fall prevention news

Survey Suggests Higher Risk of Falls Due to Dizziness in Middle-Aged and Older Americans

May 26, 2009— A full third of American adults, 69 million men and women over age 40, are up to 12 times more likely to have a serious fall because they have some form of inner-ear dysfunction that throws them off balance and makes them dizzy, according to Johns Hopkins experts.

Among the other key findings of the three-year survey and study on the subject by the Johns Hopkins team are that a third of this group, or more than 22 million, were unaware of their vulnerability, having had no previous incidents of disequilibrium or sudden falls to suggest that anything was wrong.

In the survey, to be published in the Archives of Internal Medicine online May 25, these asymptomatic people were three times more likely to suffer a potentially fatal fall than people with a healthy sense of balance, whereas people already experiencing symptoms of imbalance had a 12-fold increase in risk.

Accidental falls are among the leading causes of death in the elderly, killing an estimated 13,000 seniors each year in the United States and resulting in more than one and a half million visits to hospital emergency rooms, experts say.

“Vestibular imbalances need to be taken seriously because falls can be fatal and injuries can be painful, lead to long hospital stays and result in significant loss in quality of life,” says Lloyd B. Minor, M.D., the Andelot Professor and director of otolaryngology – head and neck surgery at the Johns Hopkins University School of Medicine. Minor says that recent government reports estimate that fatal falls in the elderly cost the U.S. Medicare program nearly $1 billion in hospital charges, and those injured with broken bones cost an additional $19 billion.

More than 5,000 men and women over age 40 participated in the survey, which took three years to complete and involved specialized exams and balance testing to find out who had vestibular dysfunction, its early signs and symptoms, and who did not.

And the chance of having a balance problem, survey results showed, increases with age and diabetes. Eighty-five percent of men and women over age 80 had an imbalance problem, 23 times more than people in their 40s. And people with diabetes were 70 percent more likely to suffer from vestibular problems. Researchers say this is likely due to damage done by high blood sugar levels to the hair cells in the inner ear that facilitate balance control and to the long-term damage from diabetes to the inner ear’s small blood vessels.

“Our survey shows that balance testing needs to be part of basic primary care, and that all physicians need to be monitoring and screening their patients for vestibular dysfunction so that we can take preventive measures to guard against falling,” says Minor.

Lead study investigator Yuri Agrawal, M.D., says one reason for the large numbers of undiagnosed and untreated individuals is that balance testing requires specialized training and the tests take more time and effort to perform than other diagnostic or screening procedures.

As part of the new survey, study participants were subjected to a half dozen key tests of unsteadiness, including physical exams.

Balance function was assessed by subjects’ ability to stand upright with and without visual cues, such as being able to stand upright while wearing a blindfold or with their eyes closed, or by not having to use their arms to maintain balance while standing on a foam-padded mat.

“Now that we have identified the magnitude of balance problems, primary care physicians are more likely to be on the look out for its early signs and symptoms, and more attuned to when a patient needs to be referred to a physical therapist,” Agrawal says.

Minor points out that physical rehabilitation exercises can aid people with vestibular dysfunction. Balancing and walking exercises can be used to train the brain to compensate for inner-ear deficits and episodes of dizziness. One such exercise has unsteady people practice standing on one leg, while resting the other leg on a Styrofoam cup and trying not to crush it. Another exercise has people turning their head while walking.

Minor adds that people with vestibular dysfunction can take preventive steps to avoid falls in their homes, such as installing guard rails along stairs or hallways where a fall might occur, making sure rooms are well lit, and removing carpeting in places where people are more prone to trip.

Agrawal says the team’s next steps are to evaluate screening tools for identifying as early as possible which people are at a heightened risk of falling. She also says other risk factors, such as sleep patterns and nutrient deficiencies, which may play a role in predicting risk of falling, need further study. Various rehabilitation techniques should also be examined to pinpoint which techniques work best at preventing falls and, ultimately, to allow people to live longer and healthier lives.

Funding for this study was provided in part by The Johns Hopkins Hospital. However, the National Health and Nutrition Examination Surveys are funded directly by the National Institutes of Health.

In addition to Minor and Agrawal, other researchers involved in this research, conducted solely at Hopkins, were John Carey, M.D.; Charles Della Santina, M.D., Ph.D.; and Michael Schubert, Ph.D., P.T.

For additional information, please go to:
The Johns Hopkins Center for Hearing and Balance http://ww2.jhu.edu/chb/

Video clips of Minor and Agrawal commenting about the study plus clips of Schubert with a patient with vestibular dysfunction demonstrating some specialized balance tests can be found online May 26 at www.hopkinsmedicine.org.

Exercise Is Safe Bet to Prevent Falls in Older People

April 14, 2009 — Exercise programs that lend strength, flexibility and balance might be one of the best ways to prevent falls among people age 65 and older, according to a Cochrane review of more than 100 studies.

A variety of other measures — from pacemakers to vitamin D supplements — might be useful in preventing certain individuals from falling, but exercise appears to be the most widely effective strategy for reducing both the risk of falling and the overall number of falls among older people.

“It may not be possible to prevent falls completely, but people who tend to fall frequently may be enabled to fall less often,” said Lesley Gillespie, an orthopedic trauma specialist at the University of Otago in New Zealand and lead author of the review.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Each year, about 30 percent of people over age 65 who live outside of assisted care facilities experience a fall. Poor balance, diminished eyesight, the side effects of medications and dementia are among the reasons older people sometimes fall.

One in five of these falls could require medical attention, but even without causing serious injury, falling can make individuals fearful of leaving their homes or participating in activities, the Cochrane researchers noted.

“Falling puts a strain on the family and is an independent predictor of admission to a nursing home,” Gillespie said.

Gillespie and colleagues examined 111 studies of falling prevention measures, which included more than 55,000 people from 15 countries. The studies suggest that group exercise programs, Tai Chi and home exercise programs all reduce the risk of falls and the rate of falling.

“Effective exercise programs for reducing falls focus on balance, strength and flexibility, and challenge the older adults to improve in all of these components,” said Bonita Lynn Beattie, a physical therapist and vice president for injury prevention at the Center for Healthy Aging. She suggested that older adults should check in with their primary doctor before beginning an exercise program, especially if they “have significant weakness, balance issues or dizziness.”

Other preventive measures might only be effective for small, targeted groups. For instance, “taking vitamin D supplements probably does not reduce falls, except in people who have a low level of vitamin D in the blood,” Gillespie said. Similarly, cataract surgery and insertion of a pacemaker can help specific groups of people with poor eyesight or certain blood pressure conditions fall less often.

Anti-slip devices worn on shoes during icy conditions and reviewing medications regularly are also effective in reducing falls. In some cases, gradually reducing the dosage of sleep aids and depression medicines can reduce the number of falls experienced by an individual, the researchers found.

Behavioral changes can also make a difference, Beattie said. “An older adult should probably reconsider climbing on a ladder to clean gutters or using a chair to change a light bulb or reach high shelves,” she said.

Gillespie said that the findings “may not be applicable to older people with dementia,” since most of the studies in the review “specifically excluded them from participation.”

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org/ for more information.

Gillespie LD, et al. Interventions for preventing falls in older people living in the
community. Cochrane Database of Systematic Reviews 2009, Issue 2.