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Fall Risks: Clinical Pearls

Fall Risks: Clinical Pearls

A Review from Dynamic Chiropractic Oct 2020 Vol 38, Num 10


At least here in Ohio, we are transitioning into the time of year when the weather sneaks up on a person.  Currently in the midwest, the trees have been dropping their leaves while it’s been raining almost non-stop for days.  If you have ever lived in a four season climate than you know, the slop of wet leaves can turn quite serious for those not wearing proper footwear, are unsteady on their feet and have any kind of balance issues. 

Not to the mention once the trees finish their annual purge, then the dreaded ‘W’ word will be right around the corner.  Bringing freezing temps, sleet, hail, ice and snow and for our patients who aren’t snow birds, this can become a recipe for disaster.  I thought with the weather lurking about, we could review an article in the most recent addition of Dynamic Chiropractic titled “Fall Risks: Clinical Pearls.” That way we can prepare ourselves and our patients mentally and physically for the upcoming seasons and their potential hazards.  As the article states, in the US falls in the elderly account for more than 3 million annual trips to the emergency room.

Here’s the issue:

1 in 3 people over the age of 65, will experience at least one fall annually. The statistics only get worse as people age. Falls can be broken into two categories; extrinsic and intrinsic.

Extrinsic would be attributed to the environment (like the weather, tripping hazards in homes, etc.)

Intrinsic is related to physiological issues like balance, muscle weakness, (you know the stuff as chiropractors we can help with).

Even though intrinsic falls make up the majority of accidents, that doesn’t mean we still can’t educate our patients both on the environmental hazards.  Anytime we can help reduce any kind of issues related to falls, we are helping to improve their quality of life. Even a simple Google search reveals that falls in people over age 65 is one of the leading causes of injury-related deaths.

Asking the Right Questions

If you decide to start screening patients for their fall risks, here are some basic questions to start with.

  1. Have you fallen in the past year?
  2. Do you feel unsteady when you stand?
  3. Do you worry about falling?

 Answering yes to any of the above questions is a red flag that your patient is at risk for a fall.

 As we know, medications have all sorts of funny side effects. Reviewing medication lists and/or always asking for an updated list from patients is also helpful. 

Here are a list of some common meds which can affect a person’s balance and coordination:

antihypertensives, anti-cholingerics, anticoagulants, CNS depressants, and other sedatives or sleep aids can be the cause of the patient’s instability.  Obviously, we can’t take stop or modify a patient’s prescriptions but we can suggest a med check by their MD or pharmacist if the side effects of the RX’s are increasing their fall risk.

 Once medication has been ruled out we have a couple orthopedic tests that are handy. One-legged standing Romberg test, mobility and ROM.  For the last two, consider also checking ankle dorsiflexions, hip extension, toe off and posture.

If you really want to get involved with assessing fall risk check out the ‘timed up & go test.’

 Management & Rehab:

Obviously, once a patient is considered high risk for a fall, it's important to develop a plan. Certain elements such as dealing with the ataxia, proprioception, etc is a great place to start. Adding in additional therapies for balanced based exercises in standing positions that progress can be added.  Also timing their ability to stand on one leg.  For strength training you can consider deadlifts, good mornings, calf raises and/or exercises that target the posterior chain.

It is recommended that therapy be spread out over a 3-6 month window and average about 50 hours of therapy during the duration.

 Assessing and managing risks for our patients starts with awareness on our part.  Knowing that once a person is over age 65, the three basic fall risk questions can be asked.  Of course, those don’t exist in a vacuum and we should still inquire and encourage our patients to lead healthy, active lives to improve quality of life and reduce the potential for falls.

Kassandra Schultz D.C.