Think about these numbers.
Approximately 30% of people over the age of 65 fall every year. That number approaches 40% by age 70. 10-15% of all falls result in a serious injury or fracture. 94% of hip fractures are caused by falling. In an 8 year period from 2001-2008, 4 million adults over the age of 65 had an emergency room visit for a fracture. The risk certainly increases with age, and women fracture twice as often as men. Half of these fractures require hospitalization, which can lead to rehab, loss of mobility, and loss of INDEPENDENCE. We fear losing our independence more than anything as we age!
So, what are the risk factors for falling? The number one risk factor is lack of muscle strength. This muscle weakness increases the risk of falling 4-5 times. A history of falling increases the risk 3 times. Other factors that increase the risk include balance issues, visual impairment (bifocals distort vision), arthritis, depression, cognitive impairment, age, and medications.
Other risk factors include Parkinson’s disease, fear of falling, heart disease, orthostatic hypotension, urinary incontinence, depression, stroke, chronic pain, and a sedentary lifestyle.
Some of these factors are modifiable.
A particularly vulnerable time for older adults is post-hospitalization. When adults come home from the hospital, often in pain, maybe undernourished, and on multiple medications, the risk of falling is much increased. Over 40% fall within 6 months of discharge, with half causing severe injury. There are twice as many hip fractures in the month after a hospitalization.
Drugs that increase the risk of falling are benzodiazepines (Valium), antidepressants including SSRI’s, sleeping pills, antihypertensives, and psychotropic drugs. Often when medication doses are changed, or other drugs are added, interactions can cause side effects such as dizziness.
Decreased mobility caused by muscle weakness, osteoporosis, and medical problems such as obesity and diabetes can all lead to falls and fractures. Fractures must be taken seriously and some can be prevented. Fractures lead to loss of quality and length of life. Pain, immobility, and disability lead to decreased quality of life. 20-24% of those who sustain a hip fracture die within one year of the fracture! 40% of those who sustain a hip fracture are unable to walk independently, and 60% will still need assistance one year later. 33% of those who fracture will end up in a nursing home or be unable to ever live independently again.
90% of older adults rank staying in their homes and living independently as their number one concern. Preventing fractures is a significant intervention that can help to achieve this goal.
Physicians should be asking their patients about falling: the frequency, circumstances, loss of consciousness, and factors which led up to the fall. Appropriate studies should be done and interventions can be made to decrease risk.
So what can we do as patients to prevent falls and fractures? Modify your home environment by eliminating throw rugs, wires, and objects that clutter. Use more lighting, especially night lights to show the path to the bathroom. Install rails and bars to help stability with movement. Avoid ladders and put items at arm’s length. Minimize or taper medications that have effects on balance and cognition. Exercise, participate in balance, strength and gait training. Tai Chi is very effective. Treat visual impairment. Treat cardiac arrhythmias or other conditions that can cause fainting, including installing a pacemaker if needed. Take Vitamin D, to reach a serum level of 40 ng/ml. This may take 2,000-4,000 IU per day to achieve this goal Wear reasonable shoes, don’t walk on ice, and be careful about curbs and uneven pavement. Schedule physical therapy for musculoskeletal problems that can lead to imbalance or difficulty walking. Decrease or avoid medications such as sedatives, sleeping pills, psychotropic drugs, antihistamines, drugs for overactive bladder, and decrease alcohol! Alcohol on top of multiple medications can cause serious interactions, dizziness, and loss of consciousness. The elderly should practice getting up off of the floor, so that if they fall, they can get up again.
It is so important that we do not look at fractures and falling as just part of getting older. There is much that we can do, and starting sooner that later can make a huge difference in how long we can live happily independent!!
Marilyn C. Jerome, M.D.
Crash, Snap: Falls Cause ‘Osteoporosis-Related” Fractures. What Can a Clinician Do?
NAMS Pre-meeting, October 11, 2017
Dr. Neil Brinkley, M.D.
University of Wisconsin School of Medicine and Public Health