Technology used at BMW’s assembly line is transferred to a new monitoring system that can accurately indicate if an elderly is at increased risk of falling.
Declining cognitive function increases the risk of fall. The possible causes are medication, lack of sleep or dementia. This is a disturbing safety problem for elderly who live alone at home, or at assisted living facilities where it is not possible to have continuous individual care.
Dr William Kearns and the research team at South Florida University have developed a novel method that accurately indicates if an elderly is at increased risk of falling. Their method is based on the finding that cognitive impairment is related to the fractal dimension value (a measurement of wondering or directional deviation) in the walking pattern.
For their research, the movements of 53 residents at the Sunrise Village Assisted Living Facility in Tampa were monitored for a year. Via the wrist bands they worn, the walking patterns of the elderly were tracked by Real Time Location System (RTLS). Automated computerized reports on each resident’s fractal dimension value were generated for study.
Daily examination of each reports allowed administrators to detect increasing signs of wandering of an elderly and find out the cause — such as change of diet, medication or sleeping habits. By taking action and making adjustments in time, the elderly’s navigation could be improved and ultimately prevent an impending fall.
RTLS was created by Ubisense and is currently used by BMW’s assembly line to help the operation runs more efficiently.
RTLS is much more accurate than GPS and updates 100 times per second. It pinpoints one’s location, indoors or outdoors, within six inches. GPS is limited to the outdoors and has a one-meter resolution. RTLS is most effective for open floorplans because obstacles in the walking path may affect accuracy.
Dr Kearns is the president of the International Society for Gerontechnology and associate professor at the University of South Florida College of Behavioral and Community Sciences.
Older people are often prescribed multiple kinds of medicines (polypharmacy). Polypharmacy 3 may cause adverse side effects such as drug interactions and other complications. The problem affects all ages, but older people are more vulnerable because they have slower metabolism and can’t excrete chemicals as efficiently as younger people.
Although opioids are sometimes necessary to treat acute pain, they can cause sedation and dizziness, and can increase the risk of falling. Besides, prolong exposure to these drugs leads to addiction.
North America is currently experiencing opioid epidemic or crisis. This is due to rapid rise of using opioid drugs for pain management in the past 20 years. Recent investigation also found that opioid prescriptions in England has nearly doubled in 10 years.
Opioid use links to fall risk and increased likelihood of death in older adults
Data analysis on 67,929 patients aged 65+, who were admitted for injury, showed that those who were using opioid were 2.4 times more likely to have a fall injury. In addition, patients whose falls were linked to opioid use were also more likely to die during their hospital stay.
The study was published in the Canadian Medical Association Journal1 on April 23. 2018.
A research study published in the British Medical Journal 2 on April 25, 2018, found that long-term use of anticholinergic* medicines links to dementia. These medications include those for treating depression, bladder control and Parkinson’s disease. Less potent anticholinergics, such as antihistamines and travel sickness drugs, appear harmless.
This is an extensive study carried out by researchers from the University of East Anglia, UK. The medical records of 40,770 patients with dementia were compared with those of 283,933 patients without the disease; and their prescriptions over two decades were analysed.
*Anticholinergic drugs block the neurotransmitter acetylcholine in the central or peripheral nervous system. Anticholinergic drugs are used to treat many conditions: depression, gastrointestinal disorders, Parkinson’s disease, urinary incontinence, epilepsy, and allergies.
Raoul Daoust, Jean Paquet, Lynne Moore, Marcel Émond, Sophie Gosselin, Gilles Lavigne, Manon Choinière, Aline Boulanger, Jean-Marc Mac-Thiong and Jean-Marc Chauny. Recent opioid use and fall-related injury among older patients with trauma. CMAJ April 23, 2018 190 (16) E500-E506. http://www.cmaj.ca/content/190/16/E500
Kathryn Richardson, Chris Fox, Ian Maidment, Nicholas Steel, Yoon K Loke, Antony Arthur, Phyo K Myint, Carlota M Grossi, Katharina Mattishent, Kathleen Bennett, Noll L Campbell, Malaz Boustani, Louise Robinson, Carol Brayne, Fiona E Matthews, George M Savva, Anticholinergic drugs and risk of dementia: case-control study. BMJ 2018;361:k1315. https://www.bmj.com/content/361/bmj.k1315
Duerden, M., Avery, T., & Payne, R. (2013). Polypharmacy and medicines optimization. Making it safe and sound. www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/polypharmacy-and-medicines-optimisation-kingsfund-nov13.pdf
The problem of balance had never crossed my mind until I had an attack of vertigo a few years ago. It was weird. It felt like being carried by the waves in a chopping sea. I had to hold on to the bed to prevent from being thrown off. But I knew I was lying on a stationary bed.
