lifestyle Medicine, October 2019.

    Summary: Researchers used data from the 2016 U.S. Behavioral Risk Factor Surveillance System to better understand the association between falls and fall injuries in older adults and factors such as health, state and demographic characteristics. Among the findings:

    • Depression had the strongest association with falls and fall injuries. About 40% of older adults who reported depression also reported at least one fall; 15% reported at least one fall injury.
    • Falls and depression have several factors in common, including cognitive impairment, slow walking speed, poor balance, slow reaction time, weakness, low energy and low levels of activity.
    • Other factors associated with an increased risk of falling include diabetes, vision problems and arthritis.

    “The multiple characteristics associated with falls suggest that a comprehensive approach to reducing fall risk, which includes screening and assessing older adult patients to determine their unique, modifiable risk factors and then prescribing tailored care plans that include evidence-based interventions, is needed,” the authors write.

    Health care use and cost

    In addition to being the leading cause of injury, falls are the leading cause of hospitalization in older adults. Each year, about 3 million older adults visit the emergency department due to falls. More than 1 million get hospitalized.

    In 2021, falls led to more than 38,000 deaths in adults 65 and older, according to the CDC.

    The annual financial medical toll of falls among adults 65 years and older is expected to be more than $101 billion by 2030, according to the National Council on Aging, an organization advocating for older Americans.

    Related research

    Healthcare Spending for Non-Fatal Falls Among Older Adults, USA
    Yara K. Haddad, et al. Injury Prevention, July 2024.

    Summary: In 2015, health care spending related to falls among older adults was roughly $50 billion. This study aims to update the estimate, using the 2017, 2019 and 2021 Medicare Current Beneficiary Survey, the most comprehensive and complete survey available on the Medicare population. Among the findings:

    • In 2020, health care spending for non-fatal falls among older adults was $80 billion.
    • Medicare paid $53.3 billion of the $80 billion, followed by $23.2 billion paid by private insurance or patients and $3.5 billion by Medicaid.

    “The burden of falls on healthcare systems and healthcare spending will continue to rise if the risk of falls among the aging population is not properly addressed,” the authors write. “Many older adult falls can be prevented by addressing modifiable fall risk factors, including health and functional characteristics.”

    Cost of Emergency Department and Inpatient Visits for Fall Injuries in Older Adults Lisa Reider, et al. Injury, February 2024.

    Summary: The researchers analyzed data from the 2016-2018 National Inpatient Sample and National Emergency Department Sample, which are large, publicly available patient databases in the U.S. that include all insurance payers such as Medicare and private insurance. Among the findings:

    • During 2016-2018, more than 920,000 older adults were admitted to the hospital and 2.3 million visited the emergency department due to falls. The combined annual cost was $19.2 billion.
    • More than half of hospital admissions were due to bone fractures. About 14% of these admissions were due to multiple fractures and cost $2.5 billion.

    “The $20 billion in annual acute treatment costs attributed to fall injury indicate an urgent need to implement evidence-based fall prevention interventions and underscores the importance of newly launched [emergency department]-based fall prevention efforts and investments in geriatric emergency departments,” the authors write.

    Hip Fracture-Related Emergency Department Visits, Hospitalizations and Deaths by Mechanism of Injury Among Adults Aged 65 and Older, United States 2019
    Briana L. Moreland, Jaswinder K. Legha, Karen E. Thomas and Elizabeth R. Burns. Journal of Aging and Health, June 2024.

    Summary: The researchers calculated hip fracture-related U.S. emergency department visits, hospitalizations and deaths among older adults, using data from the Healthcare Cost and Utilization Project and the National Vital Statistics System. Among the findings:

    • In 2019, there were 318,797 emergency department visits, 290,130 hospitalizations and 7,731 deaths related to hip fractures among older adults.
    • Nearly 88% of emergency department visits and hospitalizations and 83% of deaths related to hip fractures were caused by falls.
    • These rates were highest among those living in rural areas and among adults 85 and older. More specifically, among adults 85 and older, the rate of hip fracture-related emergency department visits was nine times higher than among adults between 65 and 74 years old.

