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| A Physical therapist Adam Flint of Mederi Caretenders checks Vicente Moreno's balance by having him stand on a soft surface (Amy Beth Bennett, Sun Sentinel) |
There is a simple screening test, widely available, that can help keep senior citizens out of nursing homes and hospitals, and save millions of dollars in health-care expenses.
Yet many seniors have never heard of it, and doctors typically don't bring it up.
It's called balance testing — and it can predict when someone is at risk of falling.
Fall prevention has become a huge public health issue as the nation's population ages, with the risk of taking a tumble increasing as we grow older. Federal statistics show Florida, with the highest percentage of people age 65 and older, had 1,714 fall deaths among seniors in 2009 — more than any state.
Early detection of balance issues might have saved some of those lives. Fixing the problem can be as easy as switching medications, or having seniors regularly do at-home exercises, like standing on one foot while holding on to a counter.
"Would I love to see balance screening become routine? Absolutely," said Debra Stern, a Nova Southeastern Universityassociate professor of physical therapy.
Seniors who routinely undergo cholesterol screenings and blood pressure checks often don't know about balance tests, nor understand the role of balance in falls, said Mike Studer, an Oregon physical therapist heading the American Physical Therapy Association's balance and falls special interest group. The focus, until recently, was on home safety changes like removing throw rugs, he said.
And doctors often don't ask about or test for poor balance during annual physicals, Stern said.
Stern thinks that's partially because balance and falling weren't considered big health concerns until recently. There's no technology or lab work involved in a baseline balance screening that Medicare could reimburse for, she said; a doctor or nurse would do it during a routine office visit, along with things like taking a blood pressure reading, which would add time to the appointment.
Primary care physicians also have said they don't feel they know enough about balance and how to properly assess their elderly patients. The federal Centers for Disease Control and Prevention heard the complaint so frequently that it's developing a balance and falls pocket guide for doctors. The STEADI Tool Kit, based on guidelines recently developed by The American Geriatrics Society, will be available online or through the CDC later this year.
Tiffany E. Shubert, a University of North Carolina-Chapel Hill researcher and advisor to the CDC, said what's needed are simple screens that are good predictors of falling risk. Among them: Asking about fear of falling; having seniors stand on one leg; and watching them get up from a chair and walk.
"We want to have something that anyone could do anywhere," Shubert said. "We want to teach people in the senior centers how to do it. Everyone needs to be screened."
A Matter of Balance classes
Stern, a member of NSU's balance and fall risk team, said 50 to 75 percent of the midlife and older patients tested at health fairs or during university clinics have had some type of balance deficit.
In fact, falls are the leading cause of fatal and non-fatal injuries among Florida seniors, according to the State Department of Health, with more than $2 billion in total hospitalization costs in 2009. Broward County had 104 senior fall deaths in 2010 and Palm Beach County had 136.
Federal health promotion grants, first offered several years ago through state aging service coordinators,created A Matter of Balance programs nationwide to teach seniors exercises and how to reduce their falling risk. Balance testing, however, wasn't included.
Free balance tests are starting to be included in senior health fairs and community events.
Shari Baer, public education coordinator for Broward County's Aging and Disability Resource Center, said she gets local health-care businesses or schools to test seniors in A Matter of Balance classes, as well as offer other free community screenings.
"Many seniors don't even tell their doctors that they are afraid of falling, or that they have fallen," Baer said. "They're afraid of losing their independence, that their kids will make them move into an assisted living facility."
Physical therapist Adam Flint, a South Florida rehab manager for Mederi Caretenders, said most elders requesting balance assessments at fairs where he volunteers already have fallen once and are worried.
Vicente Moreno, who approached Flint during a recent safety fair at the Southeast Focal Point Senior Center in Hollywood, fell off his bike a year ago. While he'd never had a balance test before, "I want to know how I'm doing," the 76-year-old Hollywood resident told Flint.
Moreno followed instructions as Flint asked him to cross his arms over his chest, then close his eyes, then do the same moves again while standing on a cushion. Flint timed each pose to see how long Moreno could hold it without wobbling.
The routine took less than five minutes and required nothing more than a chair cushion and a stopwatch. Flint gave Moreno a written copy of the results to share with his doctor.
One issue with balance screens is that there is no one standard test, Flint said, like there is for hypertension or diabetes. Many therapists follow the arms crossed, eyes closed series that Flint uses as it involves the three components of balance: vision, the inner ear and the somatosensory system, or the body's ability to orient itself.
