The risk of dying from injuries is increasing for Americans ages 65 and older, says a new report from the Johns Hopkins Bloomberg School of Public Health's Center for Injury Research & Policy, in Baltimore.

The report found significant increases in death rates from falls (42 percent increase), machinery (46 percent increase), motorcycle crashes (145 percent increase), and unintentional poisoning (34 percent increase) between 2002 and 2006. The results were published in the February issue of the publication Injury Prevention and are available online at the journal's Web site.

"Our findings reveal significant increases in death rates from several different injury causes," says study co-author Susan P. Baker, a professor with the Bloomberg School's Center for Injury Research and Policy. "While the overall change in injury mortality among persons 65 and older was small, this study identifies important causes worthy of further investigation."

The overall change in injury mortality for individuals aged 65 years and older during the 2002-2006 period was 3 percent. In contrast, the rate of deaths attributed to falls increased by at least 38 percent in all racial and ethnic groups, with the greatest increase seen in whites (45 percent). Significant declines occurred in the rate of deaths attributed to motor vehicle crashes, suffocation, and suicide.

"We know injuries are taking a toll on older adults," says Grant Baldwin, director of the division of unintentional injury prevention at the National Center for Injury Prevention and Control, part of the Centers for Disease Control and Prevention, in Atlanta. "This research helps us to build upon our knowledge and translate science into effective programs and policies that prevent these injuries and minimize the consequences of injuries when they occur."

The study also looked at changes in emergency department visits, and found that despite the significant increase in fatal falls, fall-related admissions among the study population haven't increased significantly. The authors speculate this could be attributed to a trend in recent years to report the underlying cause of death as a fall. In addition, many elderly people now are living longer with conditions that might make them more likely to suffer falls.

"Alcohol is another contributing risk factor worthy of consideration," says senior author Guoqing Hu. "Given the association between alcohol and injury, recent documented increases in alcohol problems among the elderly may be another partial explanation for the increase in severe falls."

Hu and Baker reviewed data from the Centers for Disease Control and Prevention's Web-based injury statistics query and reporting system (WISQARS), which provides data on deaths and hospital emergency department-treated injuries according to cause and intent of injury.

Support for the research was provided by the Centers for Disease Control and the National Center for Injury Prevention and Control, through a grant to the Johns Hopkins Center for Injury Research & Policy.

Preventing falls

Val Walkowiak, medical integration coordinator for the Loyola Center for Fitness, in the Chicago area, says exercise plays a major role in preventing falls, which are the leading cause of injury deaths in older adults and the most common cause of nonfatal injuries and hospital admissions.

As we age we tend to lose our flexibility, our connective tissue tightens, and we have slower reaction times, Walkowiak says. Problems with vision, including depth perception, all increase the likelihood of falling. When a child falls, that might result in a few bumps and bruises. The older we get, however, the more the ramifications of a fall escalate.

"Improving posture and balance helps strengthen weak muscle groups in the back, core, hips, and legs. This improves mobility, which limits the fall risks," Walkowiak says. "Maintaining upright posture is vital for daily living and function."

For instance, it can seem that older adults are shuffling instead of walking. This is a way to compensate for lack of balance and poor posture. The elderly take shorter strides, have a wider gait, and tend to look at the floor to avoid tripping.

Working on posture, such as sitting up straight in a chair and holding in abdominal muscles can strengthen key muscle groups, thereby helping to create a more normal walking gait. Improving static balance, which is the ability to control postural sway while standing, is key to preventing falls, Walkowiak says.

"We naturally move a lot. When you stand still you actually aren't still. Your head moves and your body moves with it to keep in line with the head," she says. "As we age it is important to train our brains to quickly activate the right muscles to anticipate and respond to changes in our environment, such as stepping up on a curb or into a bathtub."

Some of the exercises Walkowiak uses to stimulate brain and muscle control are marching in place, heel walks, working on ankle flexibility, and quick steps with sudden stops to help increase reaction times.

"So many of the everyday things we take for granted can be more difficult as we age," she says. "Cardiovascular endurance, strength, balance, and flexibility training are all needed to help a person stay independent. But balance, staying away from falls, seems to be what matters most to seniors."

Walkowiak leads a class aimed at meeting the exercising needs of older adults in a land-based setting. The class doesn't require getting up and down off the floor. Strength training is done with wrist and ankle weights so people with arthritis don't have to use handheld weights. Most exercises are done in a chair or standing up. Many seniors are drawn to aquatic classes because of arthritis or lack of flexibility, which Walkowiak thinks is great. Still, she encourages seniors to get out of the water.

"We don't live in water. It is important for seniors to perform exercises on land to increase bone density, help improve balance, and simulate the functional movements we perform each day during our daily tasks," says Walkowiak.

Exercising, which is good not just for the body, stimulates the mind, improves hand and eye coordination, and is an excellent social outlet.