What is postural balance? What keeps us upright and steady?
Balance is controlled by the nervous system. When we move, stand, walk, jump, turn, etc., a very complex mechanism is in operation which we are not aware of. To keep us in balance while continuing these activities, the body has to coordinate in precision multiple sensory inputs and motor responses.
Three sensory systems take part in collecting information relating to balance:
Vision – The eyes see the surrounding objects and detect changes in space. They sense whether you or your environment is moving.
Imagine watching buildings, trees, cars and people passing by from inside a parked car; then compare this perception with what you see when driving.
Vestibular system – These sense organs are located in the inner ear. They detect equilibrium, motion and spatial orientation. Put simply, it helps to determine if your body is stationary, moving, turning or rotating.
A problem with the vestibular organs can cause vertigo—the sensation of spinning even when you are perfectly still.
Do you have experience on a swing ride at the funfair, or on a ferry crossing the sea?
Somatosensory system – Sensory receptors (proprioceptors) in the skin, muscles and joints detect the spatial position and movement of the body. The sensory input from the neck and ankles are especially important. They determine the direction of the head, the body movement relative to the supporting surface, and positions of different body parts relative to each other.
Without looking, we can tell whether the surface we are standing on is hard or soft, and stationary or moving. By the way, do you have to look at your feet when climbing stairs?
Three parts of the brain are involved in processing these sensory impulses and maintaining balance:
The brain stem is the posterior part of the brain that joins the spinal cord. All nerve connections between the brain and the rest of the body pass through here.
The brain stem receives sensory impulses and pass them to the cerebellum and cortex for further processing. It transmits motor impulses which control movements of the eyes, head, limbs and the rest of the body.
The cerebellum is the coordination centre. It integrates sensory impulses, controls motor activities, and enables us perform voluntary tasks such as dancing and writing. The cerebellum regulates posture, movement and balance.
Patients with damaged cerebellums have difficulty keeping their balance and maintaining proper muscle coordination.
The cerebral cortex plays a key role in memory, attention, perception, cognition, awareness, thought, language, and consciousness. We are aware of ourselves and our surrounding through the cortex. The information and experience stored in the cortex helps the body make voluntary or involuntary actions. That’s why we can maintain balance and have clear vision while moving.
Having problem walking long distance, up a slope, or climbing stairs?
The tired old legs are usually the first to warn that we are young no more……
If you don’t have other health problems, that feeling of low energy and decreasing physical strength is very likely due to sarcopenia.
What is sarcopenia?
Sarcopenia is a progressive loss of skeletal muscle mass and strength or function. It is associated with ageing, but can also be due to long term illness, bed rest and malnutrition.1
Our muscles begin to atrophy or shrink around age 40. It is estimated that muscle mass loss after 50 is 0.5-1% per year. That rate can accelerate to 15% every 10 years from about age 70.
The muscles shrink because there is a reduction in the number of muscle fibres and a decrease in their size. This in turn leads to poorer physical strength and functional ability.
Even top athletes, such as marathon runners and weight lifters, experience decline in performance after about 40 because of lower muscle strength.
So, what is the cause of sarcopenia?
The pathophysiology of sarcopenia is quite complex and is still not fully understood. However, the following contributing factors have been suggested.
Age-related hormonal changes. The decreasing levels of testosterone and insulin-like growth factor (IGF-1) affect muscle growth and muscle mass.
Older people’s ability to produce the proteins which make up muscle fibres has decreased.
