Common-sense actions cut falls in elderly: study

By Gene Emery
17 july 2008--Falls by elderly people are cut significantly when health care providers take basic steps such as prescribing physical therapy, monitoring medications and checking standing blood pressure, researchers said on Wednesday.
Such a program in Connecticut reduced the number of falls among people age 70 and older by 9 percent, Dr. Mary Tinetti of the Yale School of Medicine and colleagues reported.
Their program resulted in about 1,800 fewer hospitalizations or trips to the emergency room and an 11-percent reduction in fall-related medical services.
"In addition to discomfort and disability averted, this decrease represents a potential savings of more than $21 million in health care costs on the basis of an average acute care cost of $12,000 per event," they wrote in their report, published in the New England Journal of Medicine.
In 2005, nearly 300,000 Americans had hip fractures associated with a fall, and an average of 24 percent of hip-fracture patients aged 50 and over died in the next year, according to the National Osteoporosis Foundation.
Among people over 65, fall-related injuries account for 10 percent of the cases that show up in an emergency department and 6 percent of hospitalizations.
LOWER PRIORITY
There is also evidence that doctors don't do enough to prevent them.
"If you ask most old people and clinicians, they will say falls are common, but it's not considered a disease or health condition on par with strokes or heart attacks. It hasn't sunk in that it's the responsibility of clinicians to recognize and prevent them," Tinetti said in a telephone interview.
Her team spent four years encouraging doctors and other health care providers to reduce, if possible, the doses of medicines that might increase the risk of falling.
They were also urged to measure blood pressures while standing, as well as lying down, because older people can lose consciousness when their blood pressure drops suddenly as they stand.
And the health care workers were encouraged to send older patients to physical or occupational therapists if they needed to improve their balance and strength.
At the end of the study, the researchers, using data maintained by the Connecticut Hospital Association, found that the annual risk of serious fall-related injuries had gone from 3.19 per 100 people to 2.86. In another area of the state where the interventions were not done, the risk went from 3.12 to 3.14.
"That's a similar magnitude to what you see for a lot of heart attack prevention and stroke prevention," said Tinetti.
Another team, at Harvard University and the Massachusetts Institute of Technology in Cambridge, took a more high-tech approach with shoe insole technology that could help doctors detect balance problems.
The device, developed by government-funded research, is based on technology used by NASA to help monitor balance problems in astronauts returning from space, MIT said in a statement on Wednesday.
It analyzes the pressure distribution of the foot and transmits the information to a computer that analyzes the data. The plans are to equip the insoles with an alarm to alert family members of any falls.