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November 26, 2013

Prognosis Following a Fall

It is not new that falls among the elderly are dangerous and can lead to life changing disability. The statistics are frightening: 1 in 3 people over age 65 will fall each year. Fall prevention has been a huge initiative from the federal government since the 1990s. A quick rundown of their suggestions for prevention:
1) physical activity, especially exercise
2) with your doctor's assistance, reduced the number of medications your take
3) get regular vision checks and make sure stairs and hallways are well lit
4) prevent fall risks at home by removing throw rugs, installing grab bars/railings in bathrooms, hallways, and stairwells.

I participated in a fall prevention clinic when I did an internship at the VA in Birmingham, AL. It was one of the most exciting and rewarding activities during my training. Today, I work at an in-patient facility, evaluating patients every week. One of the questions we ask is, "have you fallen in the past 2 months?" and if so, "how many times." If the answer is "yes," we evaluate patients' fall risk using the Tinetti Balance Assessment tool.

Many falls among the elderly go unreported, especially if they do not result in injury. Many who fall end up in rehab with me because of a resulting hip fracture or head injury. So, what predicts a full recovery or lasting disability in the elderly following a fall incident? New York Times' Paula Span tackles this question in The New Old Age.

The answer to that question is multifactoral. From a physical therapy perspective, prior level of function plays a huge part in predicting recovery from a fall injury. The higher the function prior to an accident, the more likely we'll be able to return that patient to function. Another factor is a patient's medical conditions. If a patient is found to have a progressive or terminal illness, then their prognosis will likely decline over time. The nature of the injury plays an important role: hip fractures are more difficult to recover from than other injuries sustained from a fall.

The probability of recovering diminished with increasing disability before the fall. Among those with moderate disabilities, only a third recovered within a year. And “if you start off severely disabled, you’re not going to get that rapid or even gradual recovery.”

So, the results of this research begs a question: How will these findings impact health care policy in the context of health care reform? As health care budgets tighten, does it make sense to spend large quantities of money on the care of people whose positive outcome has diminishing returns? As health care dollars diminish, do we begin to pick and choose who is treated with aggressive rehabilitation? What would you choose if it was your mother?

Posted by linda at November 26, 2013 7:52 AM

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