Diabetes a Risk for Falling in the Elderly
Nursing home residents with diabetes are four times more likely to fall than those who are not diabetic, according to a study in the Journals of Gerontology.
Falling is the leading cause of accidental death for elderly people. During November, American Diabetes Month is recognized to focus on the needs of persons with diabetes.
Currently, 150 million people are estimated to have type 2 diabetes, and the number is expected to reach 300 million people by 2025.
The study found that 78 percent of nursing home residents who had diabetes fell within the 299-day study period, compared to 30 percent of those without diabetes who had a similar fall.
The study followed 139 residents of the Hebrew Home at Riverdale in New York.
Previous investigations have defined risk factors for falls among frail, elderly nursing home residents, which include gait or balance disorder, vision impairment, and medications, but until now diabetes has not been widely recognized as an important risk factor.
"Our study clearly indicated that nursing homes, assisted living facilities, and others that care for the elderly should consider diabetes a significant risk factor for falling," says Dr. Mathew S. Maurer, a researcher at Columbia University Medical Center.
"In an era of limited resources, knowing that diabetics are more likely to fall may facilitate identifying older individuals who are likely to benefit from interventions aimed at reducing falls and their consequences," says Dr. Maurer, a geriatric cardiologist.
"We will now add diabetes to the list of risk factors for falling and expect this to become standard practice," says Dr. Robert Zorowitz, chief medical officer of the Hebrew Home at Riverdale, where the study was conducted.
"By controlling diabetes, addressing the complications it causes, and being vigilant about the other factors that contribute to falls, we may substantially reduce the risk," explains Dr. Zorowitz.
Although complications from diabetes include the drop of blood pressure when standing up, known as orthostatic hypotension, as well as visual impairments, the study found that neither of these were an explanation for the increased fall risk.
Dr. Maurer speculates that problems with peripheral nerves that can affect the sensation in diabetic people's feet, known as peripheral neuropathy, could be the mechanism at fault for the higher fall rate in diabetic patients.
The study was originally intended to assess if predicting fall risk could be improved by measuring blood pressure.
The researchers tried a new method that records blood pressure continuously during the process of standing, rather than the traditional method that uses a cuff to record blood pressure while sitting and one or three minutes after standing.
The study showed that this kind of measurement did not, in fact, help prediction, but instead showed that diabetes, in addition to gait and balance difficulties, were the most potent predictors of falling in this group of people.
The study was funded by the National Institute on Aging and the American Federation of Aging Research.
Always consult your physician for more information.
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Diabetic neuropathy, a nerve disorder, is a complication of diabetes that can lead to problems throughout the body.
Persons with diabetes can develop nerve problems at any time, but significant clinical neuropathy can develop within the first 10 years after receiving a diabetes diagnosis.
The risk of developing neuropathy increases the longer a person has diabetes. About 50 percent of people with diabetes have some form of neuropathy.
Although the exact causes of diabetic neuropathy are unknown, several factors may contribute to the disorder, including the following:
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high blood glucose
High blood glucose causes chemical changes in nerves and impairs the nerves' ability to transmit signals. It also has the potential to damage blood vessels that carry oxygen and nutrients to the nerves.
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inherited factors
There are some genetic traits that may make some people more susceptible to nerve disease than others.
Taking care of your feet is especially important if you are experiencing neuropathy. The nerves of the feet are the longest in the body and often are affected by neuropathy.
When a diabetes patient loses sensation in the feet, sores or injuries may go unnoticed until ulcers develop.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, proper foot care in diabetes includes checking the feet daily; washing the feet daily; and covering the feet with petroleum jelly before putting on socks and shoes.
In addition, a person with diabetes can protect his or her feet by wearing thick, soft socks; wearing shoes that fit properly; checking the shoes for sharp edges or objects before putting them on; and never walking barefoot.
Good foot care includes cutting nails short and straight across; filing away dead skin, but not calluses; testing bath water temperature before getting in; wearing socks at night if the feet have a tendency to get cold; not sitting cross-legged; and having your physician check the feet regularly at visits.
Always consult your physician for more information.
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