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Northeastern Pennsylvania is home to a large elderly population and many of the medical problems we expect to see are age related. Dedicated medical practitioners are in constant search for new knowledge and information to prevent or delay many age-related problems. One of the most devastating problems associated with aging is falling.

Loss of balance causes falls. Falls are a leading cause of injury and death. Thirty percent of women and thirteen percent of men over the age of sixty-five will fall. Twenty to thirty percent of these individuals suffer moderate to severe injuries. Preventing falls is not an easy task. A good understanding of the causes of loss of balance and knowledge of a few fall prevention suggestions can enhance your balance and reduce your risk of a fall.

The Falls Risk Self-Assessment below allows an individual to determine their risk of falling AND take the appropriate steps for prevention and treatment. The next three weeks will be dedicated to this topic to educate and inform readers and their families to make good decisions.

The Falls Risk Assessment is from the Centers for Disease Control (CDC).

WHAT IS YOUR RISK OF FALLING?

1. I HAVE FALLEN IN THE PAST YEAR.  YES (2) NO (0) People who have fallen once are likely to fall again.

2. I USE OR HAVE BEEN ADVISED TO USE A CANE OR WALKER TO GET AROUND SAFELY.  YES (2) NO (0) People who have been advised to use a cane or a walker may already be more likely to fall.

3. SOMETIMES I FEEL UNSTEADY WHEN I AM WALKING. YES (1) NO (0) Unsteadiness or needing support while walking are signs of poor balance.

4. I STEADY MYSELF BY HOLDING ONTO FURNITURE WHEN WALKING AT HOME.                YES (1) NO (0) This is also a sign of poor balance.

5. I AM WORRIED ABOUT FALLING.   YES (1) NO (0) People who are worried about falling are more likely to fall.

6. I NEED TO PUSH WITH MY HANDS TO STAND UP FROM A CHAIR.  YES (1) NO (0) This is a sign of weak leg muscles, a major reason for falling.

7. I HAVE SOME TROUBLE STEPPING UP ONTO A CURB.   YES (1) NO (0) This is also a sign of weak leg muscles.

8. I OFTEN HAVE TO RUSH TO THE TOILET.  YES (1) NO (0) Rushing to the bathroom, especially at night, increases your chance of falling.

9. I HAVE LOST SOME FEELING IN MY FEET.  YES (1) NO (0) Numbness in your feet can cause stumbles and lead to falls.

10. I TAKE MEDICINE THAT SOMETIMES MAKES ME FEEL LIGHT-HEADED OR MORE TIRED THAN USUAL. YES (1) NO (0) Side effects from medicines can sometimes increase your chance of falling.                       

11. I TAKE MEDICINE TO HELP ME SLEEP OR IMPROVE MY MOOD. YES (1) NO (0) These medicines can sometimes increase your chance of falling.

12. I OFTEN FEEL SAD OR DEPRESSED. YES (1) NO (0) Symptoms of depression, such as not feeling well or feeling slowed down, are linked to falls.

SCORE YOUR RISK.

Add up the number of points for each YES answer. If you have scored 4 or more points you may be at risk for falling. Accordingly, 0-1 = Low Risk; 1-2 = Moderate Risk; 3-4 =  At Risk; 4-5 = High Risk; 5-6 = Urgent; > 6 = Severe

Low    Moderate     At Risk     High Risk   Urgent   Severe

0          1          2          3          4          5          6          7          8         

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”   Next Monday Part I of III on Balance Disorders and Falls Prevention

Read all of Dr. Mackarey's articles at https://mackareyphysicaltherapy.com/forum/

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate clinical professor of medicine at GCSOM.

3^rd of 3 Columns on Balance Disorders and Falls Prevention

Preventing a fall can not only save your independence but also your life! Preventing injuries from falls reduces the need for nursing home placement. Injuries from falls are the seventh leading cause of death in people over the age of sixty-five.

