The elderly population is the fastest-growing segment of the population in industrialized countries. According to the US Census Bureau, between the year 2012 and 2050, the population of those aged 65 and older is estimated to nearly double from an estimated 43.1 million in 2012 to a projected 83.7 million in 2050 [7]. Injury prevention is vital to maintaining and improving the quality of life and reducing the morbidity and mortality of the elderly.

According to the CDC, unintentional injuries resulting in death are one of the top 10 leading causes of death among older adults in the USA, with approximately 50,000 deaths each year as a result of an unintentional injury [33]. Each year over 3.9 million unintentional injuries are treated in hospital emergency departments nationally for people aged 65 and over [33]. Falls are the majority of those injuries accounting for nearly 2.5 million injured patients [33]. It was found that those who suffered from an injury were more likely to be white non-Hispanic females than any other demographic, while older adult men have a higher rate of traumatic brain injury (TBI) [5, 32]. In addition, elderly TBI patients are more likely to have prior medical conditions than their younger counterparts. These statistics emphasize the need for injury prevention in the geriatric population [5].

As the US population ages, the number of falls and the cost of treating the injuries associated with falls are anticipated to increase. According to the CDC, the direct medical cost of treating falls in 2013 was $34 billion, which was paid by both health insurance companies and patients [1]. Additional indirect costs not included in the previous figure include loss of income both to the patient and caregiver and the intangible losses of mobility, confidence, and functional independence, which are incalculable [2].

When considering injury prevention strategies within a geriatric population, risk factors must be considered and addressed. Some risk factors are categorized to be non-modifiable, such as advancing age, gender, and cognitive decline (especially attention and executive dysfunction). Other risk factors are modifiable, including some visual impairments, environmental conditions, and knowledge about injury prevention strategies [2, 3].

Older individuals are more susceptible to sustaining injury due to their higher prevalence of comorbidities, age-related physiologic changes, and delayed functional recovery. This in turn leads to further deconditioning and more falls and injuries [2]. Comorbid conditions that are commonly found in the elderly who fall include hypertension, diabetes mellitus, cardiac arrhythmias, fluid and electrolyte disorders, dementia, depression, and certain neurological conditions [2, 5, 6]. Diagnoses of Parkinson’s disease, Alzheimer’s disease, and non-Alzheimer’s dementia have been shown to increase the risk of falling compared with healthy older adults. A diagnosis of dementia in both community- and institutional-dwelling older adults confers high risk for both isolated and recurrent falls [2]. Changes in gait patterns of patients with Alzheimer’s disease and Parkinson’s disease lead to increased instability [2, 9, 13]. These same factors also lead to impaired injury recovery [30, 31].

Medications can have a significant impact on an older adult’s risk of falling. Medications used to treat depression, dementia, bipolar disorder, anxiolytics/hypnotics, and antipsychotics have been shown to increase the risk of falling by 47 % in older adults [2]. Other medications that have been associated with an increase in the risk of falling include antihyperglycemic, nonsteroidal anti-inflammatory drugs (NSAID), anticonvulsant medication, and diuretics [2]. As a result, physicians should be cognizant when starting or altering the dosage of these medications due to the increased risk of falling [2].

The ACS COT guidelines offer the key elements for developing and implementing effective injury prevention programs. Some of these elements include analyzing the data, choosing evidence-based programs as a mechanism to address these injury areas, and partnering with others to maximize efforts. Program evaluation is also an important tool in monitoring prevention program effectiveness.

The following topics are common mechanisms of injuries seen in the older adult population in trauma centers.

In the USA, falls are the leading mechanism of unintentional injury and the leading cause of unintentional injury-related deaths for people aged 65 years and older [1]. These falls can result in severe injuries such as hip fractures and head traumas [1, 2]. Approximately one-third of community-dwelling older adults fall every year, and this number increases to 40 % for those older than 80 years [2, 6, 34]. In addition, those who have previously fallen are more likely to fall again [2, 8, 14]. Even with these statistics, there is evidence that 75–80 % of all falls without injury are not reported at all [2]. This evidence further reinforces the need for injury prevention and specifically fall prevention efforts in the geriatric population. Of the falls that are reported, women were more likely than men to suffer a nonfatal fall injury; however, after taking age into account, the death rate associated with falls was 46 % higher for men than for women [2]. Among older women, white women are 2.5 times more likely to die from falls than their African American counterparts [2]. In general, the incidence of falls has been shown to be higher in the post-discharge period than community-dwelling older adults who have not been admitted to the hospital recently. A recent large prospective national study in the USA reported that hospital admission is associated with an increased risk of hip fracture in the post-discharge period [3].

Although not all falls lead to injury, about 20 % need medical attention, 5 % result in a fracture, and other serious injuries—such as severe head injuries, joint distortions and dislocations, soft tissue bruises, contusions, and lacerations—arise in 5–10 % of falls [11, 14]. In terms of morbidity and mortality, injurious falls have many serious consequences of which the hip fracture is the most feared [13]. This fear is well founded considering 25 % of geriatric patients will die, 76 % will have a decline in their mobility, and 22 % will move into a nursing home after a hip fracture [2, 13]. Among older adults, approximately one-half are unable to “get up” and remain on the ground [2]. Increased complications associated with these “long lies” include dehydration, rhabdomyolysis, pressure ulcers, and pneumonia [2].

TBI is another common malady associated with falls and is responsible for more than 80,000 emergency department visits each year and 46 % of all fall-related deaths [2]. Of these visits, approximately three-quarters will result in hospitalization as a result of the injury [5]. Adults aged 75 years and older have the highest rates of TBI-related hospitalization and death, with falls consistently proving to be the most common mechanism in the elderly [5].

It has been demonstrated that risk of fall increases almost logarithmically as the patient accumulates several risk factors. An older adult with only one risk factor has a 20 % risk of falling. The risk increases with each additional factor; two factors increase the risk to 30 %, three factors contribute to a 60 % chance of falling, and those with four or more of the six risk factors have an 80 % risk for suffering injuries from a fall [37]. Appropriate intervention can decrease that risk by a third. For example, an older adult with four or more risk factors (an 80 % incidence of a fall) can see a 50 % decrease in their risk if these factors are addressed [21, 37].

The identification of older adults who are at risk of falling and providing them with both medical recommendations and referrals to appropriate resources has been shown to be effective in reducing their risk of falling. The CDC recognized that the STEADI (Stopping Elderly Accidents, Deaths and Injuries) program helps stratify fall risk in geriatric patients. It is encouraged that physicians conduct a routine fall risk assessment on their geriatric patients and refer them for the most appropriate intervention [22]. STEADI includes instructions for gait and balance assessments and an algorithm for physicians to determine best options for risk reduction in their patient population. Physicians may adjust medications, recommend physical or occupational therapy, and/or refer the patient to an exercise program or community-based fall prevention program [22]. The US Preventive Services Task Force recommends encouraging exercise to improve balance, reducing environmental hazards, and modifying medications. Other possible physician interventions are the recommendation of vitamin D plus calcium, testing for orthostatic hypotension, and several others [35].

As documented in a 2012 Cochrane Review, multifactorial interventions were shown to reduce the number of falls that an individual might sustain but not their risk of falling. Conversely, single exercise-based interventions have been shown to reduce the individual’s risk of falling [23]. Other programs that include physical therapy and exercise, home safety assessment and modification, and modification of medications have been shown to be effective [23].

In recent years, “group-based” fall prevention programs have been promoted by the National Council on Aging (NCOA) and the Center for Disease Control (CDC). Four programs in particular are cited: