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Caitlin Whyte (Host): Welcome to Hally HealthCast, your monthly wellness podcast from Hally Health, your partner in helping you live your healthiest life. Every month on our podcast, we address a new topic important to your health and wellbeing; bringing in expert doctors, therapists, and specialists who offer advice and answer your most pressing questions.

This month, we're discussing fall risk and prevention. Every year, millions of Americans fall, and although you might not think so, falls are often very serious. In fact, according to the CDC, over 800,000 Americans a year are hospitalized because of falls and falls, commonly cause broken bones and severe head injuries.

Here with us to talk about falls and most importantly, how to lower your risk, are two experts from Carle Health, headquartered

inner Banda, Illinois.

Caitlin Whyte (Host): amy Luchinski is a Senior Physical Therapist and Laura Lyon, also a Physical Therapist is a Vestibular Rehab Specialist. Welcome to both of you. And thanks for being with us today.

So let's begin first and foremost, we need to bust a common myth. The myth that falls are just a minor worry, of little concern and not something we should take too seriously. So Miss Luchinski, why is this viewpoint so wrong?

Amy Luchinski, MPT (Guest): Well, if you look at the data, the CDC actually says that falls are a lot more common than people realize. In fact, statistically, they have shown that every second of every day an older adult of age, 65 or older suffers a fall in the United States. This makes falls the leading cause of injury and injury death in this age group. They have shown that one out of every four older adults will fall each year. Making fall is definitely a public health concern. And then one out of five falls actually causes a serious injury, such as a broken bone or a head injury. In fact, 95% of all hip fractures are caused by falls. And they can also result in head injuries, which is even more concerning if the person's on blood thinners.

And also even if a person's not injured after a fall, which is the hope, they often become afraid of falling. And this creates kind of a vicious cycle because if the person becomes even less active, due to a fear of falling, it actually increases their risk for falls.

Host: Wow. That's some important info to know. Thank you so much, Miss Luchinski and Miss Lyon turning to you, now that we know how serious falls can be, can you tell us a bit more about who is at risk?

Laura Lyon, PT (Guest): Well, Amy mentioned one set of people that's more at risk. Those who have fallen before, and those who've developed a fear of falling. The fear avoidance cycle will keep them from walking and moving as much as they need to in order to stay strong and well balanced. Other risk factors include, or other people who are at risk include those who are of advanced age, anyone who has significant muscle weakness. Anyone with gait problems, such as Parkinson's disease or other neurological disorders, people with poor vision, people with postural hypotension and anyone with chronic conditions, such as arthritis, history of stroke, even incontinence, diabetes, and dementia. I think that's it.

Host: Well, thank you. And Miss Luchinski back to you. As Miss Lyon just touched upon, it's so important to know the risk factors for falls. Can you explain a little bit about what you call intrinsic and extrinsic factors? The difference between the two types and some examples of each.

Amy: Well, Laura actually did a fantastic job, kind of talking about the most important intrinsic risk factors. Intrinsic risk factors are things that are kind of within yourself. They're individual. Some of them you can control and affect. Some of them, you can not. Intrinsically we can't change whether or not we get older, we're all going to get older and intrinsically, as we get older, that does increase our risk for falls.

Sometimes a chronic medical condition we don't always have control over and that's intrinsic too, sometimes the risk factors with falls, including that she mentioned stroke, diabetes, Parkinson's, et cetera. However, some of the intrinsic risk factors that we can control are muscle weakness, balance issues. Those sorts of things. Now, on the other hand, there are the extrinsic risk factors and those extrinsic risk factors are more your environment. And those are the things that you have even more control over. And it's making sure that your environment or the, the things extrinsically outside of yourself are set up appropriately to minimize your risk of falls.

You can look at your stairs, making sure you have a railing when you're walking up and down stairs, making sure your bathroom is set up with grab bars and appropriate footing so that you don't slip, make sure that the lighting is available because vision is such an important part of balance. Making sure that the lighting is such, that you can maximize the vision that you do have.

And then also just looking at general obstacles, throw rugs, clutter around your house, those sorts of things that can increase your risk of falls. And the final extrinsic factor is making sure if you do use an assistive device, such as a cane, that you know how to use it appropriately.

Host: Wonderful. Good to know. And Miss Lyon beyond more well-known factors, such as age, how do you and other medical experts identify a person's specific fall risks? Are there any tests or screening methods you could use?