    “Falls are common among older adults, but many are preventable,” the authors write. “Primary care providers can prevent falls among their older patients by screening for fall risk annually or after a fall, assessing modifiable risk factors such as strength and balance issues, and offering evidence-based interventions to reduce older adults’ risk of falls.”

    Fall prevention

    Several factors, including exercising, managing medication, checking vision and making homes safer can help prevent falls among older adults.

    “Exercise is one of the best interventions we know of to prevent falls,” Vincenzo says. But “walking in and of itself will not help people to prevent falls and may even increase their risk of falling if they are at high risk of falls.”

    The National Council on Aging also has a list of evidence-based fall prevention programs, including activities and exercises that are shown to be effective.

    The National Institute on Aging has a room-by-room guide on preventing falls at home. Some examples include installing grab bars near toilets and on the inside and outside of the tub and shower, sitting down while preparing food to prevent fatigue, and keeping electrical cords near walls and away from walking paths.

    There are also national and international initiatives to help prevent falls.

    Stopping Elderly Accidents, Deaths and Injuries, or STEADI, is an initiative by the CDC’s Injury Center to help health care providers who treat older adults. It helps providers screen patients for fall risk, assess their fall risk factors and reduce their risk by using strategies that research has shown to be effective. STEADI’s guidelines are in line with the American and British Geriatric Societies’ Clinical Practice Guidelines for fall prevention.

    “We’re making some iterations right now to STEADI that will come out in the next couple of years based on the World Falls Guidelines, as well as based on clinical providers’ feedback on how to make [STEADI] more feasible,” Vincenzo says.

    The World Falls Guidelines is an international initiative to prevent falls in older adults. The guidelines are the result of the work of 14 international experts who came together in 2019 to consider whether new guidelines on fall prevention were needed. The task force then brought together 96 experts from 39 countries across five continents to create the guidelines.

    The CDC’s STEADI initiative has a screening questionnaire for consumers to check their risk of falls, as does the National Council on Aging.

    On the policy side, U.S. Rep. Carol Miller, R-W.V., and Melanie Stansbury, D-N.M., introduced the Stopping Addiction and Falls for the Elderly (SAFE) Act in March 2024. The bill would allow occupational and physical therapists to assess fall risks in older adults as part of the Medicare Annual Wellness Benefit. The bill was sent to the House Subcommittee on Health in the same month.

    Meanwhile, older adults’ attitudes toward falls and fall prevention are also pivotal. For many, coming to terms with being at risk of falls and making changes such as using a cane, installing railings at home or changing medications isn’t easy for all older adults, studies show.

    “Fall is a four-letter F-word in a way to older adults,” says Vincenzo, who started her career as a physical therapist. “It makes them feel ‘old.’ So, it’s a challenge on multiple fronts: U.S. health care infrastructure, clinical and community resources and facilitating health behavior change.”

    Related research

    Environmental Interventions for Preventing Falls in Older People Living in the Community
    Lindy Clemson, et al. Cochrane Database of Systematic Reviews, March 2023.

    Summary: This review includes 22 studies from 10 countries involving a total of 8,463 older adults who live in the community, which includes their own home, a retirement facility or an assisted living facility, but not a hospital or nursing home. Among the findings:

    • Removing fall hazards at home reduced the number of falls by 38% among older adults at a high risk of having a fall, including those who have had a fall in the past year, have been hospitalized or need support with daily activities. Examples of fall hazards at home include a stairway without railings, a slippery pathway or poor lighting.
    • It’s unclear whether checking prescriptions for eyeglasses, wearing special footwear or installing bed alarm systems reduces the rate of falls.
    • It’s also not clear whether educating older adults about fall risks reduces their fall risk.

    The Influence of Older Adults’ Beliefs and Attitudes on Adopting Fall Prevention Behaviors
    Judy A. Stevens, David A. Sleet and Laurence Z. Rubenstein. American Journal of Lifestyle Medicine. January 2017.

    Summary: Persuading older adults to adopt interventions that reduce their fall risk is challenging. Their attitudes and beliefs about falls play a large role in how well they accept and adopt fall prevention strategies, the authors write. Among the common attitudes and beliefs:

    • Many older adults believe that falls “just happen,” are a normal result of aging or are simply due to bad luck.
    • Many don’t acknowledge or recognize their fall risk.
    • For many, falls are considered to be relevant only for frail or very old people.
    • Many believe that their home environment or daily activities can be a risk for fall, but do not consider biological factors such as dizziness or muscle weakness.
    • For many, fall prevention simply consists of “being careful” or holding on to things when moving about the house.

