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Falls, fractures and prevention for the older patient

By By Dr. Leslie V. Rush III/Special to The Star
Aug. 19, 2001
For individuals older than age 65, falls present a serious health risk. One out of every three persons within this age group will fall each year.
Falls are the leading cause of injury related deaths among this age group. About 9,000 persons over the age of 65 died in 1998 due to fall-related injuries. Of these deaths, more than 60 percent involved people 75 years or older.
Falls account for approximately 80 percent to 90 percent of all fractures in persons over the age of 65 years. The most common fractures affect the pelvis, hip, femur, vertebrae, humerus and wrist.
Of all of these fractures, the hip fracture causes the greatest number of deaths and leads to the most serious complications. Approximately 3,000 hip fractures are treated each year in the United States as a result of a fall.
Women sustain approximately 70 percent to 80 percent of all hip fractures, and individuals greater than the age of 85 are 10 to 15 times more likely to sustain hip fractures related to a fall.
Following recovery, approximately half of these patients will be dependent upon a cane or a walker for mobility, and about a third of them will require nursing home admission for long-term care.
Only half of all patients within this population can return home or live independently after recovering from a hip fracture.
The economic impact related to falls among this population is tremendous, secondary to the multiple complications, disabling conditions, required recovery time, and hospital based rehabilitation. It is estimated that the United States spends more than $20 billion each year for treatment of such injuries after falls.
How can you make a difference?
Prevention. Most falls are preventable and are related to a risk factor that can be modified or eliminated. Approximately two-thirds of all falls occur in the home, one-third occur in the community, and 10 percent in long-term care facilities or institutions.
One-fourth of falls are the result of environmental factors such as slippery floors, uneven floors, poor lighting, loose rugs, unstable furniture and unnecessary clutter or obstacles within the home. Remaining falls are related to problems with gait and balance, which can be secondary to neurological and muscular-skeletal disabilities, dementia, visual impairment, or medication use.
Some personal risk factors to be reviewed include:
Age. The risk of fall related hip fractures increases after the age of 50 and doubles every five to six years.
Decreased Activity. Lack of weight-bearing exercise leads to decreased bone strength and osteoporosis. Approximately 1.5 million Americans suffer fractures secondary to osteoporosis. Women have two to three times more hip fractures as men secondary to this decrease in bone strength.
Lack of Exercise. Decreased strength, coordination, and confidence all contribute to falls.
Multiple Medications. Side effects may contribute to weakness, dizziness, and blood pressure fluctuation.
Bowel and Bladder Dysfunction. Attempts to get to a bathroom or toilet in a timely manner may result in stumbling or falling.
Many of these risk factors can be modified or improved by maintaining a regular exercise program to improve strength, balance, and coordination, as well as making simple home modifications. These changes within the home include:
Adequate lighting should be installed in stairways and clutter should be removed.
A sturdy handrail should be installed on both sides of the stairway.
Within the bathroom, all rugs should have a nonskid backing, and handrails should be installed for easier access to bathtub and toilet areas.
The kitchen should be arranged so that frequently used items are at counter top level so climbing or reaching to high shelves is eliminated. All spills should be cleaned up immediately, and floors should not be waxed.
Within the living area, furniture should be arranged to allow plenty of open pathway between rooms, and all electrical cords and telephone cords should be kept out of pathways.
A night light should be installed in the bedroom and bathroom to provide adequate lighting when getting up during the night.
A normal height bed should be used. Before leaving the bed, you should sit on the edge for a brief moment to make sure you are not dizzy.
All light switches should be placed at the entrance of rooms to avoid walking through a dark room to access the switch.
Emergency numbers should be provided in large print near each telephone, and at least one phone in the house should be placed so that it may be reached if a person falls and cannot get up from the floor.
For individuals who live alone, personal alarm devices are available that can be worn and activated to call for help or assistance at anytime.
Patients should undergo annual medical evaluation with review of all medications.
Patients should also have annual eye exams to correct prescription glasses or conditions such as glaucoma or cataracts to maintain optimal vision.
The Specialty Hospital of Meridian will be hosting Senior Safety Day on Thursday from 1 p.m.-5 p.m. in The Specialty Hospital Lobby, on the first floor of Rush Foundation Hospital.
There will be physical therapists and occupational therapists on hand to provide screenings and evaluations for gait and balance to assess individuals risk for falls.
They will also be available to review other fall risks and make recommendations for modifications and improvements to decrease any identified risks. Several handouts will be distributed with information on fall prevention including a checklist for home safety.
There is a pattern for falls among the older population which includes the fear of falling, the fall itself resulting in injury followed by hospitalization and decreased independence and mobility, which often results in the inability to return home and may lead to nursing home placement.
Falls can be a major life-changing event that robs many individuals of their ability to live at home independently. However, through education and identification of risk factors, as well as making appropriate changes and modifications, one-third of falls can be prevented.
Dr. Leslie V. Rush III serves as medical director of Rehabilitative Services for The Specialty Hospital of Meridian. Dr. Rush is a specialist in physical medicine and rehabilitation.

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