Fall Risk at Home
Foot Health

Are you a fall risk? Ask yourself 3 questions

Fall risk key takeaways:

  • Every second an older adult falls. Data sources: National Vital Statistics System, National Electronic Injury Surveillance System-All Injury Program, and Behavioral Risk Factor Surveillance System.
  • Falls can lead to devastating outcomes. Therefore, get screened by your doctor for fall risk.
  • STEADI: Stop Elderly Accidents Deaths and Injuries is the current initiative by the CDC to tackle this massive problem.
  • Falls are preventable. Importantly, do daily balance exercises and know your fall risk. Also, wear the right footwear.

How have falls affected your life?

Have you received the call that your mom or dad fell in the bathroom and suffered a brain injury or a broken hip? How many of you have fallen? Here’s the scoop on better understanding your fall risk and how to protect yourself or someone you love.

Thirty-six million falls a year, 3 million trips to the emergency room and thirty-two thousand deaths add up to a massive problem.(1,2) Every second an older adult falls. The CDC projects fall rates will worsen as our population ages. As a podiatrist, fall prevention has my full attention.

Guideline for Prevention of Falls

The Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative was developed by the CDC based on the American and British Geriatrics Societies’ Clinical Practice Guideline for Prevention of Falls in Older Persons. The up to date CDC recommendations for doctors include STEADI screening patients at risk, assessing modifiable risk factors and intervening using effective strategies.(3)

What are the consequences of falls according to the CDC?

  • Falls are the leading cause of traumatic brain injuries
  • Falls or fall injuries increase the risk of nursing home placement
  • Fall death rates increased about 30% between 2009 and 2018 (4)

Primary care clinics, podiatrists and physical therapists are happy to screen and discuss your fall risk factors and concerns.

The 3 key fall risk screening questions are:

1. Have you fallen in the past year? If you’ve fallen once, you’re more apt to fall again.

2. Do you feel unsteady when standing or walking? Importantly, unsteadiness is a sign of poor balance.

3. Are you worried about falling? If you’re worried about falling, in fact, you’re more likely to fall.

A “yes” to any of the three questions above results in a significantly increased risk of falling particularly if you’re an older adult (over 65). (5) Importantly, a thorough fall risk factor assessment also includes identifying these risk factors:

Top 10 Fall Risk Factors (6)

1.History of falling

What were the circumstances of the fall such as place and time of day?

2.Gait, strength and balance

Are there identifiable walking issues? In other words, a limp? Shuffling? Weakness? A podiatrist or physical therapist can perform timed up and go tests and 4-stage balance tests to measure mobility. Importantly, looking to decrease your risk starting today? Tai chi or pilates based balance exercises can in fact increase strength and balance. (7)

3.Medications that increase fall risk

Review your medication list. In fact, work closely with a pharmacist to identify medicines that subsequently can increase fall risk. 

A medicine may increase fall risk if (8):  

~the central nervous system is affected

~it can cause hypotension or low blood pressure 

~sedation and confusion are side effects

4.Home hazards

Loose throw rugs, low lighting, slippery floors and electric cords are all linked to falls. Complete the check for safety in your home brochure. As a result, you will identify the risk factors to avoid danger in your house. (9)

5.Postural hypotension

Feeling light headed when sitting up or standing from lying down indeed can be a fall risk factor. As a result, have your blood pressure checked and always stay hydrated. (10)

6.Visual Impairment

Firstly get your eyes examined, secondly check how clean your glasses are and importantly, discuss switching from bifocal to single distance lenses if walking for exercise outside the home. (11)

7.Feet and footwear issues

Wearing improperly fitted shoes, shoes with slippery soles, or socks without treads can subsequently increase fall risk. If you have foot problems, definitely see a podiatrist. (12) In addition, I also advocate wearing well fitted treaded socks if shoeless.

8.Vitamin D deficiency

Low Vitamin D is linked with increased fall risk. Have it checked by your doctor, and importantly, take supplements if advised. (13)

9.Health conditions that increase fall risk

Cognition Problems

Parkinson’s Disease

Cardiac Issues

Depression

10.Incontinence

Frequent unplanned trips to the bathroom along with “accidents” can result in significant fall risk.

The bottom line for fall risk

To sum it up, falls are preventable. Clinics and hospitals now have tools and resources to help healthcare providers Screen, Assess, and Intervene. As a result, this reduces fall risk. So now is the the time to work with your doctor to understand fall risk factors. In fact, now is the time to implement a fall prevention plan for you and the older adults in your life.

Prevent falls! Learn your fall risk!
references
  1. Centers for Disease Control and Prevention (CDC). Web-based injury statistics query and reporting system (WISQARS). Atlanta, GA: National Center for Injury Prevention and Control. [cited December 3, 2020]. Available from: https://www.cdc.gov/injury/wisqars/index.html
  2. Centers for Disease Control and Prevention (CDC). Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: Centers for Disease Control and Prevention. [cited December 3, 2020]. Available from: https://wonder.cdc.gov 
  3. Stevens JA, Phelan EA. Development of STEADI: a fall prevention resource for health care providers. Health Promot Pract. 2013;14(5):706-14. 
  4. https://www.cdc.gov/steadi/pdf/STEADI_ClinicianFactSheet-a.pdf
  5. https://www.cdc.gov/steadi/pdf/STEADI-PocketGuide-508.pdf
  6. LeeR.TheCDC’sSTEADIInitiative:promotingolderadulthealthandindependencethroughfallprevention.Am Fam Physician. 2017;96(4):220-221.
  7. LiF,HarmerP,FitzgeraldK,EckstromE,StockR,GalverJ,etal.Taichiandposturalstabilityinpatientswith Parkinson’s disease. N Engl J Med. 2012;366(6):511-9.
  8. https://www.cdc.gov/steadi/pdf/STEADI-FactSheet-MedsLinkedtoFalls-508.pdf
  9. https://www.cdc.gov/steadi/pdf/STEADI-Brochure-CheckForSafety-508.pdf
  10. Gangavati A, Hajjar I, Quach L, Jones RN, Kiely DK, Gagnon P, et al. Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study. J Am Geriatr Soc. 2011;59(3):383-9.
  11. Haran MJ, Cameron ID, Ivers RQ, Simpson JM, Lee BB, Tanzer M, et al. Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial. BMJ. 2010;340:c2265.
  12. Spink MJ, Menz HB, Fotoohabadi MR, Wee E, Landorf KB, Hill KD, et al. Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial. BMJ. 2011;342:d3411. 
  13. Murad MH, Elamin KB, Abu Elnour NO, Elamin MB, Alkatib AA, Fatourechi MM, et al. Clinical review: the effect of vitamin D on falls: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2011;96(10):2997-3006.

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