    “To reduce falls, health care practitioners have to help patients understand and acknowledge their fall risk while emphasizing the positive benefits of fall prevention,” the authors write. “They should offer patients individualized fall prevention interventions as well as provide ongoing support to help patients adopt and maintain fall prevention strategies and behaviors to reduce their fall risk. Implementing prevention programs such as CDC’s STEADI can help providers discuss the importance of falls and fall prevention with their older patients.”

    Reframing Fall Prevention and Risk Management as a Chronic Condition Through the Lens of the Expanded Chronic Care Model: Will Integrating Clinical Care and Public Health Improve Outcomes?
    Jennifer L. Vincenzo, Gwen Bergen, Colleen M. Casey and Elizabeth Eckstrom. The Gerontologist, June 2024.

    Summary: The authors recommend approaching fall prevention from the lens of chronic disease management programs because falls and fall risk are chronic issues for many older adults.

    “Policymakers, health systems, and community partners can consider aligning fall risk management with the [Expanded Chronic Care Model], as has been done for diabetes,” the authors write. “This can help translate high-quality research on the effectiveness of fall prevention interventions into daily practice for older adults to alter the trajectory of older adult falls and fall-related injuries.”

    Disparities

    Older adults face several barriers to reducing their fall risk. Accessing health care services and paying for services such as physical therapy is not feasible for everyone. Some may lack transportation resources to go to and from medical appointments. Social isolation can increase the risk of death from falls. In addition, physicians may not have the time to fit in a fall risk screening while treating older patients for other health concerns.

    Moreover, implementing fall risk screening, assessment and intervention in the current U.S. health care structure remains a challenge, Vincenzo says.

    Related research

    Mortality Due to Falls by County, Age Group, Race, and Ethnicity in the USA, 2000-19: A Systematic Analysis of Health Disparities
    Parkes Kendrick, et al. The Lancet Public Health, August 2024.

    Summary: Researchers analyzed death registration data from the U.S. National Vital Statistics System and population data from the U.S. National Center for Health Statistics to estimate annual fall-related mortality. The data spanned from 2000 to 2019 and includes all age groups. Among the findings:

    • The disparities between racial and ethnic populations varied widely by age group. Deaths from falls among younger adults were highest for the American Indian/Alaska Native population, while among older adults it was highest for the white population.
    • For older adults, deaths from falls were particularly high in the white population within clusters of counties across states including Florida, Minnesota and Wisconsin.
    • One factor that could contribute to higher death rates among white older adults is social isolation, the authors write. “Studies suggest that older Black and Latino adults are more likely to have close social support compared with older white adults, while AIAN and Asian individuals might be more likely to live in multigenerational households,” they write.

    “Among older adults, current prevention techniques might need to be restructured to reduce frailty by implementing early prevention and emphasizing particularly successful interventions. Improving social isolation and evaluating the effectiveness of prevention programs among minoritized populations are also key,” the authors write.

    Demographic Comparisons of Self-Reported Fall Risk Factors Among Older Adults Attending Outpatient Rehabilitation
    Mariana Wingood, et al. Clinical Interventions in Aging, February 2024.

    Summary: Researchers analyzed the electronic health record data of 108,751 older adults attending outpatient rehabilitation within a large U.S. health care system across seven states, between 2018 and 2022. Among the findings:

    • More than 44% of the older adults were at risk of falls; nearly 35% had a history of falls.
    • The most common risk factors for falls were diminished strength, gait and balance.
    • Compared to white older adults, Native American/Alaska Natives had the highest prevalence of fall history (43.8%) and Hispanics had the highest prevalence of falls with injury (56.1%).

    “Findings indicate that rehabilitation providers should perform screenings for these impairments, including incontinence and medication among females, loss of feeling in the feet among males, and all Stay Independent Questionnaire-related fall risk factors among Native American/Alaska Natives, Hispanics, and Blacks,” the authors write.

    Resources and articles

    This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.

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