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May 2008 Issue

Arvind Modawal, MD, (left) associate professor of family medicine and geriatrics, and medical student Robert Altenau conduct a single-leg stance test on Charles Orr. Modawal is working to prevent falls in older adults.
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Simple Tests Can Prevent Falls in the Elderly

By Katie Pence
Published May 2008

Sue Thomas, 93, remembers her days as a college student at UC vividly.

“I graduated in 1940,” she says. “At first, I wanted to teach, but I ended up getting my degree in psychology and sociology.”

Thomas went on to spend 44 years with the Cincinnati Re
creation Commission, where she made sure people of all ages stayed entertained and active every day of the week in recreation centers throughout the city.

Now, Thomas says she tries to keep herself active so that she can remain healthy, strong and avoid experiencing fall No. 2.

Last year, Thomas, who lives at Bridgeway Pointe, an assisted living facility on the campus of the Drake Center, took a big spill, but was luckily unharmed.

“They didn’t find any broken bones,” she says. “But I have an artificial shoulder, and I had a stroke about four years ago, so my doctors are concerned it may happen again.”

Falls are the leading cause of emergency room visits and injury-related hospitalizations among adults over age 65, according to the Hamilton County Fall Prevention Task Force.

Now, UC researchers are trying to see if that risk can be reduced by simply teaching people like Thomas to detect their own chances of taking a spill.

According to a random survey by the task force, almost 8 percent of Hamilton County residents could not identify the most common risk factors for falling and nearly 12 percent of those surveyed did not know how to reduce the risk of falling in senior adults.

Arvind Modawal
, MD, associate professor of family medicine and geriatrics at UC and member of the Hamilton County Fall Prevention Task Force, recently completed a study that looked at function measures in older individuals who live in assisted living facilities.

The study found that a number of simple, clinically proven tests can identify people at risk for falling.

“We hope to increase awareness in the community so that patients can administer these tests by themselves and prevent falls,” Modawal says.

“We researched differences in fall risk and functional measures between assisted living facility residents and independent living older adults,” he adds. “We found that these tests can accurately and efficiently assess balance and gait problems in the elderly.”

Researchers recruited residents from two assisted living facilities and from those who lived independently but attended a senior center.

They used physical tests that measured the amount of time it took participants to stand up from a chair, walk, turn around and sit down again (timed get-up-and-go test), how far they could reach in front of them without losing balance (functional reach test), and how long they could stand on one foot (single-leg stance).

Overall, residents of assisted living facilities had more history of falls and struggled more with the function measures, therefore having a greater chance of falling again.

The participants’ medications, exercise habits, past fall histories and medical conditions were also taken into consideration.

The results showed that participants who were on cardiac or osteoporosis medications and exercised regularly walked more quickly and accurately and could reach further.

“Now, we must study the best ways to teach these tests to at-risk populations,” Modawal says. “We need to show patients that completing these tests is as simple and routine, but as important, as taking their own blood pressure.”

Besides these tests, older people need to take disease conditions, medications and environmental factors, such as a loose rug or slippery floors, into consideration for contributing to falls.

“Even poor vision, hearing and non-use of hearing aids or glasses can throw off a person’s balance,” Modawal adds. “There are many other risk factors in the elderly that can really cause problems, and even the first fall can be fatal.”

Modawal says these tests are very cost effective and have potential to make the most impact in fall prevention efforts.

“If we can promote these tests, we can keep our older population safe, functional and independent for years to come,” he says.

Thomas, who participated in the study, says she thinks these tests are very beneficial for patients who are at risk for falling.

“I am a little off-balance, and I think that these tests would help with monitoring that,” she says. “This could definitely help with prevention of falls.”

This study was funded in part by a summer scholar award given to Robert Altenau, a third-year medical student, and by the American Federation of Aging Research.

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