In the US, health care costs related to hip fractures are expected to double (from $17 to $25 Billion) between 2005 and 2025. 90% of hip fractures are due to falls, yet only 2% of falls result in a hip fracture.  Approximately 20% of older adults hospitalized for a hip fracture are expected to die within a year, and about 50% suffer a major decline in independence.

The questions are:

• Who breaks their hips when they fall?
• Why do they break their hip?
• How can we lower the 2% of falls resulting in breaks to 1%?

Who Breaks Their Hips

The primary mechanisms of falling (≈30%) in older patients are slipping, tripping, and stumbling.  Less than half of older patients who fall tell their clinician they’ve had a fall. Frailty describes a senior's decreased physiologic reserve; assessing an older person's frailty may include evaluating their ability to walk up a flight of stairs or carry a bag of groceries. Some seniors will seem frail in their 70s, whereas others may remain active and vital into their 90s. An elder who is frail has a higher likelihood of falling and a greater risk of injury from a fall.[14]

The highest risk of hip fractures due to falls is with anyone who scores high on the frailty index.  The frailty index can be calculated using the Frailty Index for Elders (FIFE).

Why Do They Fracture Their Hips?

When someone falls only 1/16th of the entire available energy in the fall is translated into forces causing a hip fracture.  Body dynamics create a system of tensegrity where the body parts are stable in constant tension and distribute forces effectively throughout the body.  The hip joint is a ball-and-socket joint, where the head of femur rests in the cup-like acetabulum (socket) of the pelvis. Various muscles span the hip joint and contribute to the hip joint movement and consequently distribute falling forces throughout the body.   The average pelvis impact velocity is ~2.08 meters per second and the forces applied generally look like the image below.

A intuitive look at the diagram makes us think that breaks probably occur most often where the bone is thinnest and in most cases this is true.  The vast majority of hips are broken because the individual in question either lacks the robust musculature to distribute the force or has a lack of bone density which allows much less force force to break or fracture the bone.  This is called frailty.  The problems of aging come as a package and as such represent an accumulation of health deficits.  A fall resulting in a fractured hip is an outcome of those deficits that can be a painful cycle that end in mortality at a very high cost to the frail.  

Identify the Frail

The vast majority of all hip fractures occur in the frail.  Identifying them allows us to concentrate our time and resources on those who will most benefit from our efforts.  You can read more about the frailty index for elders (FIFE) and take the survey at https://zanthion.com/frailty-survey/.

Modifying the Environment

Environmental design is a major factor in safety and livability.  This is particularly true for seniors and the frail. Familiarity, ease of access, ease of use, and lack of small injuries and frustrations empowers frail seniors to be more active and either stabilize their condition or enhance their health.  Some examples of environmental factors are:

1. Removing all throw rugs
2. Ensuring that all surfaces are not slick
3. Having wide, clear paths of travel within the home
4. Removing all sharp corners and hard impact surfaces
5. Raising all seating and tables
6. Providing plugs that are elevated for ease of access
7. Ensuring that resistance heating elements have automatic shut-off and are plugged into GFI sockets
8. Ensuring that all door handles are lever arms
9. Providing simple easy communications mechanisms for times of need (always with them)
10. Making sure that all pharmaceuticals are taken in a controlled fashion with complete accountability
11. Health information readily available with medical contacts, current drug dosages and schedule, emergency contacts, and vital signs

You can read more about environmental assessment and take the survey  at https://zanthion.com/safe-environment-survey/.

Institute processes that ensure safety

Environmental safety requires that there be processes to ensure their effectiveness.  This is especially true when emergencies occur like flooding, fire, and accidents. In all of these situations access to doorways, readiness of drugs, and methods of escape and home entry are very important.  You can read more about processes to ensure safety and take the quiz at https://zanthion.com/processes-for-safety/.

Protect the frail with protective clothing

Deaths due to falls has risen 31% in the last 10 years.  There are many reasons for the increase in mortality such as an older population who are more frail.  It is obvious, however, that much more must be done to protect our frail. Zanthion has introduced stylish SMART Protective Clothing to minimize the number of fatalities directly due to falls.  The frail do not have either the level of tensegrity or bone density to absorb the forces that affect their bones during falls.  Modern elastomeric materials used for extreme sports and built into fashionable senior clothing can distribute that force by up to 50% and still be comfortable.   

Use technology to measure status

Technology has improved every market sector performance it has touched in the last 50 years and protecting frail seniors is no exception.   Since 2014 El Camino Hospital in California has reduced their falls by 39% using predictive analytics.  In their case they are using data acquired in the healthcare setting.  This same technique using real time data collected in senior communities is being implemented by Zanthion to inform caregivers and stakeholders of a need for intervention to limit falls and other problems such as urinary tract infections.  You can find out more about real time measurement at https://zanthion.com/realtime-measurement/.

Use technology to bring resources to an immediate need

There is no lack of systems to notify emergency services in case of emergencies with respect to seniors.  The problem with all the current systems is the prioritization of notification and the method by which they are employed.  Current systems like Medical Guardian and GreatCall use a central dispatch system much like emergency services. These in turn use systems that distribute calls to various authorities and relations in order to achieve their desired goal.  Unfortunately, seniors often feel very uncomfortable with the dispatch of services when they are not sure of the level of their need. They often feel uncomfortable with strangers. In fact, the most important response requirement is time and the second most important is familiarity.  In order to achieve this end result a stratified system is required that notifies neighbors, friends, physicians, and families and then notifies emergency services. Find out how Zanthion achieves these results at https://zanthion.com/crowdsourced-notification/.