A new study in theJournal of the American Medical Association found that for Americans over 75 years of age the mortality rate from falls more than doubled from 2000 to 2016. Although the authors state that the exact causes for this alarming increase are unknown, most known risks can be mitigated (except aging itself). These include eliminating tripping hazards (pets included), wearing good shoes with a tread, using mobility accessories like canes or walkers, modifying/reducing the use of certain medications like sedatives and keeping hydrated.
Proper identification of medical-related risks such as balance deficits and peripheral neuropathy are important in fall prevention as well. Our 2016 post on falls and large fiber neuropathy covered this topic in detail.
The company was gratified to learn that the American Diabetes Association’s new Standards of Medical Care in Diabetes recommendations for 2017 have advised screening of all diabetic patients for large fiber neuropathy with a 128Hz tuning fork. Furthermore, the recommendations cited testing both small and large fiber nerves. This welcome clarification better reflects our current understanding of diabetic peripheral neuropathy. Clinicians are advised that small nerve fiber screening may be done with temperature or pinprick testing. The standing recommendations for 10 gm monofilament testing and annual foot exams remains unchanged.
The importance of these recommendations is underscored by a recent report in JAMA indicating that healthcare spending on diabetes topped a list of the 155 most common disease conditions in the U.S.. Previous research has demonstrated that spending on diabetic foot complications alone may be as high as 33% of the economic burden of diabetes on the U.S. healthcare system. Both these findings support the strategic implementation of aggressive prevention including diabetic foot exams.
Large fiber peripheral neuropathy (PN) impairing somatosensory feedback and normal motor responses can occur in a variety of diseases. It is generally acknowledged that most elderly patients will have some loss of peripheral neurological function though it is seldom formally diagnosed. This age-related or “senescent” form of neuropathy can result in the same loss of large fiber nerve function as its better known correlate diabetic PN (DPN).
Regardless of the cause, large fiber PN can result in loss of proprioception, touch, vibratory sensation and muscle strength. These impairments can result in balance and postural control deficits predisposing patients to falls. Falls have long been acknowledged as a major healthcare issue affecting elderly and diabetic patients at higher rates than the general population. Large fiber PN has been determined to be a significant contributor to these falls. Recent research reveals that assessement of the Vibration Perception Threshold (VPT), equivalent to the 25v setting on the standard Biothesiometer, is an effective PN screening method for a Fall Risk Assessment protocol among elderly patients.
In light of these recommendations, the ETF can be seen as an appropriate choice when considering methods of performing recommended screening tests as part of a Fall Risk Assessment. This feature is available in the Contant Mode which provides the same vibration as the Biothesiometer at the 25v level. Using the ETF in Constant Mode, the patient can simply give a “yes” or “no” answer as to whether or not they feel the vibration. Superior portability and ease of use make the ETF ideally suited to point-of-care VPT screening in clinics and hospitals when evaluating patients for fall risk.
