Step Up Efforts for Fall Prevention

STEP UP EFFORTS FOR FALL PREVENTION

Illinois Laser Center on October 08, 2014

By John M. Sigle DPM, FACFAS, Foot & Ankle Center of Illinois, Illinois Laser Center


The National Council on Aging (NCOA) launched the seventh Falls Prevention Awareness Day on Sept. 23, 2014 to heighten awareness of fall-related injuries among older adults. Although the risk of falling increases with age, falls are preventable and may be reduced by lifestyle changes and medical interventions.

According to the Centers for Disease Control and Prevention (CDC), medical injury and cost reports are troubling and causing alarm in the U.S. Unintentional falls were the leading cause of injuries and injury deaths for seniors age 65 and above during 2011. The $30 billion direct medical cost reported for 2010 is projected to reach $67 billion by 2020.

One third of the seniors will fall each year and the number of falls increases with age. Approximately 2.4 million seniors were treated in the emergency departments for falls that resulted in over 658,015 hospitalizations and 22,901 deaths. Females accounted for 68 percent of the falls (1,637,038) and 54 percent of the deaths (12,430) caused by falls. Males accounted for 32 percent of the falls (785,425) and 46 percent of the deaths (10,471) caused by falls.

The CDC reported that 20-30 percent of the moderate to severe injuries affected the ability of seniors to live independently, hampered mobility, and increased their risk of early death.

Fractures are the most common types of injuries caused by falls. Almost all of the hip fractures (95 percent) were caused by falls. Hip fractures accounted for nearly 25 percent of the injuries leading to death for seniors over 65, and 34 percent of the injuries leading to death for those 85 and older. The prognosis for recovery from a hip fracture is not positive. One out of five hip fracture patients die within a year of injury. Fall injuries are also the most common cause of nursing home placement; even more common than strokes.

The diagnosis of balance impairment is not a simple thing. It can be caused by such things as predisposing medical diseases, irregular gait (walking), visual impairments, peripheral neuropathy, vestibular (ear) impairments, foot deformities, improper footwear, medications, lower extremity problems, and a history of falls.

Across the country, multiple medical providers (such as primary care physicians, podiatrists, geriatric specialists, ophthalmologists, audiologists, cardiologists, occupational therapists, family nurse practitioners and physician assistants, registered nurses, and physical therapists) are working to develop treatment plans for patients with balance impairment.

There are no silver bullets or magical devices to prevent falls; however, research continues to determine the origin and cause (etiology), a comprehensive treatment plan can be developed to address balance impairment. This collaboration of effort becomes even more critical as the patient grows older.

Podiatrists can play an extremely vital role in fall prevention for seniors and are an important medical touch point in the cycle of care. Podiatrists are trained to identify patients who are at risk for falls. Many of these patients have osteoarthritis, weak muscles, unstable foot and ankle joints and pain, Dropfoot (Hemiplegia), posterior tibial tendonitis, tendon contraction, peripheral neuropathy, flatfeet, malformations in the toes, Equinus foot, Charcot foot, gait abnormality; and lack of muscle coordination (Ataxia).

I like to take a holistic approach with my senior patients to monitor their status and to determine if they are at risk for falling. This may include the following:

  • Addressing the physical and biomechanical cause for balance impairment
  • Providing home-care foot exercises
  • Channeling patients for physical or occupational therapy
  • Providing patient education, home safety tips, and other fall prevention tips
  • Asking patients to complete a fall risk assessment survey

There are a variety of products that may be prescribed to help a patient achieve better support and stability like orthotics, foot braces, and appropriate shoe gear. In certain instances, I may recommend an ankle-foot orthosis (AFO) because it can potentially reduce their risk of falling. The cost of the custom AFO is usually covered by Medicare and commercial insurance for patients who are documented to have orthopaedic risk factors for falls. The combination of these approaches will help prevent falls. My goal is to do whatever it takes to improve a patient’s quality of life so they can sustain independence and reduce the risk of injury and premature death.

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