News (December 2005)

AAOS Releases Luggage lifting Techniques

The last thing you want to do this holiday season is to sustain a fall-related injury while traveling. The AAOS released several lifting and luggage carrying techniques on Nov 17 in order to help older Americans prevent luggage related injuries.

During the holidays when traveling is at the highest, a travelers’ neck, back and should are most prone to injuries because of their bulky luggage. The American Academy of Orthopedic Surgeons (AAOS) wants people to use proper judgment when packing, lifting and carrying luggage.

In 2004, according to the US Consumer Product Safety Commission there were over 49,100 luggage related injuries. The most common injury that is luggage related is the back, neck and shoulder due to a heavy, over packed luggage.

The AAOS techniques for lifting and carrying luggage are:

• When shopping for new luggage, look for a sturdy, light, high-quality and transportable piece, preferably one with wheels and a handle.
• Avoid purchasing luggage that is too heavy or bulky when empty.
• Use smart packing techniques and pack lightly.  When possible, place items in a few smaller bags, instead of one large luggage piece.
• When lifting luggage, stand along side of it, bend at the knees – not the waist – lift with the leg muscles, then grasp the handle and straighten yourself up.  Once you lift the luggage, hold it close to your body.
• Do not twist when lifting and carrying luggage. Point your toes in the direction you are headed and turn your entire body in that direction.
• Do not rush when lifting or carrying a suitcase. If it is too cumbersome, get help. 
• Do not carry bulky luggage for long periods of time.  Make sure to check heavier items when traveling rather than carrying them for the duration of the trip.
• Carry light pieces in each hand rather than one heavy item in a hand off to the side to decrease stress to the spine. Less weight on any one arm can also reduce the risk of developing "suitcase elbow," a chronic condition similar to "tennis elbow."
• When placing luggage in an overhead compartment, first lift it onto the top of the seat.  Then, with the hands situated on the left and right sides of the suitcase, lift it up.  If your luggage has wheels, make sure the wheel-side is set in the compartment first.   Once wheels are inside, put one hand atop of the luggage and push it to the back of the compartment. To remove the luggage, reverse this process.
• If using a backpack, make sure it has two padded and adjustable shoulder straps to equally balance the weight. Choose one with several compartments to secure various-sized items, packing the heavier things low and towards the center. Slinging a backpack over one shoulder does not allow weight to be distributed evenly, which can cause muscle strain.
• If using a duffel or shoulder bag, do not carry it on one shoulder for any length of time. Be sure to switch sides often.
• Make sure to carry all rolling luggage when climbing stairs.

Source: Nov. 17, 2005 Press Release; “Traveling doesn’t have to be a Pain. Orthopedic surgeons provide luggage lifting and carrying recommendations” (www.orthoinfo.org)

Diabetes Mellitus Is Associated With an Increased Risk of Falls in Elderly Residents of a Long-Term Care Facility

by Mathew S. Maurer, Joyce Burcham and Huai Cheng

Columbia University, College of Physicians and Surgeons, New York.
Correspondence: Address correspondence to Mathew S. Maurer, MD, Columbia University, Clinical Cardiovascular Research Lab for the Elderly, Allen Pavilion, 5141 Broadway, 3 Field West, Room 035, New York, NY 10034. E-mail: msm10@columbia.edu

Background. Diabetes mellitus is common among elderly persons, with several potential complications that could contribute to falls. However, diabetes mellitus is not widely recognized as an important risk factor for falls among elderly persons. Accordingly, the purpose of the current study was to determine whether diabetes is an independent risk factor for falls in elderly residents of a long-term care facility.

Methods. Ours was a prospective cohort study of 139 elderly (88 ± 7 years, range 70–105 years), Caucasian (97%) residents (women, 84%) of a long-term care facility. Inclusion criteria were age 60 years, ability to rise from a seated position, informed consent obtained from participant or guardian. Multiple domains were assessed for the association with falls including: clinical diagnoses; medication use; orthostatic changes in blood pressure, gait, or balance; cognitive/mental status; general well being; activities of daily living; affect/behavior; range of motion and/or ambulation; and communication. Diabetes mellitus was determined by use of hypoglycemic agents. Time to first fall was determined by review of daily New York State mandated "Incident and Accident" reports.

Results. Over the follow-up period (mean 299 days), 49 participants (35%) experienced a fall. The fall incidence rate for the participants with and without diabetes mellitus was 78% and 30%, respectively (p <.001). The significant unadjusted hazard ratios of fall risk factors included diabetes mellitus, Berg Balance Scale score <45, number of medications, angiotensin-converting enzyme (ACE) inhibitors, hypertension, use of assistive device, inability to independently move a wheelchair, and use of antidepressants, with the latter two factors being protective. In multivariate analysis, only diabetes (adjusted hazard ratio 4.03; 95% confidence interval, 1.96–8.28) and gait and balance (adjusted hazard ratio 5.26; 95% confidence interval, 1.26–22.02) were significantly and independently associated with an increased risk of falls.

For further information: http://biomed.gerontologyjournals.org/cgi/content/abstract/60/9/1157

Reduction in Fear of Falling Through Intense Tai Chi Exercise Training in Older, Transitionally Frail Adults

Richard W. Sattin, MD*, Kirk A. Easley, MS, Steven L. Wolf, PhD, FAPTA, Ying Chen, MS, and Michael H. Kutner, PhD

Objectives: To determine whether an intense tai chi exercise program could reduce fear of falling better than a wellness education (WE) program in older adults who had fallen previously and meet criteria for transitioning to frailty.

