FALLING: RISK, IMPLICATIONS AND PREVENTION
By Karl Kolbeck, PT, OCS, SCS, COMT, FAAOMPT, CO-OWNER
When was the last time you fell? And why? Falls are a fact of life – whether occurring during recreation or sport, a pet getting under your feet, while performing work in the yard or falling off a ladder, tripping over a loose rug or crack in the sidewalk, or slipping on soggy leaves or ice.
We all have instances where our balance is challenged every day. It’s our reaction to those challenges that either protect us, or fail us – and a fall ensues. In addition to the above mentioned causes, other environmental factors including poor lighting, slippery floors, uneven ground, poor footwear or clothing and inappropriate walking aids can contribute to falling.
The incidence of falling increases in those 50 years of age and older. Each year one out of three people over 65 years old and one out of two over 80 years old fall; and less than half tell their doctor. Other risk factors for falling include:
- Poor vision
- Vestibular problems
- Cardiovascular disease
- Diabetes
- Foot problems (i.e. neuropathy)
- Lower extremity weakness
- Those in a new environment – the first 3 months
- Those who have fallen before are 2-3x more likely to fall again within a year
- Lower Body Mass Index
- Taking benzodiazepines (i.e. Lorazepam, Diazepam, Clonazepam, Midazolam, Temazepam)
- Taking four or more prescription medications
The direct medical cost for fall injuries is $34 billion annually. One out of five falls cause serious injury including head injury, and fractures of the spine, hip, ankle, shoulder and wrist. Ninety-five percent of hip fractures are caused by falling and over 250,000 geriatrics are hospitalized for hip fractures annually. Fifty percent who suffer a fall induced hip fracture never regain functional independent walking. There is also a mortality related to fall induced fractures. In women, a five times higher mortality rate and in men an eight times higher mortality rate in the first three months after hip fracture exists. This increased mortality decreases after the first year; however, a 20-22% increased mortality rate in the 10 years following fracture persists.
Our balance is dependent on four systems. These are the visual, sensory (perception of the surface you are stepping on), vestibular (head position in space) and proprioceptive (awareness acuity of body position in space) systems. If one or more of these are deficient it’s important to enhance the others to reduce fall risk. Research supports clinical assessments provided by a physical therapist can, with high reliability, determine your risk of falling. There are numerous assessments commonly used in the clinic, including the TUG (Timed Up and Go) Test, Berg Balance Scale, and Tinetti Balance and Fall Risk Assessment. Outcomes of these clinical assessments dictate what individualized exercises your physical therapist will prescribe to enhance your strength and balance, and reduce your fall risk. Physical therapists will also assess your posture, strength, mobility – especially at the ankle and hips as deficits here correlate to increased fall rates – and can also provide home safety assessments. Research reveals that group classes at community centers and gyms prove to be good for maintenance of balance; however, if you are at a higher risk for falls these classes typically do not address individual deficits and a specific program aimed at meeting your needs is necessary.
Be proactive for yourself or a loved one. Prevention is key and staying fit and healthy will decrease your risk of falling. Review your medications with your physician and understand which in and of themselves or in combination put you at a greater risk of falling. Assess your home environment and make changes – remove loose rugs and replace with rubber backed flat matts, be sure your stair handrails are secure, have shower and bath or bedside grab bars installed. If you use an assistive device be sure it’s adjusted to fit you and all parts are in working order. And after a fall, it’s important to seek professional help to determine your cause and risk factors and how to prevent a reoccurrence.