Now a joint publication of the FJMC and MRJ

Issue #48 -  November 20, 2017

HEALTH TIP

This Issue of Health Wealth and Retirement brings you insight into a health issue that many of us will experience ourselves or through our loved ones – “Falls Can Be Prevented!”, an article created especially for HWR by James Nussbaum, PT, PhD, SCS, EMT at the request of our Medical Editor, Stephen Mandel, MD.

Falls Can Be Prevented!

Falls and fall related injuries are an epidemic in the United States, particularly in adults 60 years of age and older.  Head injuries, fractures, and decreased mobility are some of the catastrophic results of falls.  The medical literature clearly shows that a significant portion of falls can be prevented with appropriate interventions. 

• More than 1 in 3 of adults over 60 will fall every year, 1 in 2 of adults over 80 years of age
• Those who fall once, are 2-3 times more likely to fall again
• Over $34 billion are spent on fall-related injuries in the US each year
• More than 20% of those over 65 years of age who fall and fracture a hip will be dead one year post the fall and fracture
• More than 25% of the people who have fallen and fractured a hip will never return home and will be institutionalized for the remainder of their lives
• The remaining~ 55% who have fallen and fractured a hip, are at a significantly greater risk to fall and fracture again
• Fear of falling in community-dwelling older adults is a significant risk factor for falling, and it will contribute to poor mobility, imbalance, and may limit community access
• More than 30% of falls can be prevented with appropriate interventions.

There are numerous studies looking at different fall prevention programs and methods aimed to decrease the incidence of falls, decrease the risk factors for falls, and limit injuries sustained when people fall.  They include protective hip pads in older adults, group exercise classes (particularly Tai Chi), and home-based nurse directed balance programs for seniors.  Physical or occupational therapy interventions have proven successful, and are specifically tailored to an individual’s needs, and are often covered by medical insurance.  Due to many factors, including time constraints, poor reimbursement, lack of education on the importance or implementation of fall screenings and prevention programs, most primary care physicians do not assess their patients’ fall risk, nor do they refer patients to fall prevention programs.  Assessing for falls risk, or referring out for a falls risk assessment, and possible treatment or programming, can be lifesaving actions by physicians.

Eliminating risk factors are a focus of many programs.  Risk factors are often divided into 2 categories, intrinsic, or factors associated with bodily characteristics, and extrinsic risk factors, those outside one’s body.  Extrinsic risk factors are often more easily modifiable, than their intrinsic counterparts. Examples of each are listed as follows:

INTRINSIC:   Weakness (specifically lower extremity weakness), poor sensation (possibly worsened by certain conditions such as diabetes), dizziness (may occur due to changes in blood pressure – orthostatic hypotension, vertigo, etc), taking more than 4 medications, slow reflexes, and poor vision (i.e. macular degeneration) are examples of intrinsic risk factors for falling.

EXTRINSIC:  Having throw rugs, poor lighting, ill-fitting or inappropriate assistive devices, lack of proper footwear, not having grab bars in the bathroom, are examples of extrinsic risk factors.

In a review article by Sherrington et al. in 2008 in the Journal of the American Geriatric Society, they concluded that exercise can prevent falls and that a successful fall prevention program should:

• Include lower extremity strengthening activities
• Include challenging balance work
• Include at least 50 hours of intervention within a 6 month period of time
• Not include a walking program

What does this mean?

1. Lower extremity weakness is by far the greatest risk factor for falling, and as such, a program aimed to increase leg strength is a must.  Progressive functional strengthening has been proven to be the best way to increase LE strength, and with the help of a skilled physical therapist or exercise specialist, one can make significant improvements over time.  Using appropriate intensity, volume, frequency and duration of exercise along with program changes over a course of intervention are all very important factors in the success of a strengthening program, and are best implemented with individual guidance and supervision.
2. High intensity balance work is best performed under skilled supervision; however, group Tai Chi classes have proved successful in some studies looking at fall prevention and improved balance.
3. High doses of exercise, or 50 hours of programming as concluded by Sherrington et al  may include supervised and unsupervised intervention, or skilled versus non-skilled supervision.  For Medicare beneficiaries in the United States, this presents a significant problem:  While this is not the forum for a detailed explanation nor an opinion of Medicare benefits and rules, a Medicare beneficiary does not have anywhere near 50 hours of skilled therapy available to them in a 12 month period of time, let alone in HALF that.
4. Sherrington and colleagues found that programs which included a walking program were less successful.  The discussed that this may be due to two possibilities, one; those who walked may have spent their time walking and not pursuing strength and balance training, and two; people may have fallen while walking, possibly decreasing the apparent success of such programs.

