Diabetes and falls
Falls are a serious health risk for older Canadians. When diabetes is added to the mix, the risk of falling is much worse.
It’s a well-known fact: older adults have a very high risk of falling. One in three Canadians aged 65 and over falls each year, and 50% fall at least twice. In many cases the only damage is to one’s pride, but 20-30% of seniors who fall suffer moderate to severe injuries that jeopardize health, mobility and the ability to live independently.
Many risk factors have been identified that increase the likelihood of a fall, but one of the most significant is seldom mentioned and has only recently begun to receive the attention it deserves: diabetes.
DM (diabetes mellitus) is a rapidly growing healthcare concern in Canada, particularly amongst seniors. According to data from Statistics Canada and the Canadian Diabetes Association, seniors are notably overrepresented amongst diabetics: people aged 65 and over account for 47% of all diabetics but only 14% of the total population.
In Canada, 47% of people with diabetes are over 65 years of age.
40% of older diabetics report falling each year 7
When diabetes collides with seniors’ propensity to fall, a kind of double jeopardy sets in because DM complications further increase the likelihood of a fall.Research shows that elderly diabetics fare worse than non-diabetics on several critical fall-related measures:
- 25% more likely to fall (Schiller, 2007).
- 58% higher likelihood of recurrent falls.(Pijpers et al., 2011)
- 97% higher injury rate (NHIS,2001-2003)
Additional differences include:
- Slower rehabilitation following a fall-related hip fracture (Semel et al., 2010)
- Worse functional outcomes following rehabilitation after hip fracture surgery (Liberman et al., 2007).
- Lower preoperative health related quality of life, more pain, co-morbidities and reduced health status following a hip fracture (Ekstrom et al., 2013)
Why diabetes is such a significant falls risk factor
Type I and II diabetics are prone to several complications that can increase the chance of a fall, especially if blood sugars are not being managed effectively, including:
Hypoglycemia: A hypoglycemic reaction is perhaps the greatest falls risk factor for diabetics. Low blood sugar levels due to missed meals or an increase in activity level can lead to uncontrolled tremors, dizziness, sweating, blurred vision, delirium and in extreme cases, loss of consciousness.
Medications: The falls risk associated with polypharmacy is greater for diabetics than for non-diabetics because their condition requires the use of an additional medication: insulin or a hypoglycemic drug such as Metformin. Not only is the opportunity for negative drug interactions higher, some diabetic medications can elevate the risk of falls even on their own.
Diabetic Peripheral Neuropathy: DPN, impairment of the nervous system, is one of the most common diabetic complications, affecting approximately 30% of older patients. DPN causes tingling, pain or loss of feeling in the lower extremities.
Retinopathy: Damage to the retina of the eye is the leading cause of blindness in Canada and the U.S. Symptoms include blurred or cloudy vision and problems adjusting to changes in lighting, each of which increases the risk of a fall.
Renal failure: Diabetes is the leading cause of kidney failure, accounting for almost half of newly diagnosed cases. Symptoms of kidney disease include poor endurance, muscle cramps, weight loss and difficulty thinking clearly.
Preventing DM-related falls
The incidence of diabetes in the population is increasing at an alarming pace. As the Baby Boom generation continues its shift into the age 65+ cohort, the number of senior diabetics will swell significantly. Healthcare providers will need to redouble their efforts to warn senior diabetic patients and their caregivers about the additional falls risks they face and encourage them to reduce their risk by controlling their blood sugar levels, following their medication regimen carefully, remaining active and eating healthy meals.
Healthcare providers must also remind patients to think about how they would get help if a health emergency leaves them unable to get to a phone.
Lifeline is a smart investment for senior diabetic patients so that they have access to fast, expert emergency help 24 hours a day. The Lifeline with AutoAlert option is a particularly wise choice in case a fall or hypoglycemic reaction prevents them from pushing their Help Button on their own.
40% seniors over 85 take 10+ pills per day
1 in 3 seniors takes a medication that should be avoided
- Canadian Diabetic Association; The Prevalence and Cost of Diabetes: Facts, 2009.
- Statistics Canada; Annual Demographic Estimates, Table 2.1-1, 2010.
- Schiller et al.; Fall Injury Episodes Among Noninstitutionalized Older Adults: United States, 2001-2003, Table 2: Annualized frequency and rates of fall injury episodes by health characteristics.
- Crews, Yalla, Fleischer, Wu; A Growing Troubling Triad: Diabetes, Aging and Falls; Journal of Aging Research, 2013.
- Piper, Barb; Falls and Diabetes.
- McCulloch, Munshi; Treatment of Type 2 Diabetes Mellitus in the Elderly Patient, 2013.
- Mayne, D. et al., Diabetes, falls and fractures, Age and Ageing (2010) 39 (5): 522-25. http://ageing.oxfordjournals.org/content/39/5/522.full