Fall Prevention Strategy For Your Patients
Gravity is a fundamental force. If you remove it, you get gravy. 😊
As you ponder this ‘subtle’ dad joke, it's crucial to reflect on some concerning statistics that underscore the importance of reevaluating your approach to patient education regarding the elderly and their susceptibility to falls. It falls within the realm of chiropractors' responsibilities to not only inform patients about the potential risks associated with falling but also to conduct comprehensive assessments and provide targeted interventions to prevent future falls.
Over the past two decades, there has been a persistent and noteworthy 30% surge in falls among older people. Diminishing physical strength and increasing frailty contribute to the trend. An illustrative example of this decline is that a significant number of individuals over 80 now spend more than 12 hours each day seated. (1)
Is Falling An Issue?
Falling statistics in older adults:
Almost 40% of people over 70 fall at least once in an average year. (2)
1 in 5 of these falls results in serious injury. (3)
In the United States:
36 million falls annually.
8 million injuries.
3 million ER visits.
900,000 hospitalizations.
300,000 fractured hips. (1)
Consequences of hip fractures:
Nearly 25% of those who fracture their hip will be dead within a year.
50% of them won't return to their prior level of function. (1)
Why do the elderly fall at increased rates?
Falls may occur due to a combination of factors, including a lack of balance and weakness in the supporting musculature. Poor balance may lead to the act of falling, but it is the weakness within the foot that results in the inability to recover from falling. Here's how these factors can contribute to falls:
1. Vestibular System
This system is located in the inner ear and provides information about your head's position and movement in relation to gravity. It helps you maintain a stable head and detect changes in head position.
Evaluation of the Vestibular System
2. Visual System
Your eyes play a crucial role in maintaining balance by providing visual cues about your surroundings. Visual information helps you identify stationary and moving objects, aiding in balance and spatial awareness.
Evaluation of the Proprioceptive and Visual Systems
3. Proprioceptive System
Proprioception involves sensors in your muscles, tendons, and joints that provide information about the position of your body parts. This system helps you sense how your body is positioned and adjust your movements accordingly.
Can Chiropractors Reduce Fall Rates?
Yes. There must be a differentiation between a risk of falling due to weakness or balance. Falling happens when an individual struggles to regain their balance, and a crucial factor in this recovery is the strength and stability within their feet, enabling them to remain standing. Here are two ways to test if your patients can recover from a potential fall.
1. Testing The Anterior Fall Envelope for Balance
While standing upright with your arms at your sides, gradually lean forward as far as possible while keeping your hips and spine straight. Measure the final degree of forward lean from a neutral standing posture. Ideally, you can lean forward at least 4.5 inches. If a patient cannot recover within 4.5 inches, it's time to consider using the rehabilitation exercises at the end of this blog.
Anterior Fall Envelope Measurement
2. Testing Toe Strength
Toe strength is the single best predictor of a senior citizen falling is toe strength. Interestingly, there was no difference in quadriceps or ankle strength between the fallers and the non-fallers, confirming that toe weakness, not generalized weakness, is responsible for the falls.
Non-falling seniors had 20% more toe strength than the seniors who fell. (4)
Strength in the big toe is critical as it is one of the best predictors of impaired balance in older people (5).
Toe Dynamometer
Testing the strength gives you an exact number to monitor your patient's progress. The amount of strength also evaluates the reduced risk of falling. The big toe alone can exert a downward force equaling 52% of body weight. (6) Isolated strengthening is possible within a chiropractic office, and the results are significant. For every 1% increase in body weight generated beneath the big toe, the risk of falling decreases by 7%. (7)
Falls Prevention Program For Your Patients
For patients with weak toes and poor balance, prescribe simple at-home exercises. Like any skill, building balance and strength takes time and practice. It's essential to manage expectations, as noticeable improvements will take time. I have patients do these exercises twice a day for a month and provide weekly in-office appointments for treatment and guidance.
Veles’
Single-Leg Stance
Toe Pro
Hip fractures are a significant public health concern, with a high impact on patient well-being and healthcare costs. Among older adults, these fractures can result in reduced quality of life, increased medical expenses, and even mortality. Chiropractors, as experts in musculoskeletal health, play a pivotal role in preventing such incidents. They can help by addressing the link between musculoskeletal health and fall risk, offering fall risk assessments as part of routine care, and collaborating with other healthcare professionals. Incorporating fall risk assessments can improve patient outcomes, reduce pain, enhance mobility, and empower patients to take an active role in their fall prevention, aligning with the ethical and professional responsibility of healthcare providers.
For a complete guide and in-depth learning surrounding fall prevention, consider visiting Dr. Tom Michaud’s site, www.humanlocomotion.com. This site is a treasure trove of information helping evidence-based chiropractors treat many lower kinetic chain injuries.
As chiropractors, we often underestimate the range of conditions we can address. There's a common misconception that chiropractors are limited to treating only a few specific issues. With ChiroUp, you can access the knowledge necessary to broaden the spectrum of conditions your practice can effectively manage and offer to your community.
Explore our extensive library of 100+ conditions in the condition reference section in ChiroUp.
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https://www.cdc.gov/falls/facts.html
Petridou E, Manti E, Ntinapogias A, et al. What works better for community-dwelling older people at risk to fall? A meta-analysis of multifactorial versus physical exercise alone interventions. J Aging. Vol 21, Issue 5, 2009.
Alexander B, Rivara F, Wolf M. The cost and frequency of hospitalization for fall–related injuries in older adults. Am J Public Health 1992;82:1020–3.
Mickle, K, et al., ISB Clinical Biomechanics Award 2009: Toe weakness and deformity increase the risk of falls in older people. Clinical Biomechanics. 2009;24:787-791.
Spink M, Fotoohabadi M, Wee E, et al. Foot and ankle strength, range of motion, posture, and deformity are associated with balance and functional ability in older adults. Archives of Physical Medicine and Rehabilitation. 2011 Jan 1;92:68-75.
Jacob, H. Forces acting in the forefoot during normal gait: an estimate. Clinical Biomechanics. 2001;16:783-792.
Mickle K, Caputi P, Potter J, Steele J. Efficacy of a progressive resistance exercise program to increase toe flexor strength in older people. Clinical Biomechanics. December 2016;40:14-19.