The following suggestions will assist you in minimizing your risk of a fall:

• Diet & Hydration: Proper nutrition and hydration provides adequate amounts of vitamins and minerals to maintain energy levels and prevent drowsiness. Adequate hydration is also important. Treat dehydration from fever, diarrhea and vomiting by drinking plenty of fluids. You may need IV fluids administered in hospital.
• Exercise: Exercise and activity improves strength, flexibility and balance.
• Medication: Consult a pharmacist or physician regarding medications that can cause: drowsiness, dizziness, lightheadedness, faintness, fatigue, tiredness, unsteadiness, blurred vision, double vision, confusion, or otherwise affect alertness, balance or coordination.
• Positional Changes: Avoid sudden drops in blood pressure by avoid sudden changes in posture and position, standing up slowly, sitting for a few minutes and tapping your toes before getting out of bed and raise head of bed with a wedge pillow.
• Alcohol: Be cautious with alcohol since it interferes with alertness, balance, coordination and reflexes.
• Illness: Treat respiratory infections such as ear infections, colds, flu, sinus congestion to prevent labyrinthitis and Meniere’s disease.
• Frequent Urination: Be cautious with urgency, especially at night.  Consider bedside commode and a grab bar by toilet. Turn lights on and put on eyeglasses to supplement vision. Night lights are recommended. A pendant alarm may be beneficial.
• Vision: Check eyesight and hearing regularly. Poor eyesight makes it difficult to see potential hazards. Update old eyeglasses. Inner ear problems can affect balance. Adequate lighting is paramount. Light switches should be within reach without getting out of bed and on both ends of hallway. Nightlights in bedroom, bathroom and hallway are recommended. Keep a flashlight handy. Turn lights on when entering house and at night.  Use light paint and wallpaper to reflect more light. Use 100 watt bulbs for an adequate amount of light.
• Assistance Devices: Use assistive devices when negotiating uneven terrain or when you feel weak or tired. To avoid falls in the bathroom install grab bars in the shower, tub, and toilet areas. Use bathmats with suction cups or nonslip adhesive strips in tub/shower. Consider a shower stool or bench and an elevated toilet seat.
• Good Footing: Proper footwear with a flat sole, wide base and nonslip grips are important. Footwear should be tied securely and fit snugly. Do not walk in stocking feet
• Remove Hazards: Inspect your floors for hazards! Remove rugs and runners that slip or attach nonslip backing. Tack loose rugs. Glue vinyl flooring. Keep pathways free of electrical/telephone cords. Remove wax from floors. Mops up spills promptly.
• Safety on Stairs: Install secure handrails on both sides. Improve lighting. Ensure carpeting on stairs is firmly attached. Highlight with tape or paint edges of steps especially if narrow or higher/lower than the rest. Paint outdoor steps with a mixture of paint and sand for better traction. If carrying item up or down steps, use handrail.
• Walkways: Sidewalks and walkways should be clear, well lit and free of snow and ice. Salt or sand if slippery. Repair uneven paving.
• Eliminate clutter: Do not store items on steps. Rearrange furniture to move around easier. Watch out for pets. Avoid stepping over pets.
• Store Items Within Reach: Limit reaching by storing frequently used items where they can be reached easily. If reaching is required, use a stepstool with high, sturdy handrails. Repair or discard wobbly stools. Do not use a chair to reach for items.

Following these helpful hints will keep you safe by preventing a loss of balance and a potential fall!

Medical Reviewers: Mark Frattali, MD, ENT at Delta Medix, Division Chairman Otolaryngology – Head Neck Surgery at Commonwealth Health Regional Hospital

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

Read all of Dr. Mackarey's articles at https://mackareyphysicaltherapy.com/forum/

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

1^st of 3 Columns on Balance Disorders and Falls Prevention

Northeastern Pennsylvania is home to a large elderly population and many of the medical problems we expect to see are age related. Dedicated medical practitioners are in constant search for new knowledge and information to prevent or delay many age related problems. One of the most devastating problems associated with aging is falling. It will be the purpose of this series of three columns to educate readers about the risks and causes of falling and the prevention and treatment of balance disorders.

Loss of balance causes falls. Falls are a leading cause of injury and death. Thirty percent of women and thirteen percent of men over the age of sixty-five will fall. Twenty to thirty percent of these individuals suffer moderate to severe injuries. Preventing falls is not an easy task. A good understanding of the causes of loss of balance and knowledge of a few fall prevention suggestions can enhance your balance and reduce your risk of a fall.

