Caitlin Whyte (Host): Welcome to the Flourish Podcast by Prisma Health, where we bring you the latest health and healing advice from trusted experts. I'm Caitlin Whyte, your host. Today, we are featuring Dr. Pooja Ghai, a respected geriatrician with senior primary care. Dr. Ghai will be discussing an important topic for our senior community, falls in seniors: prevention and recovery tips. Let's explore some effective strategies to keep our seniors safe and healthy. To begin our conversation today, what are the most common causes of falls among seniors?

Dr. Pooja Ghai: Very good question. So, very importantly, medications can cause falls, medication changes, orthostatic hypotension, even diseases such as diabetes, peripheral neuropathy, Parkinson's disease, arthritis, hearing, vision deficits, heart disease, cardiac arrhythmias, and other geriatric syndromes such as incontinence and cognitive impairment.

So, one important point I'm making with this long, extensive list is that if an elder falls, any fall needs to be investigated and reported to the doctor, because some of the causes for these falls, as I just listed, can be life-threatening, such as a cardiac arrhythmia or diabetes. So, bottom line is falls are not to be taken lightheartedly. We need to do our due diligence and investigate why exactly did this person fall?

Host: And how do age-related changes in vision and balance contribute to these falls?

Dr. Pooja Ghai: Very good question. Orthostatic hypotension, believe it or not, this can be a result of age-related changes to our baroreceptor, which becomes less sensitive to changes as we age. So, orthostatic hypertension is a decrease in blood pressure when going from a sitting or supine position to standing, and this can result in a fall.

 In regards for vision, cataracts can be an age-related change that can result in vision deficits contributing to falls. In fact, there was a trial that looked at people who underwent cataract removal surgery, and that trial found a successful reduction in falls with the first cataract removal. So, it's very important to see your geriatrician and learn about these age-related changes so we can make a game plan together and find evidence-based strategies to help prevent falls.

Host: You mentioned some medications or changes in medications can increase the risk of falling. On that note, can you tell us which medications might contribute more to that risk.

Dr. Pooja Ghai: Absolutely. Medication changes are so important to discuss and review together with your doctor. And so, the medications with some of the greatest strength of evidence that increases the risk for falls include benzodiazepines; diuretics, so that water pill, fluid pill; analgesics, or pain medications such as opioids and NSAIDs. And NSAIDs are a class of medications like ibuprofen, Motrin, meloxicam. And also, surprisingly very common also are medicines we use for mood and behavior disorders such as antidepressants and antipsychotics as well.

So, very important to always bring your medications in to your primary care doctor's office. Let your doctor see exactly what medicines you are taking and work together with you and your family to find ways to decrease the number of medicines and, ultimately, prevent falls, and this is something I just love doing with my patients. Just sitting down together, going through all of their medications so that person knows exactly why they are taking each medication, and we can work together towards eliminating as many as possible that are not necessary. And I will say it is always a good day for a geriatrician when we see our patients walking out with less medications.

Host: Well, how about those chronic conditions like arthritis or diabetes? How do they affect fall risk?

Dr. Pooja Ghai: Very good question. The diabetes is a risk factor for falls, but it's also a risk factor for fracture and injury in the setting of a fall. And the pathophysiology that explains the connection between diabetes and falls is the altered glucose or blood sugar metabolism, which increases the risk for microvascular and cardiovascular disease, which independent of itself is a risk for falls and bone fragility. So, the altered glucose metabolism can lead to hypo and hyperglycemia, which is a risk factor for falls. Also, diabetes type 2 specifically is often associated with obesity, which increases fall risk because of immobility, inflammation, sarcopenia. Thus, as healthcare providers, we want to screen this patient population for diabetes.

And for arthritis, it is a common comorbidity and often a modifiable one. Arthritis may affect a patient's ability to step over or maneuver past an object. And of course, pain from the arthritis can act as a distractor. So for example, a patient might think, "Oh, I don't want to hurt my right knee," which has arthritis when I step with my right knee, and they might not walk as balanced or as confidently forward, and thus that pain itself can increase and distract the patient from walking safely and increase that patient's risk for falls.

Host: What about environmental modifications? What can be made to reduce fall hazards?

Dr. Pooja Ghai: Yes. So, removing rugs is a good idea. Clearing a pathway where there are no cords or wires in the home can be very helpful. Also, improving lighting in the home, for example, having a nightlight in the hallway, especially at night when we have to wake up to go to the bathroom, can be really helpful. And, in fact, in evidence-based strategy for fall prevention that addresses environmental modifications is a home hazards assessment, which has been shown to prevent falls. And importantly to note, the CDC website has lots of good resources and information on how to make a home safer.

Host: With that, what are some effective strategies for preventing falls in the home?

Dr. Pooja Ghai: Exercise is a big one. Even Tai Chi, which has been demonstrated in over 10 randomized control trials, Tai Chi prevents falls. It's a good evidence-based strategy. And in fact, one of my patients is actually a Tai Chi master. His balance and strength are just on point at every office visit. Very impressive.

And then, other preventative strategies include medication reviews like we talked about earlier. Visual interventions such as cataract surgery if indicated. Also, hearing aids, and I will add consistent use of hearing aids is associated with a decreased risk of falls. So very important. And also, furthermore, footwear. Wearing the right shoes can prevent falls. And one final point for residents in the nursing home, it has shown that medication review, but also vitamin D can prevent falls, especially vitamin D in those who are deficient in vitamin D in the nursing home. So, this was just an interesting strategy that I found in my literature review for falls, very important too.

Host: Well, how can seniors improve their balance and strength to reduce that fall risk?

Dr. Pooja Ghai: Tai Chi, like I said, is a great way to improve both balance and strength, reduce falls. Additionally, joining an exercise program and focusing on strength training can certainly improve balance and strength. And working with a physical therapist can be an effective way to really improve our balance and strength as well.

Host: well, in the case of a fall happening, Doctor, what steps should be taken immediately afterwards?

Dr. Pooja Ghai: The most important step to do is to investigate that fall, notify your primary care doctor. So your doctor. And you can work together to really figure out exactly why this patient fell.

Host: And to wrap it up for us, Doctor, how can physical therapy aid in recovery from fall-related injuries?

Dr. Pooja Ghai: Oh, physical therapists are just wonderful, wonderful people, and physical therapists can perform assessments to evaluate a patient's balance, gait, speed, strength to really improve that person's overall ability to move safely and effectively. And they're able to see if that patient needs any additional resources or device to maneuver even more safely.

So in fact, our physical therapists also have a false prevention program in place and work collaboratively with the healthcare provider and the patient to improve that patient's mobility, strength, balance to prevent falls. But remember, the first thing is to tell your doctor you had fallen so we can put these strategies in place.

Host: Well, thank you, Dr. Ghai, for sharing your insight on fall prevention and recovery tips. Remember, safety starts at home. And with the right knowledge and resources, we can help our seniors live healthier and safer lives. And thank you for joining us on this episode of Flourish by Prisma Health. For more information, visit prismahealth.org/flourish. Don't forget to subscribe and share this podcast with others who might benefit.