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Fall Prevention SUBTITLE Erik B. Eller, MD ▪ Undergraduate Education ▪ University of Michigan ▪ Medical School Education ▪ Northwestern University- Feinberg School of Medicine ▪ Residency Training ▪ Northwestern University- McGaw Mecial Center ▪ Fellowship Training- Foot and Ankle ▪ Orthopaedic Associates of Michigan – Grand Rapids ▪ Center for Orthopaedic Research and Education ▪ Foot/Ankle and Fracture specialist Epidemiology ▪ One out of three people over the age of 65 falls each year ▪ In 2013, 2.5 million nonfatal falls treated in ED ▪ Of these, 734,000 were admitted to the hospital ▪ In 2011, 22,900 elderly people died from unintentional falls ▪ In 2012, the direct medical costs of falls were $30 billion Why are falls bad? Associated Injury ▪ 20-30% of people who fall suffer injuries such as lacerations, hip fractures, and head trauma ▪ In 2000, 46% of fatal falls in the elderly were due to traumatic brain injury ▪ Fall related fractures are twice as common in women as men ▪ In 2010, there were 258,000 hip fractures ▪ 95% of all hip fractures are caused by falls Hip Fractures https://encrypted-tbn1.gstatic.com/images?q=tbn:ANd9GcSUsIjK47c9eZ52QIb5QicC0qYaXh32iuwY5A03XZVKYkCWnYa Hip fracture fixation https://encryptedtbn1.gstatic.com/images?q=tbn:ANd9GcSUsIjK47c9eZ52QI Morbidity and Mortality Following Hip Fractures ▪ 30-day mortality is 9% ▪ 17% if acute medical problem ▪ 43% if patient develops pneumonia ▪ 65% if being treated for CHF ▪ Complications: pneumonia, blood clots, pressure sores ▪ Fixing hip fractures within 48hrs leads to less complications (14.7% vs 33.3%) and a higher likelihood of returning to independent living J Bone Joint Surg Am. 2008 Jul;90(7):1436-42 Incentive Spirometer and SCD Osteoporosis DIAGNOSIS Osteoporosis ▪ Osteoporosis is low bone density as defined on a DEXA scan <2.5 SD ▪ Osteopenia is bone density on DEXA <1.5-2.5 SD ▪ 10% of women over the age of 50yrs have osteoporosis ▪ 2% of men over the age of 50yrs have osteoporosis DEXA Scan ▪ Who should get a DEXA? ▪ ▪ ▪ ▪ ▪ estrogen deficiency in women at clinical risk for osteoporosis evidence of vertebral abnormalities long term steroid use patients with primary hyperparathyroidism the need for monitoring to assess response to approved drug therapies for osteoporosis. ▪ Duel Energy X-ray Absorptiometry ▪ Measure bone density at lumbar spine and hips ▪ Compared to health women ▪ T-score -1 to -2.5 is osteopenia ▪ T-score <-2.5 is osteoporosis Risk Factors for osteoporotic fracture ▪ A maternal history of a hip fracture ▪ Any previous fracture after the age of fifty ▪ Tall height at age of 25 ▪ Poor health ▪ Some sedatives and anticonvulsant drugs ▪ The inability to rise from a chair without the use of the arms Treatment and Prevention Fall Prevention ▪ Regular exercise focusing on leg strength and balance ▪ Evaluate medications that may increase fall risk ▪ Have eyes evaluated regularly to enhance vision ▪ Reduce trip hazards such as loose rugs and ground clutter ▪ Add grab bars in and around bathroom ▪ Railings on both sides of stairways ▪ Improve lighting around home Osteoporosis Treatment ▪ Postmenopausal women with T-scores less than -2.0, regardless of risk factors. ▪ Postmenopausal women with T-scores less than -1.5, with osteoporosis risk factors present. ▪ Treatment ▪ Bisphosphonates ▪ Vitamin D/Calcium ▪ Estrogen Vitamin D and Calcium Recommendations Life Stage Group Calcium Recommended Dietary Allowance (mg/day) Vitamin D Recommended Dietary Allowance (IU/day) Infants 0 to 6 months * ** Infants 6 to 12 months * ** 1 - 3 years old 700 ** 4 - 8 years old 1,000 600 9 - 13 years old 1,300 600 14 - 18 years old 1,300 600 19 - 30 years old 1,000 600 31 - 50 years old 1,000 600 51 - 70 years old 1,000 600 51 - 70 year old females 1,200 600 71+ years old 1,200 800 14 - 18 years old, pregnant/lactating 1,300 600 19 - 50 years old, pregnant/lactating 1,000 600 *For infants, adequate intake is 200 mg/day for 0 to 6 months of age and 260 mg/day for 6 to 12 months of age. **For infants, adequate intake is 400 IU/day for 0 to 6 months of age and 400 IU/day for 6 to 12 months of age. —Source: Institute of Medicine, December 2010 Enhance Physiology ▪ Get adequate calcium and Vitamin D- (1200mg and 800IU) ▪ Perform weight bearing exercises ▪ Get screened and treated for osteoporosis Thank You All! The CORE Institute : 866.974.2673 ▪ Toll-Free ▪ Thecoreinstitute.com
