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Falls and Fractures Spotlight
SAFEHIP May Reduce Incidence of Hip Fractures
Approximately 30% of older adults who experience a hip fracture die within 2 years. According to the Centers for Disease Control and Prevention, there were approximately 281,000 hip fractures in adults aged 65 years and older in 2007 alone. Over 90% of those fractures were attributed to falls. To help reduce the number of fall-related hip fractures, Tytex developed the SAFEHIP, a device designed to protect the hips during a fall by dispersing the energy from the fall away from the hip area.
Developed in Denmark and tested on more than 6000 patients around the world, SAFEHIP is designed in the shape of a horseshoe for optimal protection and compliance. It has a shell composed of a specially developed textile called AirX, which is soft, comfortable, and breathable. The shield is not visible under clothing and is not as warm as previous hip protectors because the new shell technology wicks moisture and transfers heat away from the skin.
The SAFEHIP can fit up to a 60-inch waist and is available in a variety of models. It can also be customized to suit a patient’s needs, such as for wear underneath adult diapers, and is machine washable. For ordering information, visit www.safehip.com.
Foot Orthoses Improve Pain and Balance in Older Women With Osteoporosis
Osteoporosis has a prevalence of up to 90% among nursing home residents and is reported to result in more than 1.5 million fractures in the United States annually. Studies have found that some minor lifestyle changes, including medication, diet, and exercise, can help reduce the incidence of falls and fractures associated with osteoporosis. In a recent study, Eduardo de Paiva Magalhaes, MD, Department of Rheumatology, Medical Sciences School of State University of Campinas, Brazil, and colleagues set out to assess whether the use of foot orthoses could reduce falls and fractures associated with osteoporosis.
In a randomized, controlled clinical trial, 94 women (aged >60 years) with osteoporosis were divided into an intervention group and a control group. Those in the intervention group were assigned custom-made orthoses to be worn for 4 weeks, while the control group received no orthoses. The orthoses were made from ethylene-vinyl acetate and featured a medial arch support and a metatarsal pad. Investigators compared scores from the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, the Manchester Foot Pain and Disability Index (MFPDI), and a numeric pain scale at baseline and after the 4-week period in both groups.
The groups were well matched based on their scores on these tests at baseline. On the BBS, the average score for the intervention group improved from 43.30 to 50.68. Those wearing orthoses improved in the TUG, MFPDI, and pain scales, with a change from 15.16 to 11.97, 20.98 to 11.48, and 3.43 to 1.68, respectively. The only notable change in the control group was an increase in the numeric pain scale scores from an average of 3.76 at baseline to 4.20 at 4 weeks. Six patients in the intervention group reported minor discomfort, including foot heat and tightness of footwear. No patient in either group experienced a fall during the 4-week trial.
All improvements in the intervention group were independent of sociodemographic and clinical factors; thus, the authors concluded that the use of foot orthoses is effective for reducing pain and improving balance in older women with osteoporosis, and that these improvements can subsequently help prevent falls. To access the original report, visit https://rheumatology.oxfordjournals.org/content/52/3/515.full.
Pacemaker Implantation Reduces Falls in Patients With Sinus Node Disease
According to the Centers for Disease Control and Prevention, falls cause 95% of hip fractures in older adults and cost approximately $30 billion in medical care each year. Although there are multiple causes of falls among the elderly population, some have been related to heart rhythm disorders, such as sinus node disease (SND), which includes symptoms of syncope, bradycardia, and dizziness. Because symptoms of SND are among the leading causes of falls, Nasmi Krasniqi, MD, Clinic for Cardiology, University Hospital Zurich, Switzerland, and colleagues conducted a study to determine if implanting a pacemaker in patients with SND can reduce these symptoms, thereby decreasing the occurrence of falls and their associated healthcare costs.
To find participants for this study, the authors searched the electronic patient database at the Clinic for Cardiology of the University Hospital of Zurich for patients with SND who had received a pacemaker and had follow-ups in the outpatient cardiology clinic between January 1, 1996 and December 31, 2009. After excluding patients due to age (<40 years), incomplete records, and outlier statistics, 124 patients were included (average age, 71.9±7.9 years). All patients had a history of cardiovascular pathology, and the prevalence of hypertension was high (87.4%). The primary objective was to evaluate and compare the risk reduction of falls with and without injury. Patient records were analyzed for falls during the 12-month period proceeding implantation, and the mean observation period after implantation was 2.3 years.
