Don’t Fall into the Trap of Discounting Falls


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As suggested by the title, this essay deals with a situation that is familiar to all and is considered a minor affliction which is unavoidable and overall is of little consequence. This like many other false health paradigms places one dangerously unprepared. Falls is a situation that is far more dangerous, especially to the elderly, than is commonly recognized. Reliable CDC data lists unintentional injury as the seventh leading cause of death in the elderly. The punch-line is that this killer is preventable!

 

Each year over 25 million Americans fall. This amounts to one out of every three people over 65 years of age. This risk balloons to half falling each year after 75 years of age. Falls are the leading cause of trauma-related death and disability in America─ by far. Over 2.5 million ER visits are from falls, and 700,000 are admitted to the hospital. Ninety-five percent of hip fractures are from falls and are the most common cause of traumatic brain injury.1 This hefts a price tag of over 34 billion Washingtons ($34,000,000,000)! By 2020 the cost of falls is expected to exceed $54,000,000,000!

 

The damage from falls that resulted in hospitalizations was not finished on hospital discharge; 20% or one out of five did not return to independent lives.2 And the overall mortality rate within a year from falling was 19%! Having taken a fall is a predictor of future falls. Add these adverse hurtful consequences and you must admit that 40% of the most severe falls changed the unfortunate faller’s life permanently.
I have had some friends who have taken serious falls recently and have suffered broken bones or needed stitches. Two close friends have had serious falls and afterwards required prolonged stays in rehabilitation hospitals, only to die soon after doubtful recoveries.

 

The accelerated death rate after serious falls may be attributable to the mental state the overall trauma the experience imposes. It has been shown that people having serious falls restrict future physical efforts and grow weaker and less steady as a result of decreased activity.

 

Better gait, especially gait speed, was associated with less mental decline over time.3 Balance and gait are both correlated with poorer decision making.4 It seems that balance and secondarily gait are forerunners of present and future mental status. Falls are secondary to the decline.

 

Thus, difficulties with balance and declining mental function both are associated with an increased risk of falls. Since gait depends on balance, gait quality can indicate balance deficiencies. Balance is an integral part of mental functioning; although we think of mental functioning as our “higher” functioning, a great deal of mental function is below the level of consciousness: including digestion, temperature regulation, and also balance.

 

Several tests are available which seek to determine an individual’s confidence in their stability and steadiness. The Activities-specific Balance Confidence Scale or ABC Scale is one. It proves how confident are you that you will not lose your balance or become unsteady when you go about your normal daily activities.” The tasks mentioned progress from walking around your house, to walking up the stairs, to walking on an icy sidewalk and asks that you quantify your comfort level from 0% to 100%.  The ABC Scale can be viewed by following this link – ABC Scale.  Another similar test is The Modified Falls Efficacy Scale (MFES) which is essentially the same.

 

There are a number of tests that directly test balance. One is to walk in a straight line and suddenly turn around and walk back. Another is to stand on one leg (nearby a chair, just in case) for as long as you are able. Normal is one minute; less than 30 seconds is a warning.

 

Protection from falls primarily involves two aspects: balance and leg muscle strength. People with balance difficulties have double the risk of falls.5 Numerous studies have proven that exercise programs improve balance. In the FAME study exercises at home reduced participant’s falls by 54%. Also, those who fell had less severe injuries.6

 

In another study, people at risk for falls (balance problems or falls) were started on weekly balance exercises and their balance, muscle strength, reaction time, physical functioning, and general health status improved. And they had 40% fewer falls.7

 

Lesser factors associated with falls are poor eyesight, inappropriate shoes (backless, smooth leather soles, and high heels), medications that cause unsteadiness, and household factors (clutter, poor lighting, and no railings on stairs).

 

 

1. CDC. “Important Facts About Falls.” In, (20016).
2. Craig, J., A. Murray, S. Mitchell, S. Clark, L. Saunders, and L. Burleigh. “The High Cost to Health and Social Care of Managing Falls in Older Adults Living in the Community in Scotland.” [In eng]. Scott Med J 58, no. 4 (Nov 2013): 198-203.
3. Mielke, M. M., R. O. Roberts, R. Savica, R. Cha, D. I. Drubach, T. Christianson, V. S. Pankratz, et al. “Assessing the Temporal Relationship between Cognition and Gait: Slow Gait Predicts Cognitive Decline in the Mayo Clinic Study of Aging.” [In eng]. J Gerontol A Biol Sci Med Sci 68, no. 8 (Aug 2013): 929-37.
4. Boripuntakul, S., and S. Sungkarat. “Specific but Not Global Cognitive Functions Are Associated with Gait Initiation in Older Adults.” [In Eng]. J Aging Phys Act (Jul 12 2016).
5. Muir, S. W., K. Berg, B. Chesworth, N. Klar, and M. Speechley. “Balance Impairment as a Risk Factor for Falls in Community-Dwelling Older Adults Who Are High Functioning: A Prospective Study.” [In eng]. Phys Ther 90, no. 3 (Mar 2010): 338-47.
6. Gawler, S., D. A. Skelton, S. Dinan-Young, T. Masud, R. W. Morris, M. Griffin, D. Kendrick, S. Iliffe, and team ProAct. “Reducing Falls among Older People in General Practice: The Proact65+ Exercise Intervention Trial.” [In Eng]. Arch Gerontol Geriatr 67 (Jun 29 2016): 46-54.
7. Barnett, A., B. Smith, S. R. Lord, M. Williams, and A. Baumand. “Community-Based Group Exercise Improves Balance and Reduces Falls in at-Risk Older People: A Randomised Controlled Trial.” [In eng]. Age Ageing 32, no. 4 (Jul 2003): 407-14.

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