Deborah Behre, DPM db.foot@comcast · PDF filemuscle weakness ... 3 gait, strength and balance...

Deborah Behre, DPM db.foot@comcast.net

NO DISCLOSURES

SAVE THE DATE ! SEPTEMBER 22

PATIENTS

FAMILY & FRIENDS

YOU, YOUR STAFF AND YOUR PRACTICES

THE HEALTH CARE SYSTEM (MEDICARE)

CDC & WHO

WHO CARES?

EVERY SECOND COUNTS 1 OUT OF 3 PEOPLE 65 Y.O. OR OLDER FALL (1 IN 4 REPORT) 1 OUT OF 5 IS SERIOUS TBI’S: 81% HIP FRACTURES: 95% 1 OUT OF EVERY 3 NEVER RETURN HOME

2012 3.2 MILLION NON FATAL INJURIES 24,190 FATALITIES

NON FATAL FATAL

2012 $30.3 BILLION $616.5 MILLION

2015 $ 31.3 BILLION $637.5 MILLION

AVERAGE COST OF A FRACTURED HIP: $50,000

DIRECT MEDICAL COSTS FOR FALL RELATED INJURIES

5000 providers

6 million Pts screened

1 million falls prevented (1 in 6)

$3.5 billion direct medical cost saving

Can we make a difference?

VISION MEDICATIONS MUSCLE WEAKNESS BALANCE HISTORY OF A FALL (FEAR OF FALLING) PERIPHERAL NEUROPATHY PRE DISPOSING DISEASES (CVA, Parkinson’s) LOW VIT D LEVELS FOOTWEAR – SHOES & SOCKS FOOT PAIN OTHER PODIATRIC FACTORS

RISK FACTORS

PERIPHERAL NEUROPATHY FOOT PAIN MUSCLE WEAKNESS (includes intrinsics) BALANCE PROPRIOCEPTION FOOTWEAR (SHOES & SOCKS) FOOT DEFORMITIES (hallux valgus, lesser toe deformities, equinus,foot

drop)

LOWER EXTREMITY RISK FACTORS

WOMEN AGE BAREFOOT OR SOCKS – 11x HEEL HEIGHT > 4.5 CM – 1.9 X HALLUX VALGUS - 2x LESSER TOE DEFORMITIES – 1.32X POOR FITTING SHOES – CONTRIBUTED to 51% OF FALLS IN

HOSPITALS

RISK INCREASES

EXERCISE – most important activity (Tai Ji Quan – for balance: 28% improvement)

VIT D – 43% improvement

RISK DECREASES

Pre Fab Inserts Shoegear (Non skid – fitting) Falls Prevention Education Exercise 30 minutes 3X/week) Falls Decreased 36%

PODIATRY BASED PROGRAM

HERE’S WHERE YOUR FALLS PREVENTION PROGRAM STARTS

OR IT MAY START HERE

IF YOU DO NOTHING ELSE HAND THIS TO YOUR PATIENTS

CONSIDER GOING FURTHER

Safety Appt Vision Exercise

SAVE

CONSIDER GOING FURTHER

THE RECOMMENDATION IS THAT EVERYONE 65 YEARS OR OLDER HAVE A YEARLY FALLS RISK ASSESSMENT

HERE’S WHAT’S RECOMMENDED FOR FALLS RISK ASSESSMENT

YOUR STAFF CAN DO THE FIRST PART OF THIS FORM

QUESTIONING ABOUT FALLS

3 GAIT, STRENGTH AND BALANCE TESTS TUG (Timed Up and Go) (Recommended) 30 second chair stand (Optional) 4 stage Balance Test (Optional)

WHY START HERE ?

ARM CHAIR MARK 10 FEET AWAY FROM CHAIR RECORD TIME TO STAND UP, WALK TO MARK, RETURN AND SIT DOWN OBSERVE GAIT (12 SECONDS OR LONGER = HIGH FALL RISK)

TIMED UP AND GO (TUG)

SIT IN CHAIR DON’T USE HANDS TO GET UP (USE OF HANDS = 0 SCORE) COUNT NUMBER LOOK UP SCORE ON CHART

30 SECOND CHAIR STAND

4 DIFFERENT STANDING POSITIONS (PROGRESS IN DIFFICULTY)

IF CAN DO 10 SECOND HOLD, GO ON TO THE NEXT POSITION

IF CAN’T DO TANDEM STANCE FOR 10 SECS, HIGH FALL RISK

4 STAGE BALANCE TEST

CONSIDER GOING FURTHER

SELF PROGRAM

EXERCISE CLASS: TAI JI QUAN,YMCA MOVING FOR BETTER BALANCE, SAIL (stay active and independent for life), STEPPING ON

PT CONSULT (OTAGO EXERCISE PROGRAM - dec falls 35-40%)

EXERCISE CHOICES FOR YOUR PTS

28 % improvement

WHY DISCUSS EXERCISE?

CHAIR RISE EXERCISE

MARBLES

TOWEL CURLS

SELF PROGRAM

MOVE 20 MARBLES PER FOOT

TOWEL CURL EXERCISES

CONSIDER GOING FURTHER

CONSIDER GOING FURTHER

PCP

OT (SAFETY)

PT (BALANCE, STRENGTH, PROPRIOCEPTION, OTAGO)

REFERRALS

CONSIDER GOING FURTHER

PRESCRIBE WALKING AIDS REFER FOR MOORE BALANCE BRACES PRESCRIBE AND DISPENSE MOORE BALANCE BRACES SELL SHOES AND SOCKS

CONSIDER GOING FURTHER

NO ONE WALKS ALONE (HOSPITAL BASED FALLS PREVENTION PROGRAM)

NOWA

JAPMA Nov/Dec 2013 Vol 3 # 6

APMA Webinar ‘Cloud’ (Falls Prevention)

CDC

NCOA

Good Sources of Information

SAVE THE DATE ! SEPTEMBER 22 NATIONAL FALLS PREVENTION DAY

REFERENCES 1. CENTER FOR DISEASE CONTROL ATLANTA, GA 2. J AM GERIATRIC SOCIETY 64:425-431,2016 3. BMC GERIATRIC 2011; 11-51 4. AM J LIFESTYLE MEDICINE 2016; JAN-FEB: 10(1) 5. APMA FALLS PREVENTION WEBINAR 6. MENZ et al FOOT & ANKLE RISK FACTORS FOR FALLS IN OLDER PEOPLE; A PROSEPECTIVE STUDY; JL OF GERONTOLOGY

2006;8:866 7. NATIONAL COUNCIL ON AGING (NCOA) ARLINGTON, VA 8. KOBYASHI et al; J PHYS THER SCI 1999, 11:31-34 9. WWW.MOOREBALANCEBRACE.COM 10. SAFESTEP.NET 11. GUIDELINE FOR THE PREVENTION OF FALLS IN OLDER PERSONS; JAGS May 2001-Vol. 49, No 5 pp 664-672 12. EFFICACY OF A MULTIFACETED PODIATRY INTERVENTION TO IMPROVE BALANCE AND PREVENT FALLS IN OLDER PEOPLE;

STUDY PROTOCOL FOR A RANDOMISED TRIAL pp 1-16 Spink, Mens, Lord (Australia) BMC Geriatrics 2008 13. GAIT AND BALANCE DISORDERS IN OLDER ADULTS SALZMAN, MD AMERICAN FAMILY PHYSICIANS July 1, 2010 Vol 82 # 1

pp61-68

Thank you!

SIMBA BOOTS REX LEO !