That’s a big question. Did I give my grandma a black eye? As an intensive care nurse in the hospital, I have seen many elderly people with black eyes, abrasions, cuts, and broken bones. My first thought was always a shock, and then my suspicion led to making sure that it was not an intentional injury from someone in their life. But, most of the time, it ends up being a very explainable accident like a fall. Maybe over a rug or a small pet or just because they got a little off-balance and they weren’t quite quick enough to catch themselves. They are embarrassed that they have gotten an injury and they are scared that someone may try to take their independence away. Sometimes that happens, the family member that is worried tries to get more help through a nursing home or something similar. The person’s ethical need for autonomy is taken away and often makes their health decline. In worse-case scenarios, the patient never recovers because their injury is the “beginning of the end” for them. It is heartbreaking and so easily preventable.
Arizona is a popular place for retirement. Yavapai county is desired because it does not have the heat that southern Arizona is known for. In Yavapai County, nearly 33% of the population is greater than 65 years old (United States Census Bureau, n.d.). Increasing age is often associated with increased health problems. Unfortunately, many rural communities, like Yavapai County, do not have the number of healthcare professionals or services that they need to serve their population. The elderly population in Yavapai County is a vulnerable population due to the decreased number of primary care providers in the area. Yavapai Regional Medical Center (2019) identified that 75% of the residents in the county are in a health professional shortage area, well above the 50% noted in Arizona as a whole. Access to care is considered a determinate of health (Meacham, 2021). Many factors can lead to poor health besides access to care and these can include social or economical factors, behavioral choices, and even the environment in which you live. If someone is vulnerable due to a determinate of health, we should be able to improve their health by improving or eliminating the obstacle that prevents health.
This brings me to this post. In my experience, most elderly patients fall near their homes or their “environment”. They may not even realize that their environment is risky. It may be that the person likes to have their plants on top of their kitchen cabinet and has to climb on the counter to water them. Or those worn-out slippers that don’t fit anymore so they slide them along the floor. These environmental issues can increase a person’s risk of a fall. In addition to the environmental determinate of heath, the person in Yavapai county has that problem with access to care. This could have prevented the person from having a healthcare professional notice that their balance was a little off or their vision was worse and there needed to get their cataracts removed. The combination of these factors makes a perfect storm for a fall. Sometimes an injury leads to hospitalization, and in the worst of cases, death. Yavapai County has many injuries from falls in the elderly, and it is preventable. Factors like nutritional deficiencies, weakness and balance issues, environmental risks, and vision increase fall risk, and primary care providers have an opportunity to do fall assessments with their yearly exams to prevent falls (Dellinger, 2017).
Fall statistics Yavapai County
· Approximately 34,000 people >65 years old died from a fall in 2019 and 42,000 deaths in 2020 which is a death rate of 12.8 per 100,000 people (Centers for Disease Control and Prevention, n.d.; Moreland & Lee, 2021).
· In 2019 in Arizona, there were 992 fall-related injuries in people > 65 years old with more than half being in people older than 85 years old and female. (Arizona Department of Health Services, 2022a).
· There were 66 fall deaths in Yavapai county in 2019, which is nearly double the falls from 2009 (Arizona Department of Health Services, 2022a).
· Age-adjusted mortality rates for accidental falls for Yavapai County was 13.0 per 100,000 people which was higher than the state average of 12.2 per 100,000 (Arizona Department of Health Services, 2019).
· Yavapai County is below the HealthyPeople2020 Arizona target for reducing deaths from falls objective but is still the 5th highest in the state for deaths from falls (Arizona Department of Health Services, 2022b).
Health policy can improve determinates of health and then health status, which leads to improved health policy (Meacham, 2021). We can prevent deaths from unintentional injury from falls in our elderly. Let us create some policies to make our elderly safer so that they can continue to be independent for as long as possible.
References
Arizona Department of Health Services. (2019). Arizona health status and vital statistics
2019 annual report. https://pub.azdhs.gov/health- stats/report/ahs/ahs2019/index.php?pg=counties
Arizona Department of Health Services. (2022a). Injury mortality reports. https://pub.azdhs.gov/health-stats/report/im/index.php?pg=falls
Arizona Department of Health Services. (2022b). Status on Healthy People 2020 objectives. https://pub.azdhs.gov/health-stats/menu/info/status.php
Centers for Disease Control and Prevention. (n.d.). Faststats - Accidents or unintentional jnjuries. Retrieved January 20, 2022, from https://www.cdc.gov/nchs/fastats/accidental-injury.htm
Dellinger, A. (2017). Older adult falls: Effective approaches to prevention. Current Trauma Reports, 3(2), 118–123. https://doi.org/10.1007/s40719-017-0087-x
Meacham, M. (2021). Longest’s health policymaking in the United States (7th ed.). Foundation of the American College of Healthcare Executives.
Moreland, B., & Lee, R. (2021). Emergency department visits and hospitalizations for selected nonfatal injuries among adults aged ≥65 Years — United States, 2018. MMWR Recommendations and Reports, 70(18), 661–665. https://doi.org/10.15585/mmwr.mm7018a1
United States Census Bureau. (n.d.). U.S. Census Bureau quickfacts: Yavapai County, Arizona. Retrieved January 20, 2022, from https://www.census.gov/quickfacts/fact/table/yavapaicountyarizona
Yavapai County Silent Witness. (2022). Yavapai county towns [Image]. http://yavapaisw.com/
Yavapai Regional Medical Center. (2019). Community health needs assessment 2019. https://www.yrmc.org/docs/default-source/default-document-library/2019-community-health-needs-assessment---board-approved-12-9-2019.pdf?sfvrsn=0
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