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What’s more likely to kill you: kidney disease, pneumonia, Alzheimer's, or falling over? Surprisingly the answer is falling over. Falls kill tens of thousands of people a year in America every year. What can we do about this?

The four leading causes of death in the USA are heart disease, cancer, chronic lower respiratory tract diseases and strokes. Unintentional injury  falls  come in at number 5.

And there's an unexamined point here too, in that falls are actually underreported and their effects long-term aren't factored into the stats. The CDC says that one in three Americans over 65 fall each year  but goes on to remark that less than half tell their healthcare providers. And falls contribute to the worsening of other symptoms like arthritis, psychological symptoms like depression and isolation and general physical fitness. Falls are part of the downward spiral of mental and physical health that prefigures disability as well as mortality and morbidity.

The CDC keeps figures that show that in 2013, 20 to 30 percent of elderly people who suffered falls incurred injuries like lacerations, dislocations and hip fractures and head traumas  fairly serious injuries that make major contributions to that downward spiral we talked about earlier.

Other injuries include fractures of the spine, forearm, leg and hand. In fact, while the stats show proximate causes of death  the illness that directly ended a person's life  falls are what put people in bed, where they subsequently are at greater risk of choking, stroke, heart disease and other fatal illnesses. Falls radically increase the likelihood of a person's being taken into a long-term care facility, and are also the cause of 95 percent of hip fractures. The death certificate says "heart disease", but the fall's contribution isn't recorded.

Falls are part of their own very specific downward spiral too. The best predictor of having a fall is having already had one: the best predictor of a serious fall-related injury is having already incurred one. The cruel fact is that falls are the number one cause of traumatic head injuries (TBIs) in the elderly, and 46 percent of fatal falls are due to a TBI, itself most likely the result of a fall.

In fact, if out of two people aged between 55 and 65, one is told she has cancer and the other suffers a fall, guess whose two-year survival rate is better? Unbelievably, it's the cancer patient.

So What Can We Do About It?

Well, the trouble with a fall is that it's an event. There are things leading up to it and leading away from it, but we have to fill those in form the stats ourselves.

We can start by saying we need our approach to give two benefits: one, it will reduce the chances that a fall will happen; two, it will reduce the damage caused by a fall. We also need it to address the needs of two groups: those who have yet to fall and those who have fallen. Ideally, we'll work with just one program that will perform for both groups.

Primarily it needs to be integrated into the daily lives of older people  let's say 50 and up. That means people who probably don't go to the gym, who don't use much in the way of home fitness equipment, who are probably already carrying a sore hip, bum knee, bad elbow, whatever. And we should remember something important about the late middle aged and "young old" - these people are often very busy.

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