Polio Place

Researchers at the University of Washington’s Aging Rehabilitation Research and Training Center, agerrtc@uw.edu

Falling in older adults is a big public health problem. Injuries that result from falling in older adults are serious, life-changing, costly, potentially fatal. In the U.S., deaths from falls is the leading cause of injury-related deaths in adults over the age of 65 (1).

In 2000, the incidence of falling injuries was estimated to be 10,300 for fatal and 2.6 million for non-fatal injuries in adults over the age of 65 (2). Both fatal and non-fatal injuries from falling increase with age among older adults (3). In the U.S., the direct medical care costs from treating injuries from falling in the elderly is estimated to be $0.2 billion for fatal injuries and $19 billion for non-fatal injuries (2). The burden of economic costs for rehabilitation after falling is even greater when you consider stays in a nursing home, assistive devices (canes, walkers, etc.), and physical therapy. Once an initial fall occurs, it can lead to a fear-of-falling, which is associated with avoiding daily activities as well as physical activity (4). This, in turn, becomes a troubled cycle as lack of physical activity increases the risk of falling (5).

Polio survivors have a variety of symptoms that are known risk factors for falls in older adults and patients with neuromuscular diseases, such as muscle weakness, joint pain, and fatigue. One study showed that the rate of falling in polio survivors was 4 times higher compared to older adults (6). This study also found polio survivors report falling more often in the afternoon and inside the home (6). There were 3 important predictors of falling identified for polio survivors – 1) Problems maintaining balance, 2) Weakness in knee extension in your weakest leg “Knee buckling,” and 3) Fear of falling (6).

Polio Survivor Data from our Survey
Many of Post Polio Health International readers participated in our survey that asked some questions about falling. Here are the responses of people with post polio syndrome to these questions:

• 242 (54%) reported a fall within the last 6 months.
• 385 (86%) are concerned about falling.
• 366 (82%) reported not doing things because you might fall.
   

What can you do to prevent falls?
Sometimes knowing is half the battle. Falls inside the home have been linked to stairs with 4 or more steps, slippery floors, sliding rugs, low lighting levels, missing handrails, uneven flooring, and obstructive walkways. Falls outdoors are often linked to walking on uneven or cracked sidewalks, curbs, or streets. Other fall prevention tips include:

• Have your vision and hearing checked regularly.
   
• Talk to your doctor about side effects of drugs that could affect your coordination and balance.
   
• Wear rubber-soled and low-heeled shoes that fit well and fully support your feet.
   
• Avoid wearing socks when walking inside on hardwood or linoleum flooring. Socks with the grippers on the bottom or wearing Crocs while inside can prevent these types of falls.
   
• Be careful when walking outdoors on wet or icy sidewalks. Take your cell phone with you on walks. Try to anticipate fatigue and bring what you might need for more support (cane, walker, etc.) or even a friend, family member, or spouse.
   
• Exercise regularly to maintain strong bones, strength, and flexibility. Exercise that improves balance and coordination (like Tai Chi or Yoga) are most helpful. Ask your doctor or health care provider about the best type of exercise program for you.
   
• Keep your home safe – remove things you can trip over (such as shoes, papers, books, clothes) from stairs and high traffic areas. Keep clutter down!
   
• Install handrails or grab bars in your bathroom or other well used areas where you may need extra support (such as stairs and hallways).
   
• Improve the lighting in your home. As you get older, you need brighter lights to see well. Lamp shades or frosted bulbs can help reduce glare.
   

The Centers for Disease Control in the U.S. has produced brochures titled “What YOU can do to prevent falls” and “Check for Safety: A Home Falls Prevention Checklist for Older Adults” available in English, Spanish, and Chinese. www.cdc.gov/ncipc/duip/spotlite/falls.htm

References:

1. Stevens JA, Dellinger AM. Motor vehicle and fall related deaths among older Americans 1990-98: sex, race, and ethnic disparities. Inj Prev 2002; 8(4):272-275.

2. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj Prev 2006; 12(5):290-295.

3. Stevens JA, Ryan G, Kresnow M. Fatalities and Injuries from Falls Among Older Adults - United States, 1993-2003 and 2001-2005. Mortality and Morbidy Weekly Report 2006; 55(45):1221-1224.

4. Evitt CP, Quigley PA. Fear of falling in older adults: a guide to its prevalence, risk factors, and consequences. Rehabil Nurs 2004; 29(6):207-210.

5. Brouwer B, Musselman K, Culham E. Physical function and health status among seniors with and without a fear of falling. Gerontology 2004; 50(3):135-141.

6. Bickerstaffe A, Beelen A, Nollet F. Circumstances and consequences of falls in polio survivors. J. Rehabil Med 2010; 42: 908-915.

The contents of this column were developed under a grant from the U.S. Department of Education, NIDRR grant number H133B080024. However, the contents do not necessarily represent the policy of the Department of Education, and endorsement by the federal government should not be assumed.