Health matters

Musculoskeletal pain increases risk of falls

Conway McLean, DPM, Journal columnist

When questioned on the topic of the most debilitating condition afflicting our senior citizens, few Americans will talk about the consequences of falls. Yet, every second of every day, a senior suffers a “low level” fall in the United States. This is one not involving a fall from a height like a ladder, but down to the level of your supporting surface. Falls are the leading cause of injury and injury death in those over 65 years of age. And one out of five falls results in damage, like a broken bone or sprain.

September was Fall Prevention month, but there was little fanfare marking the event. Yet, falls are a significant health hazard in the senior population, costing our healthcare system billions of dollars, 50 according to a CDC estimate. But the consequences of falls obviously go far beyond the dollars, significant as they are. Some estimates place the number of lives lost at nearly 32,000 deaths a year.

Falls occur for many reasons with age being a huge factor. In addition, the years take a toll on our ability to heal. A senior is not able to recover from the damage after a “little tumble” on the sidewalk or over a throw rug like a young person. And with their better reflexes and strength, the youngster can more often avoid the fall. In a senior, the result is more likely a broken bone, head trauma, or worse. Nearly one out of 20 falls in those over 70 years of age result in death.

Elderly individuals, injured in a fall, are more likely to require extensive efforts to recover. Especially common is prolonged hospitalization, perhaps to resolve the pneumonia which resulted from inactivity, or the bedsore caused by not moving after a hip fracture repair. Hip fractures and the surgical repair is associated with many complications, like post-op infections, blood clots, cognition changes (thinking abilities), or breathing problems. The risk of any of these consequences of a hip fracture repair increases with advancing age.

There are numerous additional risk factors for low-level falls besides aging, including such disparate risks as medication side effects or a painful callus. Some are social issues. Those having a sedentary lifestyle, leading to muscle atrophy and weakness, increase the likelihood of “going down.” Many chronic diseases, neurologic conditions especially, can cause problems with gait and balance, resulting in potentially catastrophic, life-threatening falls.

Musculoskeletal pain is an independent risk factor for falling via several different mechanisms. When a lower extremity part, be it a joint, a bone, or a tendon, produces pain when used for standing or walking, the brain will act to prevent that pain by not allowing it. The symptomatic limb will “give out” to the surprise of the sufferer. Alternatively, pain from an arthritic ankle will alter your gait, again, making someone more susceptible to a fall.

Many of these falls are thought to be preventable, although the changes required to reduce fall risks are not easy. Physical fitness has been proven time and again to be an effective approach. Improved muscle strength and tone allows the body to resist better the pull of gravity while navigating this treacherous planet. Any physical activity, when performed in the correct way, can improve blood flow as well.

Improving fitness is best achieved with an exercise program geared for this purpose, helping seniors avoid falls. Studies have found these programs, working with a physical therapist, either at a facility or by visiting the patient, to reduce their incidence. Home visits by a physical therapist may be the most practical approach for those with mobility problems. The goal is to work on the appropriate muscles and the needed skills in an organized, research-based, approach. These programs have been shown to reduce the number of falls occurring over a 12-month span by 36%.

Most falls experienced by seniors occur at home. Consequently, fall-proofing your home is surprisingly effective in reducing these untoward events. Removing cords and throw rugs from pathways, having some lighting in hallways, these and other recommendations will reduce these obstacles to safe ambulation in the home.

Many medications have been implicated in impairing balance and stability. If you have concerns about your balance, a conversation should be held with your primary care provider about your meds and their potential for impairing balance. Vision problems can lead to falls (if you can’t see where you are going…) so having it tested can help.

Because of the effects of chronic pain on gait and stability, especially to seniors, treating gait-related pain is helpful to reducing the number of falls. The result is a reduction in the morbidity and mortality that can result. Many methods of dealing with these common conditions have been utilized. Whether it means a custom brace or one of the new regenerative medicines, many options are out there besides surgery. And minimally invasive surgical techniques have been developed for many painful ailments. Because of the significant reduction in the trauma produced, these methods are beneficial for seniors

The statistics demonstrate the significance of falls in our senior population. Although not a hot topic in the media, falls lead to more deaths than many cancers. Falls are often made light of by those who experience them, at least until an injury occurs. And most of those who fall will do so again within months. The toll to the elderly and their families is incalculable, while the health care dollars expended in the care of falls is tremendous. Unfortunately, our health care system has never focused on prevention. If exercise and fitness programs were offered to all seniors, it is likely there would be less falls and healthier seniors.

When it comes to falls, treating better the consequences of these dangerous events is not a healthy approach. Prevention is a more efficient and effective method. We need to better educate our senior citizens, those caring for them, even our health care providers, on fall prevention. Exercise programs, tai chi, physical therapy visits, have all resulted in fewer falls. What if exercise participation was part of health care for seniors? One effect would be less falls, another healthier seniors.

EDITOR’S NOTE: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula. Dr. McLean’s practice, Superior Foot and Ankle Centers, has offices in Marquette and Escanaba, and now the Keweenaw following the recent addition of an office in L’Anse. McLean has lectured internationally, and written dozens of articles on wound care, surgery, and diabetic foot medicine. He is board certified in surgery, wound care, and lower extremity biomechanics.


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