Tripping and Falling

Every second of every day in the United States an older adult falls. This makes falls the number one cause of injuries and deaths from injury among older Americans. In 2014 alone, older Americans experienced 29 million falls causing seven million injuries and costing an estimated $31 billion in annual Medicare costs.  Many of my older patients are so resistant to using a cane, let alone a walker.  Trying to get them to agree to a home assessment is next to impossible.  To get them to consider wearing an ankle brace is even harder.  I often marvel at how patients will take a myriad of medications prescribed by their doctors without question, but will be so resistant to doing something that will clearly reduce their risk of falling.  I make the analogy to them that it's my prescription for their balance issues.  "You take a prescription for your high blood pressure?  A pill for your cholesterol?  Well, my prescription for your risk of falling is...".  There are so many things that can be done for patients that are at risk of fall, most of which are covered by insurance/Medicare, why not take advantage?  Let's go through what can be done, shall we?

Visiting Nursing Services:  VNS will provide a home assessment to reduce the risk of falling in your house.  Most falls occur in the home, so if you can do anything to limit that risk, why not do it?  A home fall risk assessment is covered by Medicare and can greatly reduce injuries.

What can you do in your home?

Here are some great tips for reducing risk of fall in the home:

  1. Remove obstacles inside and outside of the house that could cause tripping.   
  2. Install handrails and lights on staircases, with light switches at the top and bottom of the stairs. You may even consider glow-in-the-dark or lighted switches.
  3. Add nonslip treads for bare wooden steps.
  4. Install shower and tub grab bars in the bathroom, around the toilet and the tub.
  5. Place no-slip mats on the shower floor and bathtub.
  6. Secure loose rugs with double-faced tape, tacks, or slip-resistant backing.
  7. Repair loose, wooden floorboards and carpeting.
  8. Store clothing, dishes, food and other necessities within easy reach.
  9. Immediately clean spilled liquids, grease, or food.
  10. Paint doorsills with a different, highlighting color to avoid tripping.
  11. Make home lighting brighter, but prevent glare. Place night lights in the bedroom, bathroom and hallways. Place a lamp within reach of the bed for middle-of-the-night needs.
  12. Store working flashlights in easy-to-find places in case of power outages.
  13. Have vision checked often and regularly.
  14. Ask the doctor to review medications regularly for side effects and interactions.
  15. If he or she is able, have the senior start exercising on a regular basis ─ tai chi or yoga can increase flexibility and strengthen muscles and joints.
  16. If the senior can’t stand comfortably, have him or her exercise in a chair.
  17. Have the senior wear sensible shoes. They should be properly fitting, sturdy shoes with nonskid soles.
  18. Note any health conditions such as dizziness, joint pain, numbness, or shortness of breath when walking. Tell the doctor, should any of these occur. He or she may evaluate muscle strength, balance and walking style (gait) as well.
  19. Have the senior use assistive devices, if needed. The doctor might recommend using a cane or walker to keep him or her steady.
  20. Consider a PERS (Personal Emergency Response System) unit that will alert others when help is needed.

Physical Therapy

I refer many patients for physical therapy to address balance issues.  Physical therapy can often be performed in the home making it easier for compliance.  Home therapy and PT for balance can greatly reduce ones risk of fall while improving balance and increasing strength and stability.  Therapists that are adept at addressing balance issues can develop individual programs for each patient to help reduce their risk of falling.

 Bracing

Over the past year, I have been utilizing bracing for many of my patients that have balance issues.  Balance issues occur from many problems, including stroke, neuromuscular disease such as Parkinson's disease, orthopedic issues such as hip and knee replacement, instability in the joints of the foot and ankle, medications, vision and hearing problems (vertigo, cataracts, etc.), neuropathy (Diabetics), etc.  Any issue that can reduce stability and balance is an indication for bracing.  

One of the types of braces I fabricate is called a dropfoot ankle foot orthosis (AFO).  This is a low-profile, lightweight brace that is applied to an existing shoe for patients that have developed dropfoot.  Dropfoot is a condition in which ones ability to flex the foot upward is compromised or lost.  This often leads to toe dragging that can cause one to trip over cracks in the pavement, and while walking up and down the stairs.  The dropfoot AFO is fabricated based on a mold of ones foot, ankle and lower leg.  The brace comes up a little bit higher over the ankle and is hardly noticeable when wearing long pants.  

Another brace I fabricate for my patients is the Moore Balance Brace (MBB).  The MBB is another super lightweight AFO that is made for both shoes.  The MBB is indicated for any condition that leads to risk of fall.  When I assess a patient for an MBB, I perform a comprehensive balance-risk assessment and gait evaluation.  The braces are fabricated from molds of the foot, ankles and lower legs and fit in your existing shoegear.  The MBB is THE GOLD STANDARD AFO for patients at risk of falling.  

In conclusion, an elderly patient's risk of fall is the leading cause of mortality in this population.  There are so many things that can be done to limit such risk.  
Here are some surprising statistics regarding risk of fall:

Falls, with or without injury, also carry a heavy quality of life impact. A growing number of older adults fear falling and, as a result, limit their activities and social engagements. This can result in further physical decline, depression, social isolation, and feelings of helplessness. The most profound effect of falling is the loss of independent living.  Don't let this happen to you.  Come in for a consultation to see if there is something that can be done for you.

Author
David Sands, DPM

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