Poor nutrition. Older people’s diet may not contain enough proteins, essential amino acids and important nutrients such as Vitamin D. Also, there might be problem of malabsorption due to chronic diseases.
Many older people lead a sedentary lifestyle and not taking enough exercise. Some of them need bed rest or hospitalization because of one or more health problems. Even healthy people suffer significant muscle wasting following a period of bed rest.
We can see that some of these causative factors are modifiable. We may be able to prevent sarcopenia or improve on its outcome by changing our lifestyle, take more exercise, improve our diet, and so on.
The diagnosis of sarcopenia
According to The European Working Group on Sarcopenia in Older People, a
diagnosis of sarcopenia is confirmed if a person has low muscle mass, plus either low muscle strength or low physical function.1
The following measurement methods and techniques have been used in both research and clinical practices to diagnose sarcopenia. Some equipment is expensive and may not be available to every situation.
Measurement of muscle mass
Body imaging techniques have been used for estimating muscle mass or lean body mass. They are: computed tomography (CT), magnetic resonance imaging (MRI) and Dual energy x-ray absorptiometry (DXA). CT and MRI are gold standards for estimating muscle mass in research. However, DXA is the preferred alternative method because it exposes the patient to minimal radiation.
Bioimpedance analysis (BIA) estimates the volume of fat and lean body mass. It is an easy and inexpensive method and is suitable for both ambulatory and bedridden patients. BIA results under standard conditions have been found to correlate well with MRI predictions.
Measurement of muscle strength
Handgrip strength measured with a handheld dynamometer is a simple and widely used measure of muscle strength. When employed with population references, it correlates well with leg strength.
Measurement of physical performance
A number of physical performance tests are available for evaluating balance, gait, strength and endurance. For example: short physical performance battery (SPPB), timed get-up-and-go (TGUG), and the stair climb power test.
How does sarcopenia affect our life?
Age-related sarcopenia is recognized as a geriatric syndrome and is linked to a number of adverse health outcomes.
When muscle are weak, simple tasks such as getting dressed, lifting up objects, using the bathroom and walking can become difficult.
The older person will lose his or her ability to live independently and needs institutional care.
Sarcopenia is also associated with a variety of other chronic diseases and earlier death.
Studies on the prevalence of sarcopenia had inconsistent results because of different choices of definition and measuring methods. Nevertheless, the numbers are significant and alarming.
A review of past research showed that prevalence in the 60–70 years olds ranged from 5–13%. For elderly aged above 80 years, 11 to 50% of them were found to be sarcopenic1. It is a world-wide problem affecting both men and women.
But it is not all groom and doom though. You can take steps to maintain muscle mass and strength. We shall look into that in the next post.
It is never too young or too old to look after your muscle health.
Cruz-Jentoft J, Baeyens J, Bauer J, Boirie Y, Cederholm T et al (2010). “Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People”. Age and Ageing, Volume 39, Issue 4, 1 July 2010, Pages 412–423 https://doi.org/10.1093/ageing/afq034
“What Is Sarcopenia?” International Osteoporosis Foundation. https://www.iofbonehealth.org/what-sarcopenia
“Sarcopenia with Aging”. https://www.webmd.com/healthy-aging/guide/sarcopenia-with-aging
“The Facts about Sarcopenia”. Aging in Motion. http://www.aginginmotion.org/wp-content/uploads/2011/04/sarcopenia_fact_sheet.pdf
Medical experts recommend people at risk of Vitamin D deficiency to take supplement every day.
The at-risk groups include older adults, people with little exposure to sunlight, dark-skinned people, and those who are on vegan diet.
Why Older Adults Need Vitamin D Supplement?
Vitamin D is available in two natural sources: (1) it is produced by the skin after exposure to ultraviolet B (UVB), and (2) it is present in a few types of food – oily fish, egg yolk, liver, cheese, and yogurt.
Older adults are vulnerable to Vitamin D deficiency because:
The skin is less efficient in producing Vitamin D as we grow older.
The exposure to sunlight is inadequate.
Some elderly, especially those living in care homes, spend little time outdoor because of mobility problem. Because UVB cannot pass through glass, therefore sitting near the window won’t help.
