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June 1, 2009

Fall Risk

I took a spill yesterday. I haven't fallen like that since I was six years old. I was in a hurry, and in the glare of flat light that an overcast day can create, shadows disappear. I caught my toe on the curb of a handicap cut-in, no less, and down I went with a spectacular roll. I'm lucky I didn't hit my head, but I got scraped up pretty good.

I'm more annoyed about my injuries than anything else. But it's the fall itself that bothers me. Old people fall. It's been drilled into our heads for the past year and a half to watch for fall risks in our patients, and they're usually elderly.

What characteristics constitute fall risks in people? Following is a list (I'm sure it's incomplete) of the most common reasons people fall.

1) Weakness: the ability to recover from tripping requires enough extensor strength (the power to straighten your legs) to elevate the body so the unaffected foot can clear the ground in order to catch yourself from the fall.

2) Flexibility: lack of flexibility in the ankle creates all kinds of difficulties with balance, the ability to walk, and the agility needed to quickly correct the body's trajectory following perturbation (being jostled).

3) Vision: if you can't see what's in front of you, you cannot anticipate approaching an obstacle. As we age, our vision naturally declines. Low light conditions make it hard for elderly eyes to adjust and see detail in their visual field. Also, as we age, our depth perception diminishes toward more tunnel vision. This is why older people really slow down when they descend stairs.

4) Vestibular: like eyesight, changes in the inner ear can occur that cause decline. Some changes result in hearing loss, others in the balance apparatus located inside the ear. Positional vertigo can occur with age or head trauma. When the vestibular system is affected by age-related degeneration, reliance on other senses such as vision and proprioception occur. Diabetes-related peripheral neuropathy makes it hard for individuals to feel how well their feet are in contact with the ground. Combine these three situations and the result can be devastating for a person's ability to balance, ambulate, or even live independently.

5) Polypharmacy: technically defined as 5 or more medications, the connotation of polypharmacy implies that so many medications are unnecessary. In reality, many people have multiple chronic medical conditions that are controlled through medication. Being prescribed 7 or 8 medically necessary drugs is not as uncommon as you'd think. Every drug has side effects. Even drugs perceived as benign have side effects. Aspirin can cause stomach upset, possibly bleeding, has blood thinning characteristics and is commonly used to prevent heart attack and control pain. Take a drug to counteract the bleeding, calm stomach pain, prevent bruising, etc and you're taking 4 or 5 medications right there.

Posted by linda at June 1, 2009 9:51 AM