Bringing falls down with a new clinic
Date: May 31, 2011
In concept, falls are a relatively simple medical problem. “There’s a loss of resistance to gravity, and the patient ends up on the floor,” says Yuri Agrawal. But, adds the neurotology fellow, managing a patient to prevent falls can be extremely complex.
According to the Centers for Disease Control and Prevention, more than a third of people 65 and older fall each year, and those who fall are two to three times more likely than those who don’t to experience repeated falls. Among older adults, falls can be devastating, with one in 10 resulting in a serious injury, such as hip fracture.
Patients might fall for numerous reasons, ranging from problems with the vestibular system to vision deficits to a poorly laid-out home with cluttered furniture and loose area rugs. Scouting out exactly why a patient has fallen is a tough challenge for most individual physicians.
“There are so many systems that interact to help a person stay upright and maintain balance and locomotion,” Agrawal says, “and most physicians don’t feel like they have the resources to study all these systems in a comprehensive way. The only way to treat this multifactorial problem is with a multidisciplinary solution.”
That’s what Agrawal had in mind in establishing a falls clinic. Every Wednesday afternoon, she and other care providers from multiple specialties plan to see patients who have been referred to the clinic after a history of falls or movement and balance problems that might predispose them to falling. Patients will see an otologist, a vestibular specialist, an ophthalmologist, a geriatrician who evaluates medications, and an occupational therapist who specializes in home modification. Then these providers collaborate to develop a unique plan of attack to stem each patient’s risk of falling.
The idea, Agrawal explains, is for patients to leave that day with strategies they can use right away. “If we recommend physical therapy,” she says, “exercises are demonstrated to the patient right then and there. If they need more therapies or surgeries, we make appointments that same day.” Patients also leave with a printed assessment they can take to their primary care physician to keep track.
After they leave the initial appointment, the care doesn’t end there, Agrawal says. A clinic member will follow up with patients, making appointments to be sure they’re seen again every three to six months. Agrawal and her colleagues also plan to study which interventions provide the best insurance against future falls.
“A fall can really alter a person’s life trajectory,” Agrawal says. “We’re hoping to turn that around.”
To refer a patient or learn more, call 410-955-1686.