Chronic Fall Risk among Aged Individuals with Type 2 Diabetes

  • Wed, 9/3/08 - 10:24am
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Author(s): 
Teresa Conner-Kerr, PhD, PT, CWS(D), and Mary Susan Templeton, MPH, PT

A pproximately one-third of community-dwelling individuals over 65 years of age will experience a fall and one-half of these individuals will become chronic fallers.1-6 Chronic falling has been defined in the literature as falling two or more times within a 1-year period. Individuals who experience chronic or recurrent falling are more likely to sustain an injury during falling.7 In fact, 10% to 15% of these falls culminate in severe injury; fractures represent the greatest category of injury. The severity of complications associated with fall-related injury also has been shown to increase with age. A greater degree of disability and functional impairment is seen with elderly chronic fallers. Falls by the elderly account for the second leading cause of death in the aged population due to unintentional injury.

Numerous risk factors are associated with chronic falling.2-7 Braun8 identified three categories of fall-related risk factors: physical, psychological, and environmental. An additional category of risk factors is the presence of polypharmacy (three or more medications) and the resulting medication-induced side effects of each drug, as well as their respective interactions.

These chronic fall-related risk factors have been extensively studied in the geriatric population at large.2-7 However, chronic fall incidence for elderly individuals with type 2 diabetes mellitus has not been directly studied. A study that examined fall incidence and self-perception of fall-related injury potential of young individuals (mean age of 32.9 ± 2.5 years) with type 1 diabetes mellitus offers current data on fall risk for individuals with diabetes mellitus.9 Evaluation by multiple linear regression revealed that individuals with type 1 diabetes mellitus and a confirmed diagnosis of peripheral neuropathy were 15 times more likely to report an injury during gait activities as compared to their counterparts without neuropathy (P = 0.050). These individuals also reported feeling significantly less safe than their peers without neuropathy during standing and walking.

Fall-related injuries commonly sustained by individuals who participated in the above-described study by Cavanagh et al9 included fractures, sprained ankles, cuts, and bruises. Similar types of injuries have been detected in other epidemiological studies of individuals with diabetes.10-12 These studies have shown that individuals with diabetes have an increased prevalence of fractures. For example, a study by Cundy et al12 showed an increased prevalence of metatarsal fractures in both males and females with diabetic neuropathy; results from another study demonstrated a greater prevalence of leg and foot fractures in females.11

Diabetic neuropathy is a common symptomatic complication of diabetes mellitus.13 Research has shown that 25% of individuals with a diagnosis of diabetes mellitus will develop peripheral neuropathy within 10 years of their original diagnosis; this percentage escalates to 50% by year 20 post-diagnosis. Likewise, the Rochester Diabetic Neuropathy Study14 showed that 60% to 65% of study participants developed some type of neuropathy, with 45% percent of these individuals exhibiting a distal-symmetric polyneuropathy.

References: 

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