How Can DPMs Prevent Falls In The Elderly?

Doug Richie Jr. DPM FACFAS

Later this month, I will have the privilege to present two lectures at the Annual Meeting of the American Podiatric Medical Association in Boston (see http://members.apma.org/Members/Events/TheNational.aspx ). My first lecture will cover the controversies of preventive ankle bracing. I have previously discussed this topic on my blog (see http://www.podiatrytoday.com/blogged/what-evidence-reveals-about-prophyl... ).

My second lecture focuses on the role of the podiatric physician in prevention of falls in the elderly. I have become increasingly interested in this subject as my research on ankle bracing, balance and postural control always led to articles about falls in the elderly. It turns out that many of the factors affecting high-level athletes that lead to ankle sprains are also prevalent in senior citizens, who are at risk for catastrophic falls.

Falls in the elderly are a huge public health issue. Not only do half of all people over the age of 65 experience at least one fall each year but over one-third of these falls lead to significant injury.1 Special populations, such as those people with diabetic polyneuropathy, are 15 times more likely to suffer injury as a result of falling in comparison to the healthy population.2 In the United States, the cost of medical treatment of fall-related injuries exceeds $20 billion annually and will probably double in the next 15 years.3

Just as podiatric physicians have a crucial role in the prevention of ankle sprains in the athlete, they have a similar but unrecognized role in preventing fall-related injuries in the elderly. Many of the interventions used for athletic patients are effective in older individuals as well. The problem is that research published on this subject rarely appears in podiatric journals or trade publications, and today most podiatric practitioners are unaware of their role in this important public health issue.

What became most startling to me during my research on fall prevention was the revelation that the most significant contribution to understanding of this subject has been made by podiatrists. No, this has not come from United States-based practitioners but folks who are at LaTrobe University in Victoria, Australia. Over the past 10 years, a wealth of groundbreaking research has been published by PhD podiatrists on the etiology and prevention of falls in the elderly. Their research has been published in a wide array of prestigious medical journals but none of them are commonly read by podiatrists in the U.S.

The crown jewel of research on the subject of fall prevention by podiatrists has just been published in the British Medical Journal.4 Spink and colleagues from LaTrobe University conducted this randomized controlled trial on 305 community dwelling men and women over the age of 65. The researchers implemented a simple, low-cost podiatric intervention program that can also be easily adapted to the primary care setting.

The results of the intervention were spectacular. A podiatric fall prevention program reduced the incidence of falls by 36 percent and significantly reduced the incidence of fracture in the treatment group. This podiatric prevention program combined several interventions including patient education, foot and ankle muscle strengthening, regular podiatric care, a subsidy for appropriate footwear as well as a custom foot orthosis device.

If a podiatric fall prevention program was implemented in the U.S. and had the same result as the study published by our Australian colleagues, the potential cost savings to Medicare could approach $7 billion annually.4

This is a fantastic opportunity for our profession and has received little attention until now. I look forward to sharing ideas with you in this blog as well as during my lecture on this subject on Friday, July 29 at the APMA National in Boston.

References

1. Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil. 2001; 82(8):1050–6.

2. Richardson JK, Hurvitz EA. Peripheral neuropathy: a true risk factor for falls. J Gerontol A Biol Sci Med Sci. 1995; 50(4):M211-5.

3. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention. 2006; 12(5):290–5.

4. Spink MJ, Menz HB, Fotoohabadi MR, et al. Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with
disabling foot pain: randomised controlled trial. BMJ. 2011; 342:d3411.

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