Study shows that nursing homes should consider diabetes a significant risk factor for falling

Falling is the leading cause of accidental death for elderly people, and a new study from Columbia University Medical Center and NewYork-Presbyterian Hospital/The Allen Pavilion suggests that nursing home residents with diabetes are four times more likely to fall than those who are not diabetic.

The study, published in the September issue of the Journal of Gerontology, found that 78 percent of nursing home residents who had diabetes fell within the 299-day study period, compared to 30 percent of those without diabetes who had a similar fall. The study followed 139 residents of the Hebrew Home at Riverdale in New York.

Previous investigations have defined risk factors for falls among frail elderly nursing home residents, which include gait or balance disorder, vision impairment and medications, but until now diabetes has not been widely recognized as an important risk factor.

"Our study clearly indicated that nursing homes, assisted living facilities and others that care for the elderly should consider diabetes a significant risk factor for falling," said Mathew S. Maurer, M.D., Irving Assistant Professor of Medicine at Columbia University Medical Center and Director of the Clinical Cardiovascular Research Laboratory for the Elderly at NewYork-Presbyterian/The Allen Pavilion. "In an era of limited resources, knowing that diabetics are more likely to fall may facilitate identifying older individuals who are likely to benefit from interventions aimed at reducing falls and their consequences."

"We will now add diabetes to the list of risk factors for falling and expect this to become standard practice," said Dr. Robert Zorowitz, Chief Medical Officer of the Hebrew Home at Riverdale, where the study was conducted. "By controlling diabetes, addressing the complications it causes and being vigilant about the other factors that contribute to falls, we may substantially reduce the risk."

Although complications from diabetes include the drop of blood pressure when standing up, known as orthostatic hypotension, as well as visual impairments, the study found that neither of these were an explanation for the increased fall risk. Dr. Maurer speculates that problems with peripheral nerves that can affect the sensation in diabetic people's feet, known as peripheral neuropathy, could be the mechanism at fault for the higher fall rate in diabetic patients.

Currently, 150 million people are estimated to have type 2 diabetes, and the number is expected to reach 300 million people by 2025.

The study by Dr. Maurer, a geriatric cardiologist, was funded by the National Insitutute on Aging and the American Federation of Aging Research. The study was originally intended to assess if predicting fall risk could be improved by measuring blood pressure with a new method that records blood pressure continuously during the process of standing, rather than the traditional method that uses a cuff to record blood pressure while sitting and one or three minutes after standing. The study showed that this kind of measurement did not, in fact, help prediction, but instead showed that diabetes, in addition to gait and balance difficulties were the most potent predictors of falling in this population.