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PT on the Run

Winter Falls

Published December 12, 2013 5:31 PM by Michael Kelley

"‘Twas the season of winter,

So if you look right or look left,

The elderly are falling,

Requiring an ORIF."

Okay, so maybe not quite the holiday story we grew up with, but as Old Man Winter once again settles in for the next few months, we're reminded that amidst the cold and wind and ice, snowflakes won't be the only thing falling out there!

I spent some time over the past few days looking for research on the prevalence of falls among the elderly during the winter months compared to the more tepid seasons. Sadly, I could only find one reference to an article published in Gerontology in 1988. I was three years old then, so how accurate or valid this article is today, well, perhaps that's a question for fellow ADVANCE blogger Lisa Mueller's post, "When is Research Outdated?" But for the purposes of this post, let's assume this article is enough to at least support what I would say is pretty obvious clinical evidence that the number of elderly patients coming into the hospital as a result of a fall increases during the winter months.

Now there are those who might argue that more elderly individuals are apt to fall during the warmer months when they're going out and being more active, but it has been my experience that even elderly individuals who appear fairly fit are no match for a slick sidewalk or patch of black ice. Just this morning I saw a woman walking with a standard walker (no wheels) down the snow-covered sidewalk, while it was snowing and the wind chill was near zero. Now I don't know this woman's story or what her station in life was, but the first thought in my head was, "Man I hope she doesn't fall and break her hip!"

Which leads me to the dreaded O-R-I-F! I don't know how others feel about internal fixations, but at our hospital, most therapists dread them. Now don't get me wrong, we have some great surgeons and I really think our nursing care is top-notch, but from a PT standpoint, working with an acute hip fracture ORIF patient is just the pits. We try our best to get these patients mobile as quickly and safely as possible, but more often than not it seems they have everything working against them.

There is the obvious emotional/psychological aspect of suffering a fall. For the average younger adult, a fall is usually not a big deal, but for elderly people, most of them realize a fall can be life-threatening. Then there's the surgery, which of course is a traumatic experience for anyone. And then the recovery, where PT is obviously involved, can seem like an uphill climb that never seems to end. Battling all of these things makes our job as PTs even harder, not to mention the obvious physical pain that the patient has to endure. Regardless, we do our best... and pray that Santa brings sunny skies and warm air soon!

What does everyone else think? Does anyone else dread hip-fracture patients as much as our staff does? Does anyone have any tips or tricks to help the elderly stay safe and "hip fracture-free" this winter?

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1 comments

Here in the UK, cold weather is recognised as a risk factor for falls as described in this leaflet for older adults by one NHS Trust: http://www.pah.nhs.uk/files/Vulnerable%20people%20booklet.pdf

Anecdotally, when I worked in home care in New York City, I would see lots of patients with fractures from falls about a week or two after a snow storm. New Yorkers tend to have small kitchens and minimal freezer space necessitating at least weekly trips to the grocery on foot. Not many people use cars in that city. At some point, older adults needed to go out and get supplies (this was in the days before one could order groceries online) and they would slip on iced-over walkways or steps.

The other time of year I would see a lot of falls was in the spring. Those adults who were "lucky" enough to have food delivered in via family or restaurants in the winter would become so de-conditioned that when they ventured out again in the spring, they had more confidence than balance and they would tumble over.

I wonder how this would compare to areas that are more car centric? If one only has to get out to their garage and negotiate a parking lot, it would seem they would be less at risk to fall than someone who has to walk 4 blocks to and from a supermarket.

Interesting epidemiological questions.

Dean Metz December 14, 2013 9:41 AM

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