UVB radiation is affected by seasonal variation, latitude, and the time of day. People who live in northern latitudes such as Ireland or Finland do not get much UVB in the winter months. While we are more likely to exercise outdoor in the morning or evening, UVB radiation is actually strongest around midday.
They may not get sufficient Vitamin D from their diet because only a few types of food contain Vitamin D. It is particularly problematic for a vegan. A possible solution is taking Vitamin D fortified dairy, orange juices and cereals.
Elderly may have problem with malabsorption, especially those with chronic liver diseases, Crohn’s Disease, and cystic fibrosis.
Because melanin blocks the absorption of UV radiation, dark-skinned people are very vulnerable to Vitamin D deficiency if they are also subject to one or more of the above factors.
The researchers also found that Vitamin D deficiency increased with age. For example, in people over the age of 80, 37% were deficient in winter, compared with 22% of age 50-59 years. Those who were physically inactive were also much more likely to be deficient.
Lifestyle seems to play a part too. The study also found that Vitamin D deficiency was more common in smokers (23%), people who live alone (21%) and those from a lower socio-economic background (17%).
We may assume these findings are relevant to all countries with seasonal variation in sunlight.
What are the known problems of Vitamin D deficiency?
Vitamin D produced by the skin or absorbed from food is converted by the liver to calcifediol, also known as 25(OH)D. Vitamin D deficiency is diagnosed if a person’s blood level of 25(OH)D is less than 12 mcg /ml (equivalent to 30 nmol/L).
Vitamin D is essential for maintaining normal blood levels of calcium and
phosphate. Therefore, Vitamin D deficiency leads to low bone density, resulting in osteopenia and osteoporosis. Abnormal calcium level also affects muscle contraction, nerve conduction, and general cellular function of all body cells.
Vitamin D deficiency is known to be associated with muscle weakness. This problem is common among elderly who are housebound. The muscle weakness is manifested by a feeling of heaviness in the legs, tiring easily, and difficulty in climbing stairs and rising from a chair6.
Recent studies also link Vitamin D deficiency with heart disease, kidney disease, brain health, diabetes, Alzheimer’s disease and cancer. However, the results from these studies are still inconclusive, so further investigation is required.
Once these associations are confirmed, we could implement appropriate health policy to deal with high incidences of Vitamin D deficiency in the older adult population. Vitamin D deficiency can be treated easily with supplementation and food fortification.
What is the recommended dosage of Vitamin D?
Because there are still a lot of unknown factors surrounding Vitamin D and its effects on body tissues, medical experts have not agreed on the optimal level of Vitamin D for health benefits. The decision is also made difficult by regional, seasonal, lifestyle, genetic, and diet differences.
Suggestions from leading authorities are:
The US Institute of Medicine recommends 800 IU/day for adult above 70 years.
The American Geriatrics Society (AGS) recommends older adults to take 1000 IU/day to help prevent fractures.
The Public Health England (PHE) advises adults and children over the age of one to take a daily supplement containing 10mcg* of Vitamin D, particularly during autumn and winter.
Most doctors think a daily dose of 800-1000 IU of Vitamin D will benefit the general health of ageing adults. This dosage is highly unlikely to cause harm, unless there is other medical reason against it. You should consult your doctor or pharmacist if you have any doubt.
If you are taking multivitamin or calcium supplement, please check whether Vitamin D is already included in the supplement, and how much. Again, it is prudent to check with your pharmacist if you are not sure.
To treat people with very low Vitamin D level, especially if they are at high risk of fall, doctors can prescribe higher dosage. Of course, that has to be monitored carefully and reduced as soon as the high dosage is not required.
Excessive intake of Vitamin D may cause Vitamin D Toxicity which is harmful to health. For example, taking large doses of Vitamin D over a long period could weaken your bones.
Vitamin D exists in two forms: Vitamin D3 (cholecalciferol) and Vitamin D2 (ergocalciferol). Most supplements contain D3. Studies suggest that D3 increases the blood level of 25(OH)D a little better than D2.
Both Vitamin D2 and D3, whether produced naturally by the skin, or absorbed from food, or taken as supplements, have to be activated by the liver and kidneys before becoming useful. People with liver or kidney disease may need to get a special type of supplement from their doctors.
