Helen Evancheck, 89, of Bangor is among the survivors of a hip fracture, which is a leading cause of death among the elderly.

“I was in the bedroom, changing my slacks when I fell,” she said recently. “That was September of 2012. I’ve been in rehab ever since, and I’m getting back to normal. I’m at about 75 percent now, but I want to get back to 100 percent.”

While the laws of physics dictate that what goes up must come down, what goes down doesn’t always get back up.

“Hip fracture is a disease,” said Dr. James Whalen, a Machias-based physician who has treated more hip fractures than he can count over his long career as an orthopaedic surgeon. “It starts with a fall and, in many cases, winds up being terminal.”

Whalen and other health care professionals term that phenomenon a “cascade” that often takes patients from a fractured hip to their deathbeds.

“People think, what’s the big deal? It’s only a broken hip,” Whalen said. “It’s hard to appreciate the pain and the trauma involved. The intense pain involved causes mental confusion that doesn’t always go away. Probably three out of four hip fracture patients wind up having brain scans as their mental confusion persists, their doctors wondering if there’s been bleeding in the brain or some other head trauma. And people who fall and break a hip and can’t get to a phone can die from being immobilized. The pressure from being on the floor for an extended period of time can cause kidney failure and death.”

Statistics show that, in Maine, 90 percent of hip fracture hospitalizations are due to an unintentional fall and that 25 percent of people that have falls that result in a hip fracture die within a year of their injuries.

According to the U.S. Centers for Disease Control and Prevention, every 15 seconds — approximately the amount of time required to read the next two paragraphs — an older adult is treated in a hospital emergency department for injuries related to a fall. In the next 30 minutes, an older adult will die from injuries suffered in a fall. Falls are the leading cause of injury among adults age 65 and older in the United States and account for 95 percent of hip fractures.

CDC statistics show that each year, one in every three adults age 65 and older falls. Falls can cause moderate to severe injuries, including hip fractures and head injuries, and can increase the risk of early death. In 2010, 2.3 million nonfatal fall injuries among older adults were treated in emergency departments and more than 662,000 of those treated required hospitalization.

Public health statistics show that 20,400 older adults died in 2009 nationwide from fall injuries, with deaths among men 34 percent higher than deaths among women. People aged 75 and older who fall are at least four times more likely than those aged 65 to 74 to be admitted to a long-term care facility for a year or longer.

Fall injury statistics for 2008 gathered by the Maine Health Data Organization show fall-related injuries that year in Maine were the No. 1 cause of emergency department visits and hospitalizations, and the fourth leading cause of death.That translates to two fall-related deaths and 82 hospitalizations every week.

Between 2004 and 2008, falls accounted for 191,309 emergency department visits in Maine. That’s four times the number of patients seen for injuries related to motor vehicle accidents. Falls also accounted for 19,576 hospitalizations in Maine during that four-year span, also four times the number related to motor vehicle accidents. During that same period, 406 deaths were caused by falls.

Fortunately, falls are a public health problem that is largely preventable.

Having taken a fall this past winter on ice during his daily walk around downtown Machias, Whalen, 72, is a big fan of strap-on ice grippers. Although he didn’t break the hip that broke his fall, Whalen said he was on the mend for five weeks.

Unsecured throw rugs and clutter on stairs are common fall hazards. The CDC suggests that the elderly reduce tripping hazards at home by installing grab bars inside and outside the tub or shower and next to toilets, as well as installing railings on both sides of stairways and improving lighting.

Whalen said regular exercise is also important in maintaining strength and balance. In addition, he encourages the use of electronic “med alert” devices that can summon help after a fall. While costs vary, the potentially life-saving technology is available by subscription for about $1 a day.

Falls, he said, are associated with dizziness that can be a common side effect of prescription drugs, including those to treat high blood pressure.

“I think there also needs to be more attention paid to the side effects of medications being prescribed for those who have or are prone to have osteoporosis [loss of bone density], especially women,” Whalen said. “Among those side effects can be dizziness, which can trigger a fall.”