The causes of loss of balance which may lead to a fall are divided into three categories: age related changes, medical conditions and medications.

Age Related Changes affecting the sensory system, the musculoskeletal system as well as psychological behavior can negatively impact balance causing a fall:

• Sensory factors that impact balance are maintained through combined sensory input from the eyes, the joints and the inner ear. Sensory deprivation decreases balance and increases fall risk. Visual changes with aging include a decrease in visual acuity, visual field and depth perception. Decreased joint position sense, (joint proprioception) especially in the legs, leads to increased sway and reliance on vision, which is already impaired. Decreased input from the inner ear (vestibular system) negatively impacts eye stability and head orientation.
• Musculoskeletal factors with aging can cause unsteadiness during walking: deceased leg muscle strength especially quadriceps, arthritis in low back/hips/knees resulting in leg pain, stooped posture and leg length discrepancies.
• Psychological factors can also interfere with balance. Fear of falling increases with age. Denial of frailty leads to poor judgment when performing certain tasks. Anxiety and depression not only decreases attention and awareness of environment but may also cause poor sleep leading to drowsiness during the day.

Medical Conditions can also cause loss of balance increasing the risk of a fall:

• Cardiovascular conditions may cause loss of balance due to dizziness or lightheadedness caused by a sudden change in blood pressure. These include: abnormal heart rhythm, heart attack and heart failure. Orthostatic hypotension is an excessive fall in blood pressure on assuming the upright position (quickly standing up after lying down). Syncope (fainting) is a sudden brief loss of consciousness due to decreased blood flow to the brain. Vertebral artery insufficiency occurs from leaning head back too far compromising arterial blood flow to the brain causing dizziness.
• Neurologic conditions  can negatively affect sensory input (visual, vestibular and joint proprioception) and motor (muscular) responses and result in loss of balance. These include: multiple sclerosis, epilepsy (seizures), brain tumor, stroke, Parkinson’s disease, peripheral neuropathy, cerebellar degeneration and head trauma.
• Cognitive conditions contribute to loss of balance because of poor judgment and behavioral problems (e.g. dementia and Alzheimer’s disease).
• Vestibular conditions cause vertigo (sensation that the room is spinning or moving) resulting in loss of balance. Benign Paroxysmal Positional Vertigo (BPPV) is caused by a change in the position of the head when debris is lodged in a symptomatic part of the inner ear. Labyrinthitis is a viral infection of the inner ear following a cold or flu. Meniere’s disease is a common inner ear problem resulting in vertigo and ringing in the ears.
• Genitourinary conditions can contribute to loss of balance. For example, individuals with bladder control problems (incontinence) use poor judgment by moving quickly, especially at night, to prevent an “accident”.
• Endocrine conditions can produce dizziness causing loss of balance.  Hypoglycemia (low blood sugar associated with diabetes) causes dizziness.

• Gastrointestinal conditions may lead to loss of balance. During defecation syncope, fainting is caused by a decrease in arterial pressure when bearing down to assist a bowel movement. Any condition resulting in dehydration (diarrhea/vomiting), decreases blood volume which may cause lightheadedness and loss of balance

Medications can also negatively effect balance and increase the risk of falls. Interactions between medications as well as the side effects of certain medications can cause dizziness or drowsiness resulting in loss of balance. Theses medications include: tranquilizers, sedatives, anti-depressants, alcohol, diuretics, blood pressure medications, cardiac medications, laxatives and pain killers.

In conclusion, determining who is at risk for a fall is a complex task since many factors including age, disease and medication can affect the outcome. Early intervention to prevent a fall can avoid many costly consequences.

Medical Reviewer: Mark Frattali, MD, ENT at Delta Medix, Division Chairman Otolaryngology – Head Neck Surgery at Commonwealth Health Regional Hospital

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”   Next Monday Part II on Balance Disorders and Falls Prevention

Read all of Dr. Mackarey's Articles at: https://mackareyphysicaltherapy.com/forum/

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate clinical professor of medicine at GCSOM.