*The amount of Vitamin D contained in supplements is either expressed in international units (IU) or microgram (1µg). One microgram (1µg) is equal to 40 IU of Vitamin D.
National Institutes of Health Office of Dietary Supplements. Vitamin D – fact sheet for health professionals. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional
Vitamin D Deficiency and Related Disorders. https://emedicine.medscape.com/article/128762-overview#a3
Kernisan, Leslie. Vitamin D: The Healthy Aging Dose (Plus Answers to 7 FAQs). https://betterhealthwhileaging.net/Vitamin-d-healthy-aging-dose-faqs/#comments
One in eight older adults in Ireland are deficient in vitamin D. https://tilda.tcd.ie/news-events/2017/1710-vitamin-d-paper/
Getting Enough Vitamin D in Later Life. http://www.healthinaging.org/resources/resource:getting-enough-vitamin-d-in-later-life
Janssen, H., Samson, M., Verhaar, H. Vitamin D deficiency, muscle function, and falls in elderly people. The American Journal of Clinical Nutrition, Volume 75, Issue 4, 1 April 2002, Pages 611–615.
Elderly who fell and injured themselves often were found wearing inappropriate shoes.
In “The Guideline for the Prevention of Falls in Older Persons”, both American Geriatric Society and British Geriatric Society have pointed out inappropriate footwear as a major cause of concern.
Whether indoor or outdoor, unsafe footwear can cause loss of balance and bad gait. The risk of falls is especially high for elderly whose muscular strength and balance are already impaired.
What kind of footwear increase the risk of falls?
Evidences collected by researchers show that falls were often associated with the following kinds of shoes:
Loose, worn or backless slippers. These are one of the most common causes of older people falling.
Poorly fitting shoes. To accommodate painful feet, some elderly like to wear soft and/or overly long and wide shoes.
Slip-on shoes, such as sling backs or flip flops and shoes without fasteners.
Shoes with poor grip or worn soles can cause you to slip especially on wet surfaces.
Shoes with minimal contact with the ground, such as high heels, can make your foot unstable and can cause your ankle to turn.
Wear Proper Shoes to Prevent Falls
People of all ages should understand the importance of wearing well-fitting shoes, and wear suitable shoes for a particular activity. One of the main causes of foot problems such as bunions and corns is badly-fitting shoes.
Apparently, three out of four people over the age of 65 wear shoes that are too small. Perhaps it is because we did not realise our feet actually get bigger as we age. Besides, the feet and ankles may become swollen because of chronic medical conditions.
It is often a combination of foot problems and inappropriate footwear that increases the risk of falling.
What are the characteristics of safe shoes?
It should fit well and neither too loose or too tight on the feet. Some people may need footwear specially made to accommodate and protect swollen feet and ankles.
It has a high back or collar to support the ankle.
The sole is firm and not too thick for better sensation of foot position.
The sole is slip resistant with tread for good grip.
A low square heel which is not more than an inch to improve stability.
Adjustable fastener – laces or buckles or Velcro – on the front so that it won’t slip off easily.
As mentioned earlier, elderly should avoid loose, backless slippers. It is recommended that older people wear close-backed, well-fitted, slip-resistant slippers or house shoes indoors. A house-shoe offers the comfort of a slipper, but with the stable support of a shoe.
A wide opening makes it easier to get your foot in and out of the slipper which is important if you have swollen feet. But make sure it can be strapped down securely so that it won’t slip off easily.
Do not walk bare-footed or in socks or stockings.
For some cultures and in hot climate, folks may prefer to walk bare-footed at home. However, it has been shown that a proper pair of shoes provide more grip than bare feet and enhance walking stability. Shoes also protect the feet from mechanical injuries.
Podiatrists, also called chiropodists in UK and Ireland, are foot care specialists. Ask your doctor to refer you to one if you have pain or any other foot problems.
Your podiatrist can help you choose suitable shoes and orthotic inserts if you need them.