Laura: We have many standardized tests that we use to try to gauge how a patient is of falling. The first thing we usually do is assess strength and range of motion. As we mentioned earlier, muscle weakness, particularly in the legs and trunk can lead to an increased risk of falling. Some other tests that we do include a standing test called Romberg stance, where the patient stands with their feet close together. And we look at how much they sway or if they lose their balance with eyes both open and closed.

We also look at other balance measures and standings such as how they do on compliant surfaces and how they do with catching their balance, if they're gently nudged. There's a number of gait tests that we can do to assess walking and you know, basically they entail all sorts of different conditions, such as walking at different speeds, walking while turning your head side to side or up and down, walking while turning, going up and downstairs, maneuvering obstacles. There's just a number of different components to gait. And most of the screening tools we use try to incorporate as many as possible.

Host: You know, we're talking a lot about risk factors in this episode. So sticking with you, Miss Lyon, can you tell us why knowing a person's specific fall risk is so important?

Laura: Usually if you know, you're at a high risk of falling, then you can try to determine whether the use of a cane or a walker wouldn't be most beneficial to help that person to keep them upright and mobile. And hopefully not fall. If they're at a minimal risk of falling, then you know, you know that they won't necessarily need an assistive device all the time, but there are some things that you need to work on. So just knowing how much risk they are, leads you to a different treatment, depending on where they fall on that spectrum.

Host: Thank you. And back to you, Miss Luchinski. Can you explain how physical therapy, specifically can help people lower their risk of falls?

Amy: Well, we've talked about the intrinsic risks with, with falling and in many ways, poor balance, which results in falls is a skill where it kind of quote, practice makes perfect or you use it or you lose it sort of thing. There's many systems that you have to work together for balance to be at its ideal. A physical therapist can assess those different systems to determine what specific area a person may need to work on in order to improve their balance. Laura mentioned strength. You mentioned balance reactions, but even kind of determining how much vision is playing into that.

And so sensory awareness. So it's always nice to kind of have the specifics as to what areas may be weak, that may be resulting in some of these balance issues. Plus it's always helpful to quote, practice balance or challenge balance in a safe environment. Obviously, if you're at a risk for falling, you don't want to necessarily challenge those on your own, but if you come and see a physical therapist, they can closely work with you and put you into those challenging positions where you could actually improve your balance.

Also, a physical therapist is very helpful in education. Just educating on what their fall risk is. Physical and occupational therapists can do a home safety assessment to kind of look at those extrinsic risk factors and that, that may be increasing your fall risk. I guess that's kind of the, the general idea is the education and then looking more specific so that they can work on increasing strength, improving walking speed and working on walking on different surfaces.

Host: Great such wonderful information. Expanding on this a bit though, miss Lyon, your unique specialty is vestibular rehabilitation. Can you tell us a little bit about this type of physical therapy and why balance is key to addressing fall prevention?

Laura: Vestibular rehabilitation deals with treatment specifically for conditions that affect the inner ear. These might include things like benign vertigo, Meniere's disease, infections that hit the inner ear like labrynthitis or neuronitis. And the inner ear is, you know, one of your main balance systems. It's the balance system that's working to help you all the time to maintain your position in space appropriately.

So when something goes wrong here, it can drastically affect your balance and lead to falls. There's many ways that we work on improving the use of the inner ear. Some of the balance things we mentioned before, walking stability with the head moving is key. We look at how the eyes and the inner ear interact and how well they work together. And that's a big part of our treatment as well as correcting any benign vertigo or otoconia or crystal issues that arise. So, all of those are important for our patients to maintain good balance.

Host: And turning back to you, Miss Luchinski, how else can physical therapists help those at risk of falling?

Amy: Well, we've kind of alluded to many of them. There's several ways that we can help them. First, obviously, just by assessing with the standardized tests that have been developed and normed, we can kind of determine what their fall risk is. And then if people know what their fall risk is, they can take some more proactive measures in order to decrease those risks.

As we've stated, a physical therapist is trained to assess what needs to be worked on both intrinsically and extrinsically, and also, if it's determined based on these tests, if an assistive device such as a cane or a walker is appropriate, a physical therapist can be helpful in training them in the, in the safest way to use those devices.

And again, the education component is huge. Just awareness of the fall risk is a huge strategy to decrease it. The home safety assessments can take it to the next level. And so just making sure that you're kind of recognizing how your fall risk can affect your life and how you can control it.

