Falls resulting from a lack of balance, weakness, poor eyesight, or taking a large number of different medications (or drugs that cause dizziness) that cause a fracture of the hip, knees, spine, or other part of the skeleton can be the “straw that breaks the camel’s back,” leading to functional deterioration, life in a geriatric nursing home, or even death.
Many of these events occur when an elderly person who is half asleep gets up in the middle of the night to go to the bathroom. They may rise too fast, with low blood pressure causing dizziness. They should rise gradually to allow the blood pressure to return to normal. They often do this in inadequate lighting or slip on a rug – or forget to use their cane or walker. At older ages, quick reflexes and strength to cover may be lacking.
Numerous municipalities offer free services to the elderly, installing hand grips in the shower or bathtub, special non-skid rubber mats in the bathtub, and improved lighting. Reportedly, the Beersheba Municipality does not. Although there are many risks that can cause a fall, even patients with mild Alzheimer’s or Parkinson’s disease can be helped to minimize the risks of falling.
Medical studies have shown that people who have suffered a fracture due to osteoporosis – the thinning of the bones – are at increased risk of developing more fractures, especially in the period immediately following the first fracture.
Therefore, it’s very important to provide targeted treatment to reduce the risk of a second fracture after the first one. Treatment includes orthopedic surgery, pain management, intensive physical rehabilitation, and drug therapy that has been scientifically proven to reduce the risk of recurrent fractures.
Falling is the leading cause of death in this age group; about half of those who fall don’t regain normal function. According to the Health Ministry in Jerusalem, about 1,000 Israelis fall on an average day. Many falls don’t result in fractures, but if the person is living alone and can’t get up, he or she may develop dehydration and psychological distress as a result of the trauma. ZAKA, the voluntary search-and-rescue organization based in Jerusalem, often finds people in their homes who have died after a fall.
SOROKA-UNIVERSITY Medical Center in Beersheba has had impressive success at its Fracture Liaison Service (FLS) in accomplishing a 48% reduction in the risk of recurrent hip fracture and a 29% drop in mortality. Soroka is the largest of the 14 medical centers owned and run by Clalit Healthcare Services, the country’s largest health fund that insures 55% of the population. Soroka has run the service for over a decade, but the team now had the opportunity to take a long view for their study and found that it had a beneficial effect in preventing subsequent falls.
The service, established in collaboration with the hospital’s endocrinology unit and the geriatrics department, works to identify all patients aged 50 and over who were hospitalized at Soroka with a hip fracture and to offer them appropriate follow-up and treatment. The service involves multidisciplinary teams that include doctors, nurses, physiotherapists, occupational therapists, and a research coordinator.
Osteoporosis is a common disease that affects tens of thousands of Israelis, mainly among the elderly population, and is manifested by fractures that occur in the spine, hip, and other organs, after minimal or no trauma.
After the age of 50, the incidence of fractures in women is twice that of men, and most fractures occur at home from a standing height. Mortality associated with this type of fracture increases with age, especially in people whose functional status was poor before the fracture and in people with other diseases.
The new study examined patients aged 65 and over who had undergone hip fracture surgery and were subsequently treated in the geriatrics department. The FLS service made possible the speedy provision of osteoporosis treatment, along with a significant increase in follow-up rates, endocrinological consultations, and bone density tests. The service helped patients avoid further serious complications and improved their quality of life.
The study was conducted by Dr. Uri Yoel (a senior physician in the endocrinology unit), Dr. Hadar Alkobi Weiss (an internal medicine specialist), Dr. Ethel Silverman Siris from Columbia University in New York, Dr. David Lewis Fisher (a specialist in Soroka’s endocrinology unit), Dr. Adi Goldbert and Dr. Lior Hassan from the hospital’s Center for Clinical Research, and Prof. Merav Fraenkel (director of the endocrinology unit).
They published their study in the journal Osteoporosis International under the title “The impact of a fracture liaison service with in-hospital anti-osteoporosis treatment on subsequent hip fracture and mortality rates – a single-center retrospective study.”
“We focused on hip fractures because such patients remain in our hospital for two or three weeks for rehabilitation, and it gives us a chance to work with them. We follow them up to check whether they had a second hip fracture over the next four years,” Yoel told The Jerusalem Post.
“The implementation of the FLS service is an important and significant step in the treatment of elderly people suffering from osteoporotic fractures,” noted Yoel. “The study’s results clearly show how rapid and targeted intervention can save lives and prevent great suffering. It boosts personalized and targeted services in the elderly population, with the aim of reducing the rates of fractures and death.”