The National Council on Aging (NCOA) is launching the 7th Falls Prevention Awareness Day on the first day of fall, Sept. 23. Forty-seven (47) State Falls Prevention Coalitions, including the Illinois Coalition, have joined the effort to heighten awareness to prevent fall-related injuries among older adults. The theme for this year’s campaign is “Strong Today, Falls Free Tomorrow.” 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, unintentional falls were the leading cause of injuries and injury deaths for seniors age 65 and above in the U.S. during 2011. 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.
CDC reported that 20-30 percent percent of the moderate to severe injuries (lacerations, head traumas and fractures) affected the ability of seniors to live independently, hampered mobility and increased their risk of early death. Fractures of the hand, arm, forearm, hip, spine, pelvis, leg and ankle are the most common types of fractures caused by falls.
Almost all of the hip fractures (95 percent) were caused by falls. Hip fractures account for nearly 25 percent of the injuries leading to death for seniors over 65. They account for 34 percent of the injuries leading to death for those 85 and older. The prognosis for recovery 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 most recent CDC cost report (2010) indicated that the direct medical cost for fall injuries was $30 billion. This did not include other indirect costs such as a reduction of income from disability, lost wages from employment or high cost of home care. The report estimated that costs would be around $67.7 billion by 2020.
The CDC website offers a brief overview on how seniors can stay independent and reduce their chance of falling. The suggestions include regular exercise, reviewing medications with a physician, getting regular eye examinations and making living environments safer. The site also provides suggestions for reducing hip fractures by taking vitamin supplements and screening for osteoporosis.
The National Safety Council also promotes fall prevention awareness. Their web site provides a wide range of tips to reduce the susceptibility of falls. Here is a list of the informational materials that they provide:
* Fall Proofing Your Home — tips that will make the environment safer by eliminate hazards
* Older Adult Falls — tips for caregivers to help keep loved ones safer
* Slips, Trips and Falls — tips to reduce slips, trips, and falls as well as ladder safety tips
* Older Adult Fall Prevention Checklist — includes lifestyle changes for exercise, health, shoes and clothing, and medications
* Falls — provides information on common locations for falls and prevention tips, and window safety tips
* Community-Based Fall Prevention Programs — includes an overview of the proven sources for adults to stay healthy to prevent falls and encourages participation in the following: Tai Chi (moving for better balance); Stay Safe and Active (weekly sessions structured for moderate-intensity exercise and home exercises); Ostago Exercise Program (individually tailored programs given by a physical therapist or visiting nurse in your home); and A Matter of Balance (program designed to reduce fear of falling and to improve balance and strength)
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.
The diagnosis of a balance disorder is not a simple thing. Balance impairment may be caused by such things as:
* Predisposing medical diseases (such as arthritis, neuropathy, hypertension, vertigo, cerebral vascular accident (CVA), Parkinson’s, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS) and Huntington’s disease, Alzheimer’s, loss of limbs, seizures, arthritis, fractures, osteoporosis, post-stroke paralysis, infections (viral or bacterial), mental/cognitive impairments, head injury, brain disorder, vascular problems)
* Gait (walking) and balance problems
* Visual impairments
* Peripheral neuropathy
* Vestibular (ear) impairments
* History of falls
* Foot deformities
* Walking and talking deficits
* Inability to get up and go
* Medications (anesthetics, antihistamines, cathartics, diuretics, antihypertensives, antiseizures, benzodiazepines, hypoglycemics, psychotropics, sedatives /hypnotics)
* Lower extremity problems
There are no silver bullets or magical devices to prevent falls; however, as the multiple medical touch points converge and consort 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. Continued fall assessment strategies by medical touch points are essential to counteract diminished muscle strength, dizziness, and environmental obstacles that cause slips, trips, and falls. Real progress can be achieved by decreasing the frequency and severity of falls.
Podiatrists can play an extremely vital role in fall prevention for seniors and are an important medical touch point in the cycle of care. They are trained to identify patients who are at risk for falls. Many of these patients typically have the following biomechanical problems: osteoarthritis; weak muscles; unstable foot and ankle joints; foot and ankle pain; Dropfoot (Hemiplegia); posterior tibial tendonitis; tendon contraction; peripheral neuropathy; flatfeet; malformations in the toes (over-lapping, under-lapping, hammertoes, mallet toes); Equinus Foot; and Charcot Foot; gait abnormality; and lack of muscle coordination (Ataxia).
In my practice, I like to take the “offense” with senior patients. I encourage them to schedule regular visits so I can monitor their status and treat problems that may put them at risk for falling. I encourage them to participate in home-care foot exercises and to work with a fitness trainer to improve muscle strength, flexibility and balance. This may include physical and occupational therapy as well.
Patient education is essential so I provide seniors with literature from the CDC and NOCA for home safety tips and other fall prevention tips. In selected cases, I ask seniors who are at risk to complete fall assessment tools to monitor their status.
There are a variety of products that are sometimes prescribed to help a patient achieve better support and stability like orthotics, foot braces, and appropriate shoe gear. In certain instances, I will recommend an ankle-foot orthosis (AFO) because it can potentially reduce their risk of falling. The AFO is not a treatment intervention that will prevent falls or catastrophic events; however, it can aid in balance and stability for some patients with altered gait patterns. This device also can enhance mobility. The AFO is a prescription orthotic that is worn as a pair. It is light weight and designed to fit easily into a doctor recommended shoe. It is easy to put on and take off. 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 to reduce the risk of injury and premature death.
If you have a balance impairment caused by a lower extremity problem and difficulty recovering from a fall, contact Dr. John Sigle at the Foot & Ankle Center of Illinois at (217) 787-2700 for a consultation and fall balance assessment. Visit myfootandanklecenter.com to review information on AFOs.
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