In this engaging discussion, guest Sarah Berry, a geriatrician at Hebrew SeniorLife in Boston, shares her expertise on the critical issue of falls and fractures among older adults. She highlights that one in three seniors experiences falls annually and emphasizes the importance of proper screening and intervention. Berry busts myths about vitamin D and stresses the role of exercises like Tai Chi in preventing falls. The conversation also navigates the complexities of medication management, including the careful use of bisphosphonates for fracture risk.
Falls are prevalent among older adults, significantly impacting their health and quality of life, necessitating effective prevention strategies and proactive screening.
Implementing tailored multifactorial interventions, including exercise and careful assessment of individual risk factors, is essential for minimizing fall and fracture risks.
Deep dives
The Impact of Falls Among Older Adults
Falls represent a significant health risk for older adults, with one in three experiencing a fall each year in community settings, and this statistic rises to one in two for those in nursing homes. The consequences of falls extend beyond immediate injuries, as they can lead to increased social isolation and feelings of anxiety over falling again. This fear can inhibit mobility, exacerbating the likelihood of further falls and a decline in overall health. Understanding the prevalence and serious implications of falls is crucial for developing effective prevention strategies.
Screening for Fall Risks
Screening for fall risk is essential and can be effectively initiated by simply asking older adults if they have fallen in the past year or if they are concerned about falling. The presence of a fall within the last year is a primary indicator of future fall risk. Other significant risk factors include cognitive impairment, balance issues, and certain medications, all of which should be carefully assessed by healthcare providers. A proactive approach in screening can lead to timely interventions that significantly reduce the likelihood of falls.
Intervention Strategies to Reduce Falls
Various intervention strategies can be employed to minimize fall risks among elderly individuals. Exercise is recognized as one of the most effective methods for preventing falls, particularly exercises that enhance gait, balance, and strength such as Tai Chi. Additionally, tailored multifactorial interventions addressing individual risk factors—like vision impairment, mobility issues, and medication management—play a pivotal role in fall prevention. Incorporating these strategies into routine care can lead to improved outcomes for older adults.
Fracture Risk Assessment and Management
Assessing fracture risk in older adults, especially those living in nursing homes or facing multiple health challenges, requires a comprehensive understanding of individual characteristics rather than solely relying on bone mineral density tests. Tools like the FRAX model can help estimate fracture risk over 10 years, but a new Frail model has been developed for predicting short-term hip fracture risk in nursing home residents. Treatment options such as bisphosphonates can be considered for those with a reasonable life expectancy and multiple risk factors. Effective management of both falls and fractures stems from an integrated approach that combines screening, risk assessment, and tailored treatment plans.
Falls are very common among older adults but often go unreported or untreated by healthcare providers. There may be lots of reasons behind this. Patients may feel like falls are just part of normal aging. Providers may feel a sense of nihilism, that there just isn't anything they can do to decrease the risk of falling. On this week's podcast, we try to blow up this nihilism with our guest Sarah Berry.
Sarah is a geriatrician at Hebrew SeniorLife in Boston where she does research on falls, fractures, and osteoporosis in older adults. We pepper Sarah with questions ranging from:
Why should we care about falls?
What are ways we should screen for falls?
What are evidence based interventions to decrease the risk of falls?
What about Vitamin D and falls???
How should we assess for fracture risk?
What are some evidence-based ways to decrease fracture risk?
When should we prescribe vs deprescribe bisphosphonate therapy? How does life expectancy fit in with all of this?
If you want to do a deeper dive into some of the articles we discuss, take a look at the following: