Preventing Falls in the Elderly

PREVENTING FALLS IN THE ELDERLY

            An important public health issue that has become more prevalent in podiatry today is the issue of fall prevention in the elderly.  One in three adults over the age of 65 falls each year and a half of these people fall multiple times.  The Centers for Disease Control and Prevention report that falls are the leading cause of injury related deaths in people over the age of 65.  In 2000, the cost of treating non-fatal fall related injuries was $19 billion and is expected to double by 2020.

What are the risk factors for falling?

            With multiple levels of input and output from the central nervous system to provide us with proper muscular activation to respond to unexpected hazards, it is easy to see how numerous risk factors associated with aging can predispose people to traumatic falls.  The medical literature has identified many independent risk factors for falling. The risk factors include previous falls, balance impairment, decreased muscle strength, visual impairment,  more than four medications,  psychoactive drugs, gait impairment, and walking difficulty, depression, dizziness or orthostasis, age older than 80 years, female sex, incontinence, cognitive impairment arthritis, diabetes, and pain. 

            More than one risk factor increases the risk of falling, with no risk factors the risk of falling is 8 percent and grows to 78 percent with four.  More alarming is the finding that the risk of falling quadruples for a patient within two weeks of discharge from the hospital. 

            Medications that physicians commonly prescribe for elderly patients can negatively affect all aspects of our neuromuscular control of the body during gait.  While the use of four or more medications from any category of drugs will increase the risk of falling, identifying certain drugs that can independently increase the risk is more difficult.  In general, an increased risk of falling is associated with the following medications:  serotonin reuptake inhibitors, tricylic antidepressants, neuroleptic agents, benzodiazepines, anticonvulsants and class IA antiarrhythmic medications.  Withdrawal of these medications becomes a complicated issue when considering fall prevention.  Many times the condition patients are taking the medication for is itself a risk factor for falling.

            Most of our elderly patients experience a decline in balance and muscle strength.  The combination of this decline with visual and vestibular compromise increases the risk of falling. What can be done? One way that podiatrists offer relief from imbalance issues is the MBB or Moore Balance Brace. It is all about making it easy for the elderly. The MBB has been designed to easily fit into a variety of different shoes. Because the MBB is so light weight and has a sleek design, the MBB is easy to wear.
            The type of shoe used with MBB is important and should not be left to the patient alone to figure out. There are many light weight stable shoes that are options for seniors, but care needs to be taken to make sure that the MBB is not being used in a house shoe or slipper or without shoes. You should see your Podiatrist to evaluate your needs because your quality of life is the most important to us.