In summary, falls are a big problem.  They significantly contribute to morbidity and mortality, can be fatal, cause a financial burden to society, and negatively impact individuals’ quality of life.  Balance is a multi-dimensional and factorial bio-motor ability, which includes strength, reflexes, coordination, sensory integration, awareness, and more.  Identifying an individual’s risk and an intervention aimed at minimizing those risks, promote positive changes in fall risk tests and measures.  Repetition of successful balance strategies, which help to turn the purposeful into the habitual are a keystone in fall prevention programming and safe mobility.  A number of home based and community programs have proven successful in reducing falls, and falls risk.  Individualized fall prevention programs supervised by skilled PTs and OTs can be covered by Medicare and other insurers, and may significantly reduce your risk.  Speak to your doctor today to intervene before it is too late!

REFERENCES:

1. Tromp AM, Pluijm SMF, Smit JH, et al. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. Journal of Clinical Epidemiology 2001;54(8):837–844
2. Stevens JA, Burns ER. A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults. 3rd ed. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2015.
3. Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC.  Effective exercise for the prevention of falls: a systematic review and meta-analysis.  J Am Geriatric Soc. 2008 Dec;56(12):2234-43. Review.

James Nussbaum, PT, PhD, SCS, EMT is the Research and Clinical Director at ProHealth & Fitness PT OT, a rehabilitation organization in New York City.  He has been an active member of the New York State Department of Health Fall Prevention Task Force, and has presented his research in Barcelona, Beijing, Berlin, and throughout the United States.  Dr. Nussbaum sits on numerous medical and academic advisory boards, and leads his clinical team which is a proud member of the Hospital for Special Surgery Rehabilitation Network.  He is a Clinical Instructor for Doctoral PT students, and is the Clinical Coordinator for Clinical Education at ProHealth, partnering with many of the Doctoral Physical Therapy programs in New York State.  Dr. Nussbaum and his team of PTs and OTs have been working with patients and their physicians on fall prevention strategies through skilled physical and occupational therapy for many years.  Dr. Nussbaum and his colleagues at ProHealth & Fitness PT OT collaborate with physicians affiliated with many of NYC’s finest medical institutions and they provide highly skilled outpatient, home based, and clinical research programming throughout Manhattan.

WEALTH TIP

We would like to thank our sponsor RCA, Retirement Corporation of America. They have graciously been our primary sponsor for the last 2 years.

For our Wealth tip we bring you a podcast interview with Ellen Langer, PhD., about “The Science of Mindfulness and Mindlessness” that should help us take more positive control of our lives, inherently making us Wealthier and better prepared for the future. 

It is linked here at the “On Being” web site.

Her unconventional studies have long suggested what neuroscience is now revealing: Our experiences are formed by the words and ideas we attach to them. Naming something play rather than work — or exercise rather than labor — can mean the difference between delight and drudgery, fatigue or weight loss. What makes a vacation a vacation is not only a change of scenery, but the fact that we let go of the mindless everyday illusion that we are in control. Ellen Langer says mindfulness is achievable without meditation or yoga. She defines it as “the simple act of actively noticing things.”

Ms. Tippett: So one of the things you’ve said is that most of us live mindlessly, virtually all of the time. And you say that with a smile on your face, but you mean it.

Ms. Langer: Yes. Yes. Oh, I mean it. [laughs] And I find that I’m not infrequently — not frequently, but not infrequently, I, too, am mindless. As I’m fond of saying, whatever you’re doing, you’re doing it either mindfully or mindlessly. And the consequences of being in one state of mind or the other are enormous. So in study after study, we plug in — we manipulate this mindfulness and change the measures from study to study, and almost no matter what we put in, that when we encourage people to be more mindful, we find enormous improvements.

Email sent at approximately 11:45 pm, November 20, 2017
 

LEGAL DISCLAIMER: This work is based on current events, interviews, corporate press releases, and what we've learned from several mentioned health and wealth newsletters. It is also based on some personal experiences. It may contain errors and you shouldn't make any investment decision based solely on what you read here. It's your money and your responsibility. FJMC is not making specific recomendations of stocks or bonds just possible ideas that might be considered for research and investing purposes. This information is being provided for informational purposes only.

FJMC - Federation of Jewish Men's Clubs - Involving Jewish Men in Jewish Life.  The FJMC involves Jewish Men in Jewish Life through Leadership   Innovation   Community