Quality indicators for falls and mobility problems in vulnerable elders.

Falls and mobility problems are common and serious problems facing older adults. Accidents are the fifth leading cause of death in older adults, with falls accounting for two-thirds of these accidental deaths. About one-third of those aged 65 and older living in the community fall at least once a year. This increases to one in two for those aged 80 and older. Although most falls result in no serious injury, in any given year, approximately 5% of these older fallers experience a fracture or require hospitalization. The related problems of mobility disorders are also prevalent in older adults. Detectable gait abnormalities affect 20% to 40% of individuals aged 65 and older and 40% to 50% of those aged 85 and older. Falls are generally the result of multiple, diverse, and interacting etiologies. Several cohort studies have identified gait and balance disorders, functional impairment, visual deficits, cognitive impairment, and use of psychotropic medications as the most important risk factors for falling. Several studies have shown that the risk of falling increases dramatically as the number of risk factors increases. Three separate studies have reported that 65% to 100% of elderly individuals with three or more risk factors fell in a 12-month observation period, compared with 8% to 12% of persons with no risk factors. However, the quality of falls care in vulnerable older adults remains suboptimal. One study found that only 34% of recommended care for falls and mobility disorders was completed. Numerous clinical approaches have been advocated for ameliorating the complex and serious problems of falls and mobility problems in older persons. The following indicators have been updated from those developed in Assessing Care of Vulnerable Elders (ACOVE)-1 and reviewed by an expert panel to reflect the current literature in this area. Recent data on vitamin D supplementation and footwear were reviewed but did not pass the expert panel process. Figure 1 conceptualizes an approach to the detection, evaluation, and intervention options for falls and mobility disorders.