How Ageism is Preventing Seniors From Getting Effective Fall Prevention Care
Fall prevention is a critical aspect of healthcare, given its impact on well-being, longevity and safety of older adults. Yet, falls are the number one cause of trauma death and trauma injury among any age, falling is not just a senior problem [1]. As healthcare providers strive to develop effective fall prevention strategies, it is essential to address the issue of ageism within this context. Ageism refers to the discrimination or stereotyping of individuals based on their age, often resulting in biased decision-making and limited access to appropriate care. Fall prevention is an area where ageism tends to thrive due to healthcare providers’ reliance on age as a primary factor for assessing fall risk. Many also fail to provide adequate support to their older patients who express concerns about their balance.
As an example of how ageism limits quality care, take this true story of our friend in his early 80s. Recently, he mentioned to his doctor that he is concerned about his balance and can’t come down the stairs anymore without holding onto the railing. Rather than giving him suggestions about how he could address his underlying balance issues, the doctor simply said, “that’s why they invented handrails, for old people!”
Relying solely on age as a predictor neglects the individual variability in risk and misses a major opportunity for clinicians to provide personalized care and build trust with their older patients. This paper explores the implications of ageism in fall prevention, discusses the limitations of current clinical tools, and introduces alternative, age agnostic methods. By shifting the focus from age to objective measures of balance, healthcare practitioners can provide targeted and personalized fall prevention care, empower older adults and drive fall reduction outcomes.
Limitations of Age as a Fall Risk Predictor
Age itself is widely recognized as a risk factor for falling, yet this does not mean that age is the only factor that matters. The rate of falls and the severity of related injuries tend to increase as individuals age. Statistics show that approximately 28.7% of people over 65 years [2] and 32-50% of people over 80 years [3] experience falls annually. Recent statistics show that 53% of the cost of falls is actually attributable to patients younger than 80, those who are aged 45-79 years of age [4].
While age is correlated with an increased likelihood of falling, it is not a strong predictor in determining who will actually experience a fall. Using age as the sole criterion for fall risk identification is quite limiting. For example, categorizing individuals aged 65 and above as high risk would identify all fallers within that age group but also falsely label a significant portion of the population as being at risk when they are not. Such generalizations based on age alone fail to account for the heterogeneity of individuals and their unique risk factors for falls. Falls are not solely attributable to age but are influenced by various factors, including reduced physical activity, the presence of clinical conditions, and environmental hazards. By solely focusing on age as a risk factor, healthcare practitioners miss the opportunity to address controllable risk factors and implement targeted interventions to reduce fall risk.
The reality is, many other health conditions also have increasing incidence with age, e.g. cancer and cardiovascular disease. With these conditions, age may guide who should be screened, but ultimately, objective measures are used in the process of screening for and diagnosing that health condition. In contrast, fall risk assessment relies predominantly on subjective evaluations, making it more susceptible to biases, including from aging patients themselves. This vulnerability allows ageism to manifest within fall prevention practices, as age becomes the determining factor rather than individualized assessments.
Consequences of Ageism in Fall Prevention
Ageism in fall prevention has significant consequences for older adults. We have already discussed the problem of making assumptions about someone’s fall risk status based solely on their age instead of using an objective measure. Another consequence of using age as the sole predictor of fall risk status is that doing so can lead to a defeatist belief that older people cannot improve their balance. The reality is that balance can be improved at any age, yet communicating age as the primary reason for balance decline eliminates the perceived opportunity for improvement. This approach diminishes hope and disregards the fact that balance can be improved. By attributing falls solely to age, healthcare providers miss the chance to address modifiable factors such as exercise, sensory training, sleep, diet, and medication management, all of which can contribute to improved balance and reduced fall risk.
The implications of ageism extend beyond individual empowerment. Disturbingly, the rate of falls has actually increased by 1.5% annually over the last decade [5], indicating a need for more effective and inclusive fall prevention approaches. To achieve effective fall reduction outcomes, targeted and personalized fall prevention care is crucial. However, applying a broad stroke of age to fall prevention care prevents the provision of tailored interventions and hinders progress in reducing falls.
Furthermore, ageism disempowers older adults, preventing them from proactively discussing fall prevention with their healthcare providers. Many older individuals refrain from bringing up fall concerns because they believe there is little that can be done (which is not true!), or that their concerns will be dismissed due to age-related biases, which is unfortunately quite common. Another of our friends told us that when they brought their concerns about balance and falling to their doctor, the doctor responded by saying, “well, you are 85!” and offered no further counseling or solutions. Examples of ageism encountered by seniors seeking help with balance reinforce the need for age-agnostic fall prevention approaches.
Introducing the ZIBRIO Stability Scale: An Age-Agnostic Tool
To combat ageism in fall prevention, the Stability scale, an age-agnostic, objective screening tool offers a promising solution. Originally developed in the US Space program, ZIBRIO technology focuses on understanding how the body handles gravity and its impact on falls, rather than relying on age as a determining factor. The Stability scale measures postural stability control and predicts fall risk via a simple 60-second standing test.
ZIBRIO's objective assessment of balance provides a comprehensive understanding of an individual's fall risk, irrespective of their age. Population normative data reveals that while the average person's balance declines by 10% per decade after the age of 40, the top 10th percentile maintains good balance regardless of age. By measuring capability rather than age, ZIBRIO technology empowers older adults to improve their balance and reduce fall risk.
Research indicates that ZIBRIO technology identifies 2-5 times more at-risk patients than current clinical practices, without relying on age as a predictor [6]. Moreover, the implementation of ZIBRIO technology has been associated with a remarkable 74% reduction in falls, even without additional interventions [7]. This outcome is attributed to ZIBRIO technology's ability to enhance the self-efficacy and self-regulation of older adults by measuring their capability rather than age. The accompanying BalanceCare software equips providers to provide personalized counseling to their patients based on the health and lifestyle factors (besides their age) which are likely contributing to their poor balance.
Conclusion
Ageism in fall prevention hinders the development of effective strategies and denies older adults the personalized care they deserve. Relying solely on age as a fall risk predictor fails to capture the complexities of individual risk factors and potential interventions. Objective screening tools like ZIBRIO’s Stability scale offer a promising solution by shifting the focus from age to objective measures of balance. By empowering older adults and providing targeted interventions, healthcare practitioners can significantly reduce falls and improve the overall well-being of older adults.
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