People with diabetes (PWD) have an increased risk of balance problems and falls. The CDC reports one in three adults aged ≥ 65 fall each year. The incidence is even higher in PWD. Sara Quandt and colleagues reported nearly 43 percent of adults aged ≥ 65 fell once in the previous year and 26 percent fell two or more times (J Gerontol A Biol Sci Med Sci. 2006;61(4):394-398). Carolyn Wallace and colleagues reported on PWD and a history of foot ulcers, average age 62 years, with 64 percent reporting at least one fall in a two-year period (Diabetes Care. 2002;25(11):1983-1986).
There are several possible risk factors that can increase falls and injuries in PWD including insensate feet, obesity, visual and hearing problems, autonomic neuropathy, orthostatic hypotension, arthritis and pain, inactivity and mobility disability, and co-morbid conditions (h/o stroke, heart arrhythmias, hypertension). The use of four or more medications increases the risk of falls and some medications put people at higher risk including those that cause drowsiness, dizziness, lightheadedness and confusion.
Falls can cause major injuries, including hip fractures and traumatic brain injury, and increase risk of death. Even if a person is not injured, they may be more fearful of falling causing a decrease in activity level, eventually worsening the ability to move well, and increasing the risk of a future fall.
This is a huge problem! As diabetes educators, what can we do?
Exercise can improve balance. Important exercises include those that challenge balance and increase leg strength. Many community programs include balance exercises. Tai chi is a great way to improve balance. It is low impact and safe for most people. Learn about programs in your area to provide options to PWD.
Refer to a physical therapist
A PT exam can reveal areas of impairment including decreased leg strength or vestibular problems. A specific exercise program can help PWD, in spite of co-morbidities (i.e., neuropathy, visual disturbance). Appropriate assistive devices can be recommended. Safety first, then challenge balance.
Perform a complete review, or refer to someone who can, to discontinue those that are not necessary or make adjustments where possible, especially those that increase fall risk.
Encourage eye and ear examinations
Visual and hearing impairments increase the risk of falls. Are glasses current, clean, being worn? Is a hearing aid required, batteries working?
Provide a home safety check list
The CDC has many available. I just ordered some for free!
Teach your patient that balance can improve and falls are not okay!
People often do not realize they can do something to improve their situation.
It is not acceptable to fall, and eventually, a major injury could occur. Let’s work together to help people improve balance and prevent falls and the consequences.
Do you do something for the PWD you work with to help prevent falls?