The Consequence of Falls
Most educated readers of this publication are likely aware of the changing global population trends, with the blossoming number of seniors certainly being one of the most impactful. Persons 65 years or older represented 14.5% of the U.S. population in 2014 and that number is expected to grow to be 21.7% of the population by 2040. World-wide, the number of older people is projected to increase more than 60 percent in just 15 years—in 2030, there will be about 1 billion older people, equivalent to 12.0 percent of the total population.
Each year, millions of older people fall. In fact, one out of three older people fall each year (although less than half tell their doctor). Obviously, falls can be serious and costly. One out of five falls causes a serious injury such as broken bones or a head injury. Each year, 2.5 million older people are treated in emergency departments for fall injuries, with a significant percentage of those requiring hospitalization, most often because of a head injury or hip fracture. More than 95% of hip fractures are caused by falling, which also is the most common cause of traumatic brain injuries. Naturally, the financial burden of falls is tremendous, accounting for direct medical costs of $34 billion annually.
The ability of a human to remain upright while standing and walking requires an intricate, fascinating system of neuromuscular control, which operates at multiple levels in the body. One of the most crucial systems is the sensory (aka the five senses), which receives input primarily from three “levels”, or components of the neuromuscular apparatus. One of them is obvious: sight. Another is the vestibular system, a central nervous system function that provides us with a sense of balance. The third is the body’s sensory system of the extremities, which includes nerve receptors in muscles and joints, and pressure receptors on the bottom of the foot. Processing of these signals occurs centrally at the brain stem and cerebral cortex to coordinate the muscles required for ambulation, and to maintain an upright stance.
Research has identified many conditions that contribute to falling. The more of these risk factors a person has, the greater their chances of falling. But these risk factors can be changed or modified to help prevent falls. A knowledgeable physician can work with you to create a strategy for reducing the number of these recognized factors. Additionally, a referral to an occupational therapist may be of benefit. Your physician and the O.T. can help you brainstorm ways to reduce some of these risks. Some solutions are easily installed and relatively inexpensive.
With the complexity of this nerve-muscle-balance system, it should be easy to see how numerous risk factors associated with aging can predispose someone to traumatic falls. These factors include a history of previous falls, problems with balance, decreased muscle strength, and visual impairment. Other items that increase a person’s risk are: the use of more than four medications, walking difficulties, depression, dizziness, functional limitations, being older than 80 years, arthritis, diabetes and pain.
Numerous studies have reported an association with “foot problems” and an increased risk of falls in the elderly. Specific foot deformities apparently impair balance, as revealed by studies showing those with a history of multiple falls had a significantly higher number of foot deformities such as bunions, hammer toe deformities, plantar calluses and corns.
Certain health conditions will make one more susceptible to falls. How comfortable are you when you walk? Do you feel any dizziness, joint pain, numbness or shortness of breath? An evaluation should be made of your muscle strength, balance and walking style (ie gait) as well.
Many strategies have been identified that can reduce some of these factors. Clearly, a certain level of physical fitness is extremely helpful. With your doctor’s approval, consider activities such as walking, water workouts or tai chi. An exercise program should target some combination of strength, balance, flexibility, gait or endurance.
A review of your medications for side effects and interactions should be undertaken with you and your health care provider. To decrease your risk of falling, being weaned off certain medications — such as sedatives and some types of antidepressants— may be recommended. As previously mentioned, those on multiple medications are at greater risk, and these should be evaluated.
Some strategies are surprisingly simple. Improving the lighting in your home environment, where most falls occur, can help one to avoid tripping on objects that are hard to see. Placing night lights in your bedroom, bathroom and hallways will allow one to better see obstacles, and aid in safely reaching your destination for those middle-of-the-night needs.
Shoe gear is also a critical step. Consider changing your footwear as part of your plan. Certain types of shoes can make you slip and stumble, initiating a fall. Floppy slippers and shoes with slick soles are common culprits, as is walking in your stocking feet. Wear properly fitting, sturdy shoes with nonskid soles to maximize your stability.
Many individuals find that some type of bracing can provide for greater proprioceptive feedback. This means that special nerve receptors in the joints of the lower extremity will be giving you more information about your positioning and gait, as well as reducing arthritic joint pain. Painful joints appear to be an important factor in a susceptibility to falling.
An evaluation of possible hazards in your home is also essential. Many common hazards can be found in the average home. Clear walkways of boxes, newspapers, electrical cords or phone cords. Move coffee tables, magazine racks and plant stands from high-traffic areas. Secure loose rugs with double-faced tape, tacks or a slip-resistant backing.
Falls can be devastating, and can cause significant morbidity and mortality. Recognition of the factors which lead to instability in stance and gait can allow you and your physician to make smart choices about how you may reduce your risk factors. Clearly, these are important choices that can affect not only your ability to stand and walk better, but to live better. Don’t delay: plan your fall prevention strategies today!