Mortality rates for Mainers 65 and older who have fallen rose sharply in the past decade. Though the exact reason why is difficult to nail down, some health care providers think it could be a result of more Mainers over 65 and fewer residential living facilities and nursing homes.
Though the national fall mortality rate has risen steadily over the past few years, Maine has seen an especially stark increase, according to data from the federal Centers for Disease Control and Prevention.
In Maine, the number of deaths per 100,000 Mainers 65 and older went from 47.7 in 2012 to 126.5 deaths in 2023, according to provisional data, an increase of 165%.
The rate hit as high as 140 deaths in 2018, and remains historically high.
THE THEORIES
Why rates have increased is not entirely clear, according to Sean Sibley, clinical assistant faculty for the University of Maine School of Nursing in Orono.
He expects the answer has to do with fewer residential living facilities and nursing homes, a higher number of Mainers over the age of 65, and possible barriers to accessing devices and modifications to help older people with mobility in their homes.
That includes such things as handrails and replacing carpets with flatter flooring.
“Older adults want to age in place, they should be able to age in place, but Maine’s housing infrastructure is a hot topic,” he said. “Older adults may be living in homes that they’ve lived in for a long time that are not retrofitted for their new mobility needs.”
Falls are particularly concerning for older Mainers who live in rural areas where nobody else lives close to them, he said. They also may experience more barriers to accessing health care providers and having people checking in on them more infrequently.
CAUSE OF FALLS
The cause of falls among older Mainers is largely due to aging itself, Sibley said. As people age, the threshold for losing balance is lowered. Muscles weaken, and vision and spatial judgment decline.
Sometimes medications can also cause dizziness and lower blood pressure when standing from sitting, causing a fall.
Falls typically occur at home because of environmental factors, he said. It is also a place where people feel comfortable and are less likely to be cautious.
“Because their guard is down, they’re in what should be familiar territory to them, and … you can take that for granted and end up getting tripped up,” he said.
Once people have fallen, they are at high risk for falling again.
INJURIES AND ACTIONS
Common injuries seen in falls among older people include musculoskeletal injuries, including broken bones, fractures, trauma and bleeding that can cause certain types of strokes and other complications, he said.
To reduce the risk of these common fall injuries, people can remove trip hazards in their homes, install grab bars in high-risk areas such as the shower, do strengthening and balancing exercises like tai chi and physical therapy, ensure that they have healthy levels of calcium and vitamin D for strong bones, and avoid medications, including over-the-counter medications, that can increase the risk of falls, he said.
TALK IT UP
Talking to family members about age-related decline can be difficult and is often a sensitive topic, Sibley said, but there are ways people can test their mobility at home and follow up with their doctor if needed.
One of those tests includes the TUG Test, in which a person has someone stand up from a sitting position and walk 10 feet, turn and then sit back down. If it takes more than 12 seconds, they are likely at risk of a fall.
Primary care providers are usually familiar with their patients’ abilities, he said. Medicare also does a fall risk assessment for people over the age of 65 as part of its annual review. However some people do not have access to care and in turn may not get screened for mobility issues.
There are a number of agencies on aging around the state that offer resources for fall prevention. SeniorsPlus is the agency in the Lewiston area where older individuals can sign up for fall prevention training and access resources. For more information about what it offers visit seniorsplus.org.
The CDC’s STEADI program has information and resources where older adults and their family members can learn more about fall prevention. That information can be found at cdc.gov/steadi/.
Sibley said aging at home is often difficult for the elderly and their families, made more so when a person falls. Which is why devices and skills to prevent falls are important, he said.
“It’s challenging enough … to help older adults age in place if you’re a family member, but I think it’s even more challenging if they fall, as they start to lose independence,” he said. “… Where we are as a state with some lacking resources” makes it that much more burdensome, he added.
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