Diabetes sufferers will benefit from seam-free footwear made to avoid rubbing, which can lead to ulcers that are difficult to heal. In UK, specially fitted footwear can be purchased free of VAT if the wearer has a chronic medical condition such as diabetes. You should be able to get further information about this from a podiatrist as well.
Menant J, Steele J, Menz H, Munro B, Lord S (2008). Optimizing Footwear for Older People at Risk of Falls. Journal of Rehabilitation Research & Development, 45(8), pp. 1167–1182.
A friend phoned and said doctor told her she has plantar fasciitis in her right foot. “The pain is killing me,” she said. “Could be the walking.”
She has recently taken up walking exercise and strength training, and has been very enthusiastic about it.
So, what isplantar fasciitis?
Plantar fasciitis is a foot problem that results in pain and stiffness in the bottom of the foot, usually in the heel. The pain is most unbearable when you climb stairs or standing still.
What causes plantar fasciitis?
Despite advance medical science, the cause of plantar fasciitis is not very clear.
The plantar fascia is the ligament that connects the heel to the front of the foot (runs under the arch of your feet). It supports the arch of your foot and helps you walk.
In plantar fasciitis, the ligament is damaged by tiny tears and breakdown of collagen. It is the result of repetitive injury of excessive straining. The damage is most significant where the plantar fascia joins the bones, especially the heel bone.
Some known risk factors include standing, walking, running over long period, especially on hard surfaces. Flat feet, high arch, inward rolling of the foot, a tight Achilles tendon or calf muscles, pregnancy and obesity have also been blamed.
Wearing shoes with poor sole and arch support when you do training can also result in plantar fasciitis.
Although heel spur, a small bony calcification on the heel bone, is found in up to 50% of those with plantar fasciitis, it is not the cause of heel pain.
Who are likely to suffer?
Plantar fasciitis is a common cause of heel pain. One in ten people are affected at some point of their life, especially people between 40–60 years of age.
The condition tends to happen to people whose occupations or sports put a lot of stress and strain on their feet. They include: teachers, shop assistants, catering staff, factory workers, ballet dancers, soldiers, athletes, long distance runners etc. It seems more common in women.
What are plantar fasciitis symptoms?
Typical symptom of plantar fasciitis is sharp heel pain. It usually affects just one foot but may happen to both feet. The pain is most acute in the first few steps after getting out of bed, or after sitting down for some time. The pain may ease off when you continue walking. Symptoms of numbness, tingling, swelling, burning, or radiating pain have been reported but they are rare.
Although heel pain is the most common complaint, we may have pain in the ball of the foot and along the arch too. It hurts most when climbing stairs or standing for a long time.
Common plantar fasciitis treatments
If you have foot pain, please go to see your doctor or a podiatrist to get a proper diagnosis. It is important to differentiate plantar fasciitis from other foot complaints such as arthritis or stress fracture.
In most cases, plantar fasciitis will improve with rest and conservative treatment. There isn’t a best treatment applicable to everybody. You may find relief from a combination of remedies. And it may take several months for the symptoms to clear.
To start with, rest and stay off your feet if possible. You should stop or reduce the activity which brought on the problem. In the acute stage, apply cold compress to the sore area for 15 to 20 minutes, three or four times a day may help to reduce pain and swelling.
Stretching the plantar fascia and Achilles tendons is a recommended treatment for plantar fasciitis. You can get help from a physical therapist for this. He or she can also teach you plantar fasciitis exercises to strengthen your calf muscles, to stabilize your walk and lessen the workload on your plantar fascia.
You can wear a night splint to stretch the Achilles tendon and plantar fascia. This can help prevent pain and stiffness in the morning.
Inappropriate footwear is often the culprit of foot problems. You must wear shoes that have good arch support and heel cushioning.
Orthotic or shoe insert for arch support may be helpful. It is designed to alleviate the pain, and reduce the strain on the ligament to prevent further damage. If the pain is specifically in the heel, a gel heel cradle can be worn to cushion and support the heel.
A boot cast can be worn to immobilize the foot and reduce strain, thus allow the plantar fascia to heal. You can take the boot cast off when you need to, for example, to take a shower.
Nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, may help to relieve the pain. You should ask for medical advice if there is any worry about allergies or contraindications.
