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Questionnaire helps determine risk of falls.

WASHINGTON -- Offering interventions to improve balance and ensure proper functioning of assistive devices can cut the incidence of falls by half in older people, researchers found. The same study showed that indicators as diverse as difficulty clipping toenails and leg weakness could predict fall risk.

John Parrish, Ph.D., executive director of the Erickson Foundation, and his associates developed a six-page, 29-item questionnaire to predict fall risk. The questionnaire can be self-administered or given by medical personnel or other professionals, Dr. Parrish said at a session on fall prevention at the sixth annual World Health Care Congress.

The researchers administered the questionnaire to 198 people aged 62 years or older and then checked back 6 and 12 months later. A total of 152 patients completed the survey and both follow-ups.

The researchers found that 48% of respondents had experienced one or more falls within the 6 months before the survey, including 0.5% who had as many as six falls. People who had fallen were more likely to report problems cutting their toenails, poor balance, leg weakness, numbness in their feet, use of an assistive device such as a walker, inability to walk one-quarter mile, inadequate exercise, and dizziness when standing up, Dr. Parrish said.

After the survey, patients who had histories of falling were referred for interventions including balance retraining, medication management, and evaluation of their assistive device to make sure it was working properly. About 94% of the patients who reported falls had received at least one intervention by the end of the 6-month follow-up period, Dr. Parrish said.

Of those who pursued an intervention, 91% either stabilized or decreased their fall frequency, while 9% experienced more falls than they had before completing the questionnaire. At the 12-month follow-up, the researchers found that only 25% of respondents had fallen during the previous 6 months, a statistically significant decline from baseline.

Dr. Matthew Narrett, executive vice president and chief medical officer of Erickson Health, said in the session that his company, which provides health insurance coverage and medical care at 20 retirement communities nationwide, reduced hip fractures in a population of 2,300 seniors from 45 in 2004 to 26 in 2008. Measures taken included:

* Patient evaluation. When a patient falls, an e-mail is sent to all relevant parties. A health care worker goes to the patient's apartment the next day and documents the circumstances of the fall, and results are entered into the patient's electronic medical record.

* On-site osteoporosis screening. "We cover it in our [health] plan for men as well as women," since 20% of men over age 80 have osteoporosis, Dr. Narrett said.

* Provider education on vitamin D deficiency. "Using the electronic medical record, we demonstrated a fourfold increase in vitamin D screenings among our residents" after providers were given information on vitamin D deficiency in the elderly, he said.

Preventing falls has an economic benefit as well, since 25% of patients who sustain hip fractures will end up being admitted to long-term care facilities, he noted.

Bonita Lynn Beattie, vice president of injury prevention at the National Council on Aging, said in her presentation that 35%-40% of adults aged 65 or older fall each year, and if they fall once, they're two to three times more likely to fall again. Of those who sustain hip fractures, 20% die within a year.

"We think many falls are preventable," she said. "If a person has a history of falls, they really need a clinical assessment to see if there's appropriate intervention."

All adults need to work on balance and strength, ensure that their meds are managed appropriately, and adhere to their medication regimen, Ms. Beattie said. Vision problems also are an important component that needs to be addressed.

Home hazards also need to be reduced, she said. "Putting grab bars in the bathroom ... where people will use them and teaching people how to use them can make a significant difference," she said.

The panel was sponsored by Erickson Health. The Milton H. Erickson Foundation is a private research and philanthropic foundation.

RELATED ARTICLE: Resources for Fall Prevention

Dr. Parrish recommended the following Web sites for fall-prevention information:

* The Web site of the Fall Prevention Center of Excellence was created by the California Fall Prevention Consortium. It includes information for providers, individuals, and researchers.

* (type "falls" into the search bar): The Web site of the National Coalition on Aging includes information on fall prevention funding, fall prevention checklists, and other news related to fall prevention campaigns.

* (click on "Publications and Presentations" and find Project ABLE): The Web site of the Jefferson College of Health Professions a project aimed at making homes safer for older adults having trouble performing daily activities.
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Title Annotation:GERIATRICS
Author:Frieden, Joyce
Publication:Internal Medicine News
Article Type:Survey
Geographic Code:1USA
Date:May 15, 2009
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