Fall PreventionSUBTITLE

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:ANd9GcSUsIjK47c9eZ52QIb5QicC0qYa-Xh32iuwY5A03XZVKYkCWnYa

Hip fracture fixation

https://encrypted-tbn1.gstatic.com/images?q=tbn:ANd9GcSUsIjK47c9eZ52QIb5QicC0qYa-Xh32iuwY5A03XZVKYkCWnYa

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

OsteoporosisDIAGNOSIS

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 GroupCalciumRecommended Dietary Allowance (mg/day)

Vitamin DRecommended 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

▪ Toll-Free: 866.974.2673

▪ Thecoreinstitute.com