I am surrounded by ‘older people.’ Almost every one has fallen, has had, arm, knee or hip replacement surgery.
My aunt has fallen, my mother has fallen…. The most amazing thing about my neighbors not one has said, I need to get my eyes checked. Not one has said, my doctor told me to get my eyes checked. Ellen Troyer of Biosyntrx wrote an excellent article on Balance, Falls and Fractures, which after reading I think you should add to your forms ‘Have You Fallen in the last…??
Balance, Falls & Fractures
- Falls are the leading cause of death by injury in people over the age of 65.
- Falls can be caused by many factors including poor eyesight; loss of balance due to illness; physical condition, dehydration or side effects of prescription medications, and the aging process.
- The Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control reported 9,256,761 unintentional falls in 2011, with an ever exceeding health care cost estimated to exceed $40 billion dollars annually by 2020.
- According to the 2012 U.S. Census Bureau report, one in three adults age 65 and older out of the 40.3 million folks of that age fall each year.
- Of those 13.3 million people who fall, 20% will suffer moderate to severe injuries that make it hard for them to live independently.
- Falling dramatically increases the risk of early death.
- Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes. People with visual impairments are more than twice as likely to fall as people without visual impairments.
Like so many other healthcare issues, it’s time to put more focus on the cause of falls and fractures. Disease and adverse event prevention is most always less expensive than treatment.
Balance-Related Falls and Fractures
To maintain balance, our brains integrate messages they receive from our vestibular system when we are moving. This system includes eyes, ears, muscles and joints.
Unfortunately, this system ages just like the rest of our body so the risk of falls and fractures increase as the years go on.
The medical term for this age-related balance condition is called presbystasis.
Fall & Fracture Prevention
Annual eye exams are necessary to identify vision problems that can be addressed through new prescription glasses and contacts, necessary surgery and community-based services, and low vision therapies designed to help prevent falls.
Why doesn’t Medicare cover routine eye exams to prevent the often painful and expensive low vision outcomes? The public cost of an annual eye exam on healthy older adults and low vision therapies doesn’t begin to compare to the pain and public costs of treating low-vision-related broken bones that can lead to expensive and emotionally devastating loss of independence and, too frequently, loss of life.
Gentle Tai chi exercise, as an example, has been reported to reduce age-related falls by up to 45% according to a study published in The New England Journal of Medicine. It’s also particularly effective for balance in people with Parkinson’s disease.
Could it be possible that something as simple as government or community sponsored Tai chi classes for older adults could help cut the cost of falls and fractures by 20-30%?
What financial statistician could disagree with government supported Tai chi classes for all older people – if the potential healthcare savings amounted to billions of saved dollars; got the elderly into enjoyable social situations and allowed us to identify the cause and improve other areas of preventive healthcare.
Tai chi improves balance because it targets all the physical components needed to stay upright: leg strength, flexibility, range of motion and reflexes, all of which tend to decline with age. Tai chi also helps prevent fear of falling; one of the biggest predictors of falls. It makes us more aware of our internal body and the external world; giving us a better sense of our position in space. Tai chi also increases energy and improves mood in most people.
The medical term for our sense of position in space is proprioception.
As we age, we simply don’t get as thirsty as we did when we were younger. Our bladders are not as strong as they once were, so sometimes we avoid drinking as much water as we need.
Dehydration leads to balance issues linked to falls and fractures.
So, drink up. Making more trips to the bathroom, or wearing leakage protection is easier, less painful and far less expensive than a broken arm, wrist. leg or hip.
Dehydration, vitamins C, D, K, and the B vitamins associated with elevated homocysteine levels, B6, B12 and folate deficiencies are also linked to balance issues.
Electrolyte imbalance too frequently caused by prescription drugs that mug minerals including calcium, magnesium, potassium, selenium and zinc are the first dietary suspects where loss of balance and loss of muscle mass that cause falls and fractures are concerned.
Unfortunately, older people sometime live lonely lives of quiet desperation that include loss of appetite. These people are particularly prone to nutritional deficiency related falls and fractures.
Osteoporosis and Fracture
Vitamin K plays a major role in bone health and fracture prevention.
Due to the high prevalence of the prescription blood thinner, Coumadin, usage in the aging population, (Coumadin is a vitamin K antagonist) most well-designed multiples have not included vitamin K for a number of years.
Most physicians also recommend limited consumption of dark green vegetables that include vitamin K to their Coumadin patients.
Fortunately, this issue is becoming less of a problem because more physicians now prescribe PRADAXA to their patients who require anticoagulants. It helps prevent blood clots from forming by working directly on thrombin instead of vitamin K.
Regular prothrombin time checks are not required with PRADAXA and vitamin K dietary restrictions are also not required with this blood thinning drug.
Unfortunately, this drug is not considered appropriate for people with artificial heart valves.
Calcium has been proven to have beneficial effects on bone mass at all ages. Higher doses of vitamin D than the recommended 600 IU per day is required for optimal bone health and to help prevent falls, as are the trace elements like magnesium, manganese, selenium, zinc, copper and boron, just to name a few.
A well-designed multiple should provide most of these trace elements, with boron being one of the possible exceptions.
A note about vitamin B12: taking large doses of B12 can cause imbalance of other B vitamins so always take a well-designed multiple that includes the full complex of B vitamins when you are taking large doses of B12, or larger doses of any single vitamin or mineral, including vitamin C.
The natural and more expensive form of B12 (methylcobalamin) is always preferred over the less expensive form of semi-synthetic vitamin B12 (cyanocobalamin). The natural form is less toxic and far easier on the liver and kidneys. Unfortunately, the folks who opt for B12 injections almost exclusively receive the semi-synthetic cyanocobalamin, not methylcobalamin.
Our favorite pharmacist, Suzy Cohen, says that to get injectable methylcobalamin you will probably have to beg your doctor to phone the local compounding pharmacy and ask them to make it. It’s three times as expensive, but we and Suzy think it’s worth it.
More information and references available from Ellen Troyer, MT MA
PEARL: In keeping with the Biosyntrx commitment to identifying cause and ways to lower the societal burden of increasing healthcare costs, as well as pain and suffering, we will frequently address the issue of vision, balance, falls and fractures because low vision, lack of physical conditioning and nutritional deficiencies all play major roles.