Balance, Brain Health, and Fall Prevention Majid Fotuhi, MD PhD Ingleside at King Farm & Rockville Office on Aging Rockville, MD September 12, 2014

Objectives  The impact of falls  Why do falls occur?  How to prevent falls?  How walking well can protect your brain 2

Falls Are Costly  Every year, 32-42% of people aged ≥ 70 experience falls worldwide 1  Fall frequency increases with age and frailty 1  #1 reason for entry into long-term care facilities  Leading cause of injury-related death in older adults – every 35 minutes 2 1.WHO Global Report on Falls Prevention in Older Age. WHO; 2007: France. 2.Sward D. Legisbrief. 2010;18(21). National Conference of State Legislatures; Washington, DC. 3

Fatal Fall Rates by Age and Sex Rate Per 100,000 Population National Center for Health Statistics, WHO Global Report on Falls Prevention in Older Age

What Happens When We Fall? 5

Hip Fractures  Hospital stays extended to 20 days 1  Older persons are likely to remain in the hospital for the rest of their lives 2  20% die within 1 year subsequent to falls 3 1.The economic cost of hip fracture in the U.K. Health Promotion. The University of York;2000: England. 2.WHO Global Report on Falls Prevention in Older Age. WHO; 2007: France. 3.Zuckerman JD. N Engl J Med. 1996;334(23):

Post-fall Syndrome  Dependence  Loss of autonomy  Confusion  Immobilization  Depression Restriction in daily activities WHO Global Report on Falls Prevention in Older Age. WHO; 2007: France. 7

Objectives  The impact of falls  Why do falls occur?  How to prevent falls?  How walking well can protect your brain 8

Why Do Falls Occur? 9

Mechanical  You slipped, tripped, or lost your balance.  Ex: Falls caused by the environment like a slip and fall on ice or a loose rug. 10

Medical Toes Back Brain Eyes 11

Frailty 12

Objectives  The impact of falls  Why do falls occur?  How to prevent falls?  How walking well can protect your brain 13

How You Can Reduce Your Fall Risk Neurological Assessment (Ready) Check Your Balance (Set) Action (Go!) 14

Conditions that impact walking ability Circulation / OSA Mental fogginess Neurological Assessment 15

Check Your Balance 16

Action: 6 Steps to a Stable Stride 1. Get Sharper 2. Eat Well 3. Get Fit 4. See Well 5. Check Your Home 6. Sleep Well 17

Walking Reduces Your Risk of Dementia 6 Action Steps 1. Get Sharper 2. Eat Well 3. Get Fit 4. See Well 5. Check Your Home 6. Sleep Well Fall Less & Walk Better Protect Your Brain 18

1. Get Sharper Cognition Stimulate Your Brain Better decisions Faster reactions Better coordination 19

2. Eat Well  Heart-healthy diet  Avoid obesity 20

Less Brain Volume in Patients with Obesity and/or Sleep Apnea Am J Respir Crit Care Med. 2002;166:1382–

3. Get Fit  Leg strengthening: - 15 squats, twice a day  Balancing act: - Stand on one foot for 15 seconds, then the other - Twice a day - With your eyes closed: even better! 22

Physical Therapy  If your balance is poor, see a physical therapist soon. They consider – functional limitations – environmental hazards – Provide you with guided and progressive therapy – Multi-component exercise, which are: beneficial for bone health and maintaining functional ability the most effective physical therapy approach for prevention of falls and fractures Karinkanta S, et al. Nat Rev. 2010;6:

4. See Well  Vision: – Provides sensory input for controlling posture – Provides information about the size and position of obstacles in our paths – Allows you to safely negotiate steps and stairs Elliott DB. Optom Vis Sci. 2014;91(6):

Age-related Vision Changes Cataracts Normal Glaucoma Normal 25

5. Check Your Home 26

6. Sleep Well If urinary issues  fix bladder If use sleep meds  take only as-needed If sleep apnea  use CPAP 27

Action: 6 Steps to a Stable Stride 1. Get Sharper 2. Eat Well 3. Get Fit 4. See Well 5. Check Your Home 6. Sleep Well 28

Objectives  The impact of falls  Why do falls occur?  How to prevent falls?  How walking well can protect your brain 29

Walking 1 Mile a Day… Reduces Your Risk of Alzheimer’s ~50% Raji C, et al. Presented at: RSNA 96th Annual Meeting; Chicago, IL:

Brain Fitness Program  A multidisciplinary program devoted to: Reducing risk for Alzheimer’s disease and stroke Making your brain feel 3-5 years younger  Each patient receives a  comprehensive brain assessment  personalized treatment plan 31

Comprehensive Diagnostics to Evaluate Brain Health Customized Treatment Program to Maximize Brain Performance NeurExpand’s Unique Integrative Approach 32

Better Fitness 33

Better Memory 34

THANK YOU! Friendship Blvd. Chevy Chase, MD