But nutrition, medications, circulation and neurological conditions also can play a role.
"Balance is so complicated," Flint said. "People think they are born with it, like the color of their eyes, but it's a learned skill."
dlade@tribune.com
Copyright © 2012, South Florida Sun-Sentinel
Fall prevention has become a huge public health issue as the nation's population ages, with the risk of taking a tumble increasing as we grow older. Federal statistics show Florida, with the highest percentage of people age 65 and older, had 1,714 fall deaths among seniors in 2009 — more than any state.
Early detection of balance issues might have saved some of those lives. Fixing the problem can be as easy as switching medications, or having seniors regularly do at-home exercises, like standing on one foot while holding on to a counter.
"Would I love to see balance screening become routine? Absolutely," said Debra Stern, a Nova Southeastern Universityassociate professor of physical therapy.
Seniors who routinely undergo cholesterol screenings and blood pressure checks often don't know about balance tests, nor understand the role of balance in falls, said Mike Studer, an Oregon physical therapist heading the American Physical Therapy Association's balance and falls special interest group. The focus, until recently, was on home safety changes like removing throw rugs, he said.
And doctors often don't ask about or test for poor balance during annual physicals, Stern said.
Stern thinks that's partially because balance and falling weren't considered big health concerns until recently. There's no technology or lab work involved in a baseline balance screening that Medicare could reimburse for, she said; a doctor or nurse would do it during a routine office visit, along with things like taking a blood pressure reading, which would add time to the appointment.
Primary care physicians also have said they don't feel they know enough about balance and how to properly assess their elderly patients. The federal Centers for Disease Control and Prevention heard the complaint so frequently that it's developing a balance and falls pocket guide for doctors. The STEADI Tool Kit, based on guidelines recently developed by The American Geriatrics Society, will be available online or through the CDC later this year.
Tiffany E. Shubert, a University of North Carolina-Chapel Hill researcher and advisor to the CDC, said what's needed are simple screens that are good predictors of falling risk. Among them: Asking about fear of falling; having seniors stand on one leg; and watching them get up from a chair and walk.
"We want to have something that anyone could do anywhere," Shubert said. "We want to teach people in the senior centers how to do it. Everyone needs to be screened."
A Matter of Balance classes
Stern, a member of NSU's balance and fall risk team, said 50 to 75 percent of the midlife and older patients tested at health fairs or during university clinics have had some type of balance deficit.
In fact, falls are the leading cause of fatal and non-fatal injuries among Florida seniors, according to the State Department of Health, with more than $2 billion in total hospitalization costs in 2009. Broward County had 104 senior fall deaths in 2010 and Palm Beach County had 136.
Federal health promotion grants, first offered several years ago through state aging service coordinators,created A Matter of Balance programs nationwide to teach seniors exercises and how to reduce their falling risk. Balance testing, however, wasn't included.
Free balance tests are starting to be included in senior health fairs and community events.
Shari Baer, public education coordinator for Broward County's Aging and Disability Resource Center, said she gets local health-care businesses or schools to test seniors in A Matter of Balance classes, as well as offer other free community screenings.
"Many seniors don't even tell their doctors that they are afraid of falling, or that they have fallen," Baer said. "They're afraid of losing their independence, that their kids will make them move into an assisted living facility."
Physical therapist Adam Flint, a South Florida rehab manager for Mederi Caretenders, said most elders requesting balance assessments at fairs where he volunteers already have fallen once and are worried.
Vicente Moreno, who approached Flint during a recent safety fair at the Southeast Focal Point Senior Center in Hollywood, fell off his bike a year ago. While he'd never had a balance test before, "I want to know how I'm doing," the 76-year-old Hollywood resident told Flint.
Moreno followed instructions as Flint asked him to cross his arms over his chest, then close his eyes, then do the same moves again while standing on a cushion. Flint timed each pose to see how long Moreno could hold it without wobbling.
The routine took less than five minutes and required nothing more than a chair cushion and a stopwatch. Flint gave Moreno a written copy of the results to share with his doctor.
One issue with balance screens is that there is no one standard test, Flint said, like there is for hypertension or diabetes. Many therapists follow the arms crossed, eyes closed series that Flint uses as it involves the three components of balance: vision, the inner ear and the somatosensory system, or the body's ability to orient itself.
But nutrition, medications, circulation and neurological conditions also can play a role.
"Balance is so complicated," Flint said. "People think they are born with it, like the color of their eyes, but it's a learned skill."
dlade@tribune.com
Copyright © 2012, South Florida Sun-Sentinel
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