Fall Prevention subtitle

Erik B. Eller, MD Undergraduate Education Medical School 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 CDC.com

Why are falls bad? Funzypics.com

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 CDC

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

Osteoporosis www.Tabletsmanual.com Diagnosis

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? Duel Energy X-ray Absorptiometry 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 Medchrome.com

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 Group Calcium Recommended Dietary Allowance (mg/day) Vitamin D Recommended 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 14 - 18 years old 19 - 30 years old 31 - 50 years old 51 - 70 years old 51 - 70 year old females 1,200 71+ years old 800 14 - 18 years old, pregnant/lactating 19 - 50 years old, pregnant/lactating *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