Risk factors and prevention of falls

Risk factors and prevention of falls

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Vitamin D may reduce the risk of falls by as much as 72 percent

Falling is not a big deal when you are young, but that changes with age. Most of us have seen the commercial where the woman has fallen and can’t get up. Although this commercial has been mocked, for older adults, falling can be seriously debilitating or cause life-threatening complications. In a study, 24 percent of people over the age of 71 who had at least one fall experienced reduced quality of life (J Gerontol A Biol Sci Med Sci. 1998;53A(2):M112-M119).

In a survey, 80 percent of women said they preferred death over the risk of a “bad” hip fracture from a fall that would cause loss of independence and nursing home admission (BMJ. 2000;320(7231):341-345). Unfortunately, falls in those over age 65 are quite common, with 30 to 40 percent falling annually (Clin Geriatr Med. 2002;18(2):141-158).

Now that I have your attention, what increases the risk of falls and what can we do to prevent them? When we think of the risk, we think of making the home safer by, for example, making sure that there are no loose rugs or by providing adequate lighting. But the potential causes and prevention go far beyond these steps. The factors that increase risk include chronic diseases, such as osteoarthritis, Parkinson’s, dementia, atrial fibrillation, AMD and cataracts, as well as obesity and medications.

Medication’s impact

Many patients over the age of 65 are on blood pressure medications. It turns out that diuretics (water pills) may increase the risk of falls. In a case-control study (those with high blood pressure compared to those without), nursing home patients who newly started diuretics or had their dose increased had a significant twofold increased risk of fall, especially the first day (Pharmacoepidemiol Drug Saf. 2012 May;21(5):560-563). Loop diuretics, such as Lasix (furosemide), had the most damaging effects on risk.

The authors recommend close surveillance of elderly patients for at least two days when initiating diuretic medications to treat high blood pressure. High blood pressure can be effectively treated with lifestyle modifications, such as an antioxidant-rich diet like the DASH diet that focuses on fruit, vegetables and low saturated fat (Circulation. 2010;122:A18589).

Chronic diseases

Those with osteoarthritis (OA), especially of the knee, are more likely to fall. This makes sense, since it is more difficult to walk with OA. In the GLOW study, a prospective (forward-looking) study involving postmenopausal women, those with OA had a 27 percent greater risk of falling, compared with those who didn’t have the disease (Ann Rheum Dis. online June 23, 2012). There was also a 21 percent increased risk of fracture that occurred, as well. Over 50,000 women with a mean age of 68 participated in the study. I recommend reading my article on the treatment and prevention of OA from July 10 for more details.

Obesity effect

We tend to associate falls and fractures with elderly patients who are gaunt and frail. However, it turns out that obesity increases the risk of falls. In an observational study, there was a linear relationship between obesity and fall risk (J Am Geriatr Soc. 2012 Jan;60(1):124-129). In other words, as patients increased their BMI, their fall risk went up proportionally.

Even more interesting, the risk of fracture increased with increasing BMI associated with obesity. Just a reminder that obesity is a BMI of 30 kg/m2 or over. According to the authors, the reason for obesity’s effect is that people who are obese have difficulty with balance. In this study, underweight patients did not have an increase in falls. To treat obesity, lifestyle modifications have shown significant results. And as you decrease weight and inflammation, it also helps to treat osteoarthritis.

Vitamin D

Although it is not surprising that vitamin D helps to prevent falls, since this supplement strengthens bones and muscle in the elderly, dose and frequency are determining factors of whether it is beneficial or detrimental. In a randomized controlled trial (RCT), the gold standard of studies, annual oral doses of 500,000 IUs of vitamin D3 actually increased the risk of falls and fracture in elderly patients, 15 percent and 26 percent respectively (JAMA. 2010;303:1815-1822).

However, when given on a daily basis, vitamin D does what we have come to expect, decreases the risk of falls and fractures with the appropriate dose. In a secondary analysis of a RCT, it was the lower doses of 200 IUs, 400 IUs and 600 IUs that were ineffective, while the higher dose of 800 IUs taken daily showed a large, statistically significant 72 percent reduction in the risk of falls (J Am Geriatr Soc. 2007;55(2):234-239).

The difference between this and the previous study on vitamin D was the frequency and dosing regimen. Hence, taking vitamin D is an easy and very efficient way to reduce falls and fractures in the elderly. Many elderly are deficient in vitamin D and should have their blood levels checked. Regardless of the results, they should receive at least 800 IUs of vitamin D — if not more — on a daily basis. This will either maintain or improve blood levels of vitamin D.

Exercise

In a RCT, exercise in women with a mean age of 65 increased the bone mineral density (BMD) of the spine by 77 percent compared to a control group, which had a 66 percent reduction in BMD. In other words, the women developed stronger bones with increased exercise. The trial design looked at the exercise group, which focused on increased exercise intensity, and compared it to a control group with low-intensity and low-frequency exercise. This translated into a significant reduction in fall risk for the exercise group.

We should be aware of the risk factors for falls. Complications from falls are the leading cause of mortality in older adults. This is not something to be taken lightly. Fortunately, many of the risk factors are modifiable with lifestyle changes, including a nutrient-dense diet, vitamin D supplementation and increased exercise.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management.  For further information, go to the website www.medicalcompassmd.com and/or consult your personal physician.

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