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Falls Among Adults Aging With Disability.

TitleFalls Among Adults Aging With Disability.
Publication TypeJournal Article
2015
AuthorsMatsuda P N, Verrall AM, Finlayson ML, Molton IR, Jensen MP
JournalArch Phys Med Rehabil
Date Published2014 Oct 19
ISSN1532-821X

OBJECTIVE: To investigate the prevalence of and risk factors for falling among individuals aging with multiple sclerosis (MS), muscular dystrophy (MD), postpolio syndrome (PPS), and spinal cord injury (SCI). DESIGN: Cross-sectional survey data from 2009 to 2010 were analyzed. We used forward logistic regression models to examine whether risk factors such as age, sex, mobility level, years since diagnosis, vision, balance, weakness, number of comorbid conditions, and physical activity could distinguish participants who reported falling from those who did not. SETTING: Surveys were mailed to community-dwelling individuals who had 1 of 4 diagnoses (MS, MD, PPS, or SCI). The survey response rate was 91%. PARTICIPANTS: A convenience sample of community-dwelling individuals (N=1862; age, 18-94y) with MS, MD, PPS, or SCI in the United States. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Self-reported fall within the last 6 months. RESULTS: Fall prevalence for people with MS (54%), MD (70%), PPS (55%), and SCI (40%). Across all 4 groups, fall rates peaked in middle age (45-64y) and among people with moderate mobility limitations. Seven risk factors differentiated participants who fell from those who did not: mobility level, imbalance, age, curvilinear age (age(2)), number of comorbid conditions, duration of diagnosis, and sex. The models differed across diagnostic groups. CONCLUSIONS: People aging with long-term physical disabilities experience unique challenges that affect their risk of falls. A better understanding of the frequency, severity, and risk factors of falls across diagnostic groups is needed to design and implement customized, effective fall prevention and management programs for these individuals.

10.1016/j.apmr.2014.09.034
Full Text

Summary:

What is this research about?

If you’re living with muscular dystrophy (MD), multiple sclerosis (MS), post-polio syndrome (PPS), or spinal cord injury (SCI) that impacts your mobility, falls may be an everyday part of your life.  Falls are harmful both from the injuries that we may suffer as well as the fear that may impact how we live our day to day lives after a fall. Sometimes injuries from a fall are minor cuts and bruises, but other times injuries are severe, like a broken hip or back that drastically impacts our lives. In the worst cases, the injuries are deadly. After a fall, the fear may keep us at home and we might limit our activities, even activities that bring us great joy. Sometimes we may realize that fear is guiding how we do things, but other times we might not even be aware of it. We were interested in learning more about how many people living with MD, MS, PPS, or SCI report falling. Also, we were interested in what types of factors place people with these conditions at higher risk for falls. 

What did the researchers do? 

We asked about 2,000 people living with MD, MS, PPS, and SCI about falls in the last 12 months. We also asked about other things that might place someone at risk for falling such as their age, gender, walking ability, and how long they’ve had MD, MS, PPS, or SCI. We also asked about their vision, balance, and weakness. We asked how often they exercised and how many other health conditions (like diabetes or cardiovascular disease) they had. When we studied the answers, we first looked at how often people reported falling.  We knew that age and walking ability may be really important. We looked at the how often people reported falling by age and walking ability. Then we looked at each condition separately, MS, MD, PPS, and SCI. For each condition, we looked at which risk factors could better group people who reported falling from those that didn’t.  

What did the researchers find? 

People living with MD, MS, PPS, or SCI reporting falling more often than not. Seven out of 10 People with MD that filled out our survey reported falling. About 2 – 3 of every 4 people with PPS or MS reported falling. Lastly, 2 out of every 5 people with SCI reported falling. A greater number of falls reported were from people who were middle-aged (45 to 65 years old) and who described their walking ability as limited, using an assistive device such as a cane, crutch, or walker.

People who were at risk of falling was different per each condition, however, walking ability was a risk factor across all 4 conditions, except for PPS.  For people with MS, being a man, having more health conditions, and trouble with balance placed you at higher risk of falling. For MD, trouble with balance placed you at greater risk. For PPS, vision trouble placed you at higher risk. For SCI, if you had a greater number of other health conditions, that placed you at higher risk. 

How can you use this research? 

For those living with MD, MS, PPS, and SCI, are you worried about falling? Falls are preventable. Here’s what we recommend:

  • Check out our factsheet on Fall Prevention in our series Aging Well with a Physical Disability. 
  • Are you using your assistive device (cane, walker, crutch etc.) correctly? Are you using the right one? Does it fit you properly? Find out by seeing your physical therapist (PT). Our ability to get around changes as we grow older. It’s important to make sure we’re using the right type of device and using it correctly.
  • Are there falling dangers in your home? Find out by seeing an occupational therapist (OT). These providers will come out to your home and suggest ideas to make your home safer.
  • Talk with your doctor. Check out our factsheet, Getting the Most Out of Health Care Visits. Ask your doctor about seeing a PT or OT. They may be able to refer you to someone in your health insurance network and locate someone who has experience with your condition and falling. 
  • Sign up for a fall prevention class. Often these are done at your local community or senior center. A Matter of Balance, is one program that is offered nation-wide.
  • Talk with your family and friends. Ten to one, they might be concerned about falls too, but didn’t know how to start the conversation with you.  

What you need to know:

  • People living and aging with a condition that impacts our walking ability are at higher risk for falls.
  • Fall prevention is particularly important for this group of people. 

About the researcher:  

Patricia Matsuda, PT, DPT is a physical therapist for UW Medicine’s Department of Rehabilitation Medicine and is an expert in falls and fall prevention. 

Citation: 

Matsuda PN, Verrall AM, Finlayson, ML, Molton IR, Jensen MP. 2015. Falls Among Adults Aging with Disability. Arch Phys Med Rehabil, Mar; 96 (3): 464-71. 

 

PubMed ID25449191