In the year prior to implantation, 40 (32%) patients experienced at least one fall, with 19 having acquired an injury, whereas after implantation, only 10 patients experienced falls during the observation period, with seven experiencing an injury; this resulted in a relative risk reduction (RRR) in the number of fallers by 75% (P<.001) and injured fallers by 63% (P=.014). Total falls were reduced from 60 before pacemaker implantation to 22 afterwards (RRR, 62%; P=.035), while total falls with injury was reduced from 22 to seven (RRR, 67%; P=.013).
Based on these results, the authors conclude that patients with SND experience a significant reduction in the number of falls and in fall-related injuries when a pacemaker is implanted. The full-text article is available at www.ncbi.nlm.nih.gov/pmc/articles/PMC3488401.
Some Psychiatric Drugs May Increase Falls in Older Adults
Falls are widely recognized to be the primary cause of fracture and injury in older adults. According to the Centers for Disease Control and Prevention, there were 2.3 million falls reported among older adults in 2010 alone. This is not surprising given that multiple factors can lead to falls in this population, including vision impairments, mobility problems, cardiovascular diseases, and adverse effects from medications. Almost 50% of inpatients receive multiple psychiatric drugs, placing them at increased risk of adverse medication effects. To determine how certain psychiatric drugs affect falls risk among older adults, Astrid van Strien, University Medical Center, Utrecht, Netherlands, and colleagues performed a retrospective cohort study.
Between January 1, 2011 and April 1, 2012, 404 patients who had visited the university day clinic were retrospectively analyzed for falls and medication usage. During that period, 58.9% had experienced one or more falls. After multivariate adjustment, frequent falls remained significantly associated with exposure to psychotropic medications (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.17-3.28), antipsychotics (OR, 3.62; 95% CI, 1.27-10.33), hypnotics and anxiolytics (OR, 1.81; 95% CI, 1.05-3.11), short-acting benzodiazepines or Z-drugs (OR, 1.94; 95% CI, 1.10-3.42), and antidepressants (OR, 2.35; 95% CI, 1.33-4.16). Of the approximately one-third of patients receiving psychiatric drugs, 45% had fallen three or more times, whereas only 22% of those not receiving psychiatric drugs experienced frequent falls.
Because age, cognitive impairment, and living situation were all taken into consideration, van Strien and colleagues concluded that taking psychotropic medications, including short-acting benzodiazepines, strongly increases the frequency of falls among older adults. Based on their findings, the authors recommend that physicians should avoid prescribing these medications to their elderly patients, particularly those prone to falling, and if use of these agents is unavoidable, that physicians counsel patients regarding their increased risk of falls while on these agents. For more information on this study, visit www.ncbi.nlm.nih.gov/pubmed/23375674.
Dual-Stiffness Flooring May Reduce Fractures Associated With Falls
In experimental models, dual-stiffness flooring (DSF), which is designed to absorb impact, has shown promise in reducing morbidity rates associated with falls. In a recent study, Frank Knoefel, MD, Bruyere Research Institute, Ottawa, Canada, and colleagues undertook a study to measure the impact of SmartCell flooring (a type of DSF) on fall-related injuries in an Arizona nursing home.
Knoefel and colleagues assessed reported falls between July 1, 2008 and December 31, 2010, identifying the age and sex of the fallers and their medical history, including diagnosis of osteoporosis, number of medications, and history of previous falls. Type of flooring (normal vs DSF), time of day, type of injury, and resulting actions related to the fall were noted. The authors found that 85 falls occurred on the regular flooring, while 82 falls occurred on the SmartCell flooring. Two fractures occurred from falls on the regular floor (2.4% fracture rate), but no fractures resulted from falls on the SmartCell floor. Because these results are consistent with previous reports, the authors concluded the DSF shows a clinically significant improvement in reducing the risk of fractures from falls in older adults and should be considered as a practical approach for institutions seeking to reduce fall-related injuries. More information about this study is available at www.ncbi.nlm.nih.gov/pubmed/23375479.