Host: Great well, such wonderful, helpful resources. As we're approaching the end of today's program, I'd like to finish with a brief lightning round of final questions. So if you could provide some short and quick responses, that would be wonderful. So let's start with you, Miss Lyon, it's December and harsh winter weather will be gripping many of our listeners'

communities

Host: for the next few months. What winter specific fall risks should people be aware of?

Laura: The most important fall risk in winter is ice. And it is better to just avoid walking on ice, avoid going out when it's icy or the roads, or the sidewalks are slick because they do lead to many falls, no matter how good your balance is, a fall on ice can be a life-threatening and very injurious.

Host: Ms. Luchinski, in addition to physical therapists, what other medical professionals can someone turn to for help in preventing falls?

Amy: Occupational therapists are often the ones that perform the home safety assessments and they are a fantastic resource as well, from the educational perspective, they look at the activities of daily living and how those activities may affect people's falls, but as with any medical condition an ongoing conversation with your primary physician is, is of extreme importance.

Host: Miss Lyon, what can family members or caregivers do to help support a loved one and lower their risk of falling?

Laura: Family members and caregivers can certainly help remove some of those extrinsic fall risk from the patient's house. Make sure the home is accessible, has proper guardrails, handrails and, you know, throw bugs removed. Also oftentimes a home alert system, a wearable, either bracelet or necklace that the patient can wear, if they run into trouble, those are very helpful. And I know caregivers can help set that up too

Host: All right. And the next one is a hard question for both of you maybe, and you can only pick one or two, but what is the best exercise someone can do at home to help lower their risk of falls? Ms. Luchinski, you can go first.

Amy: Just at the top of my head, I would say if people could improve their strength with working on sit to stands, they can work on sit to stand without using their hands. That's a very good, helpful, useful skill to have. They've also shown that working on standing on one leg, if you can do that in a safe way, has a high correlation to fall risk. So if you can still be able to safely maintain and work on balance, standing on one leg, those are two of the biggest exercises that I can think of.

Host: And how about you, Miss Lyon?

Laura: I usually tell my patients that if you want to be able to continue walking, you need to practice walking. And it needs to be for a longer duration and distance than just around the house in most cases. So whatever allows you to get up and move, whether it's with a cane, hiking stick, walker whatever you need to feel safe. You need to keep walking. Ideally 30 minutes a day, but you can split that up, however you need to into five or 10 minutes increments. But that needs to be a part of every day in order to keep that walking balance.

Host: Got it. And another hard one for both of you, if you had to pick, what's the most important takeaway from our conversation today? Miss Luchinski what should our listeners know?

Amy: So while we can't control aging and some of the other intrinsic risk factors that come with an increased risk of falls, there is some things that you can control. So you just need to keep moving and just seek help if you need to so that you can minimize that risk as much as possible.

Host: And Miss Lyon, your final thoughts.

Laura: I agree completely with Amy Luchinski. If you feel unstable or are not moving around as much as you'd like to, because you are concerned about your balance to have low confidence, then definitely seek treatment from your doctor, from a healthcare professional, from the therapist, because you don't want to stop moving. You need to keep walking and you need to keep moving.

Host: All right. And one final final question just for you, Miss Luchinski. If our listeners are interested in physical therapy to help lower their risk of falls, who should they contact or what steps should they take to get started?

Amy: Well, the first step is always to talk to your, your healthcare provider or your, or your primary physician. As part of that conversation with the physician, they can kind of do a general assessment of the fall risk, but then their doctor is able to, if they feel like more therapy is warranted, they can refer directly to physical therapy and then the physical therapist can do a much more thorough assessment to not only assess the fall risk, but also make specific recommendations for treatment/interventions.

And also just to keep an ear out. Sometimes within the wellness programs, there are free fall risk screenings that are available. And so sometimes just kind of having the knowledge and being educated is a good thing to have as well.

Host: Well, you both have truly been such wonderful guests. Thank you so much, Miss Luchinski and Miss Lyon for joining us today and for all you do every day at Carle Health to help so many individuals and families. And just a final reminder to our listeners, make sure you discuss your own personal fall risk with your primary care provider during your next scheduled visit. That concludes today's Hally HealthCast.

Tune in next month as we tackle yet another topic important for your health and wellbeing. And remember, Hally Health is your partner in helping you live your healthiest life. Visit hally.com for resources, information, tips, and much, much more. Let us help keep you and your family healthy and well. Thanks for listening. We hope you tune in next month.