The University Record, February 11, 1998

Neurological disorder may be behind elderly people's falls

By David Wilkins
Health System Public Relations

It¹s a terrifying aspect of old age: falling.

Nearly one in three people over age 65 and not living in a nursing home fall each year‹and those falls often result in serious injury and significant cost.

In a series of studies begun in the early 1990s, James Richardson and colleagues at the Health System have documented a strong link between falling and a neurologic disorder called peripheral neuropathy. As many as 20 percent of older adults suffer from peripheral neuropathy, which is particularly common in diabetics.

In Richardson¹s studies, more than half the subjects with peripheral neuropathy (PN) had suffered a fall, compared with only 10 percent of the subjects without PN. In fact, Richardson has shown that PN affecting the feet and legs makes elderly people about 20 times more likely to fall.

The body collects information about its position from the peripheral nervous system. PN affects that system, however, and causes people to gradually lose sensation in their feet, legs and, to a lesser extent, hands.

Older adults with PN have difficulty sensing the position of their feet and how much their ankles are turned inward or outward. As a result, their center of gravity can easily shift too far without their realizing it, making them unstable. Also, feet and ankle muscles in people with PN develop strength slowly, so they are far less likely to recover when they wobble.

In one study, PN patients could stand on one foot without teetering for only 3.8 seconds. A similar group without PN achieved 32.3 seconds.

That, Richardson says, means doctors can diagnose PN by observing how long a patient can stand on one foot. An ongoing study, in fact, suggests that a patient¹s ability to stand on one foot is a better indicator of PN than a detailed physical examination.


Preventive measures

Steps that can help people avoid PN-related falls include:

 

Support. By using a cane in their non-dominant hand, elderly PN patients can significantly reduce their risk of losing balance on irregular surfaces, especially under low-light conditions. People who are reluctant to use a cane can get the same support by leaning on a railing, stable furniture or another person.

 

Education. PN typically develops slowly, so people often are unaware that their balance is impaired. Understanding neuropathy and its progression can help them recognize it.

 

Regular eye exams. Patients with PN use their eyes to compensate for their sensory loss. It¹s important for them, therefore, to monitor their vision and make a habit of turning on lights at night.

 

The right shoes. Shoes with thin, wide soles help maintain balance.

 

Exercise. Ideally, 20 percent to 25 percent of a person¹s body weight should be supported by the cane. For that reason, they can benefit from exercises that improve balance, grip and upper body strength. Richardson also recommends people practice balancing on one foot, which can improve ankle strength and help PN patients understand their limitations.