Monday, December 31, 2012

Different fall risk factors for different people

from...DontFall.ca Posted on December 28, 2012

We’ve talked a lot about falls and fall risk, but it occurs to me that we’ve not actually defined what a fall is. Over the years there have been a number of different definitions that have been proposed, mostly subtle twists on one another. But the definition that has persisted and is now generally accepted as THE definition of falling is:

“an unexpected event in which the person comes to rest on the ground, floor, or lower level.”

When I’m talking about falling, that’s what I mean. Today, I want to talk about a scientific paper that I recently came across, which provided an excellent review of risk factors for falling among older adults ( click here for more information about the published paper).

It’s possible that different groups of older are affected by different risk factors for falling. The purpose of the study was to see if this is true. Overall, can a system be developed that could be helpful in reducing falls for individual people?

The first step in this study was to test each person on measures of: vision, proprioception, muscle strength, reaction time, and balance. This set of tests screened the participants and categorized them into “low fall risk” and “high fall risk” groups. 500 community-living older people (70-90 years old) participated in the study, and 166 of these people fell in the next year. Note that this is exactly what we’d expect, that 1/3 of community-living people over the age of 65 would fall. What’s really interesting though, is that once people were split into the low and high risk groups, different factors took over for explaining fall risk.

In the low fall risk group, disability (determined as mobility, mental function, and pain) and exercise were the factors that predicted fall risk. In this group, only 10% of those folks who reported no disability fell in the next year. In comparison, 30% of those with any level of disability – those who reported some disability – fell in the next year. And those who reported some disability were more likely to have fallen if they also reported that they do not exercise, or if they do more than 4 hours per week of exercise. It seems that doing some exercise was protective for those who were deemed to be at low risk of falling.

In the high fall risk group, different factors were associated with fall risk. 72% of folks in the high-risk group also demonstrated some level of impaired mental function, and almost half of these people fell in the next year. Only 25% of those with normal mental function fell in the next year. Those with impaired mental function were more likely to fall if they also demonstrated reduced ability to control their balance under challenging circumstances – reduced “dynamic balance.”

Here is how it all breaks down for community-living older adults:

...Those in the low fall risk group, but having some level of disability and not engaging in any exercise (or doing excessively too much exercise) are at a 37% risk of falling in the next year; those without disability are only at a 10% risk of falling;

...Those in the high fall risk group, with impaired mental function, poor dynamic balance, and who do no exercise are at the highest risk of falling, 57%, in the next year.

Based on the results of this study, what can you do to reduce your fall risk?

...Muscle strengthening exercise – increase the strength of your leg muscles;

...Vision – get your eyes checked and ensure that you have the proper and best prescription for your vision

...Balance exercise – we’ve talked about balance exercises before (click here for a quick review), but this is so important that we’ll talk about it again in a later post

...Regardless of whether in the low or high risk group, depression increased the risk of falling, so seek help for any symptoms or signs of depression (we’ll focus on the relationship between depression and fall risk in a later conversation)

...Those in the high-risk group may be best served by a group-exercise approach, which can be encouraging as well as supervised.

These are five things that any older person can do, and all older people should address, to reduce their risk of falling. We’ll continue talking about all of these things (and more), so come back and keep reading. And please tell your friends.