Design: Cluster-randomized, controlled trial of 48 weeks' duration.

Setting: Ten matched pairs of congregate living facilities in the greater Atlanta area.
Participants: Sample of 291 women and 20 men, aged 70 to 97.

Measurements: Activity-related fear of falling using the Activities-Specific Balance Confidence Scale (ABC) and the Fall Efficacy Scale at baseline and every 4 months for 1 year. Demographics, time to first fall and all subsequent falls, functional measures, Centers for Epidemiologic Studies Depression Scale, medication use, level of physical activity, comorbidities, and adherence to interventions.

Results: Mean ABC was similar in both cohort groups at the time of randomization but became significantly higher (decreased fear) in the tai chi cohort at 8 months (57.9 vs 49.0, P<.001) and at study end (59.2 vs 47.9, P<.001). After adjusting for covariates, the mean ABC after 12 months of intervention was significantly greater in the tai chi group than in the WE group, with the differences increasing with time (mean difference at 12 months=9.5 points, 95% confidence interval=4.8–14.2, P<.001).

Conclusion: Tai chi led to a significantly greater reduction in fear of falling than a WE program in transitionally frail older adults. The mean percentage change in ABC scores widened between tai chi and WE participants over the trial period. Tai chi should be considered in any program designed to reduce falling and fear of falling in transitionally frail older adults.

Source: Journal of the American Geriatrics Society Volume 53 Issue 6 Page 943  - June 2005 doi:10.1111/j.1532-5415.2005.53302.x

A Simple Gait-Stabilizing Device Reduces Outdoor Falls and Nonserious Injurious Falls in Fall-Prone Older People During the Winter

by Fergus Eoin McKiernan, MD*

Objectives: To determine whether Yaktrax Walker (YW), a nonmedical gait-stabilizing device, prevents outdoor falls and injurious falls in fall-prone older people during the winter.

Design: Prospective, randomized, interventional trial.

Setting: Community-based, northern United States, winter, outdoors.

Participants: Ambulatory, community-dwelling, fall-prone people aged 65 and older.
Intervention: Participants were randomized to wear YW or their usual winter footwear (UWF) outdoors during the winter of 2003/2004.

Measurements: The number of indoor and outdoor slips, falls, and injurious falls was recorded daily in a fall diary. Winter footwear satisfaction survey was completed after study completion.

Results: One hundred nine subjects completed 10,724 diary days. Mean age was 74.2. There were 93 indoor slips, 13 indoor falls, 714 outdoor slips, and 62 outdoor falls. The tendency for both groups to slip/fall indoors was comparable. The relative risk (RR) of outdoor slip for YW was 0.50 (P<.04) for all diary days and 0.61 (P=.14) when only days walked on snow and ice was the exposure variable. The RR of outdoor fall for YW was 0.42 (P<.03) when only days walked on snow and ice was the exposure variable. RR of injurious falls per day walked on snow and ice for YW was 0.13 (P<.02). Twelve of 19 outdoor falls occurred when YW subjects were not wearing their assigned device. No serious injury or fracture occurred in either group. The number needed to treat for the YW to prevent one nonserious injurious fall in one winter was six.

Conclusion: YW may reduce the risk of outdoor winter falls, and of nonserious injurious falls, in older community-dwelling people with a history of previous falls.

Source: Journal of the American Geriatrics Society Volume 53 Issue 6 Page 943  - June 2005 doi:10.1111/j.1532-5415.2005.53302.x

Home Modification to Prevent Falls by Older Emergency Department Patients

by Lowell W. Gerson, Carlos A. Camargo, Jr. and Scott T. Wilber
Northeastern Ohio Universities College of Medicine: Akron, OH, Harvard Medical School: Boston, MA, Summa Health System: Akron, OH

ABSTRACT

BACKGROUND:
The Society for Academic Emergency Medicine (SAEM) Public Health Task Force did systematic reviews of 17 preventive services that could be delivered in the ED. The recommendation for fall prevention for older patients was that further study was needed.

OBJECTIVE:
To test the effectiveness of distributing information about fall prevention to older patients who were discharged home from the ED.

METHODS:
This IRB-approved prospective non-randomized comparative trial was conducted for 9 days in 10 EDs. All patients 65 years old discharged home and providing consent were eligible. Control patients were enrolled the first 2 days, and intervention patients the next 7. All patients were told they were enrolling in a home safety study. Intervention patients were given 2 fall prevention brochures and were called 2 weeks later to remind them of the brochures. All patients were called 1 month after discharge and asked if they made, or planned to make, changes to their home and if they started an exercise program, had medications reviewed, or had vision checked. We present proportions with 95% CIs. Statistical significance was tested with chi-square;  = 0.05 was considered significant.

RESULTS:
396 patients were enrolled (149 control, 247 intervention), of whom 80% had complete follow-up interviews. The average age was 76 years (SD 7), 62% were women, and 67% were white. 8% (95% CI, 4-12%) of the intervention group made a home modification, as did 9% (95% CI, 4-17%) of the controls, p = 0.70. 17% of the intervention group and 16% of controls (95% CI, 9-25%) were planning a change, p = 0.82. Both groups reported high rates of compliance with the other fall prevention recommendations: 32% of patients started an exercise program, 83% had medication reviews, and 68% had vision checks.

CONCLUSIONS:
Distributing fall prevention literature in the ED is feasible. The similar home modification rates in the 2 groups suggest that even minimum discussion (e.g., the consent procedure) may increase patients' fall prevention activities.

SOURCE: Academic Emergency Medicine 2004 11: 474-a