If the problem has not improved after trying all the above for several months, your doctor may recommend other options:
platelet-rich plasma injection
extracorporeal shockwave therapy
Surgery is the last option when all else failed to stop pain. But it must weigh against the unwanted side effects of weakening the arch of the foot.
If you ignore the condition and not getting treatment or rest, further strain can rupture the plantar fascia. Typical signs and symptoms of plantar fascia rupture include a clicking or snapping sound, significant local swelling, and acute pain in the sole of the foot.
You can develop chronic plantar fasciitis from recurring acute attacks. This can change the way you walk and cause injury to your legs, knees, hips, and back.
Therefore, it is wise to stay with some of the preventative remedies even when all the symptoms have cleared.
Common symptoms of foot problems are pain, swelling, redness, tingling and numbness of one or both feet. Many of us probably have experienced some or all of above. It takes a lot of grit to walk with blisters, right?
Whether causing pain or numbness, foot problems can affect our balance and change the way we walk. It increases the risk of falling and injuries which the elderly are particularly vulnerable.
Our feet are small compared to our body that they have to support. Every footfall and every step we take is a big stress on the bones, joints, muscles, ligaments and tendons. Just imagine the wear and tear of our poor feet after decades of standing, walking, jumping and running.
Like other parts of the body, our feet change as we grow older. The padding under the heel and the ball of the foot wears off gradually. The arches are flatter and less flexible, and the ankles and joints become stiff. We need bigger size shoes because the feet are wider and longer. Because of these changes, we may develop foot pain and other problems. Apparently, one in three people over the age of 65 has foot pain, stiffness, or aching feet.
Foot pain are caused by a number of conditions such as arthritis and gout. The most common ones seen in older adults are listed below.
Fractures or small crack can happen to anyone of the 26 bones of the foot, especially the toes. This is often caused by overactivity or change in activity such as trying a new exercise. People with osteoporosis are particularly vulnerable.
Bunions develop when the joints in the big toe (sometimes the small toe) are out of alignment. Eventually, the toe bends abnormally inwards and becomes swollen and tender. Bunions tend to run in families. In the early stage, the pain may be relieved by wearing shoes wide at the instep and toes, taping the toes, or wearing cushion pads. Severe cases require surgery to relieve the pressure and repair the toe joint.
Calluses and corns are dead, yellowish, thickened skin found on toes or the ball of foot. It is caused by friction and pressure when the feet rub against the shoes. Wearing better fitting shoes may be the answer. Over-the-counter medicines for treating corns contain acids that destroy the tissue but do not treat the cause. It is safer for the elderly, especially those with diabetes or poor circulation, to get help from a podiatrist or chiropodist.
Hammertoes is caused by shortening of the tendons at the toe joints. Usually the second toe is affected but it may happen to other middle toes too. The toe
curls up with a rigid or flexible joint, which becomes bigger and stiffer as it rubs against the shoes. Hammertoes can affect walking and balance and lead to other foot problems. It may run in families but the usual culprit is pointed and badly fitting shoes. Splinting and corrective footwear are helpful. In very serious cases, surgery may be needed.
Ingrown toenail occurs when part of the nail grows into the flesh causing pain and bleeding. It usually affects the large toes and is the result of not cutting the nails properly. The nail can be removed safely by a foot specialist and the damaged tissues allowed to heal. Ingrown toenails can often be
avoided by cutting the toenail straight across and level with the top of the toe.
Heel pain is usually caused by heel spurs or plantar fasciitis. A heel spur is a bony protrusion of calcium deposits on the underside of the heel bone. Plantar fasciitis is inflammation of the connective tissues that join the heel bone to the toes. These two conditions are often related. They are caused by over straining of the muscles and ligaments from: long periods of standing/walking/ running, wearing badly fitting shoes, or being overweight. Helpful treatments include foot supports, heel pads, heel cups, and physiotherapy. Sometimes surgery is needed.
Our feet can become swollen after standing or sitting for long periods. It is because of blood pooling in the lower part of the body.
A sprained ankle is swollen and painful because you might have torn a ligament or tendon. Another likely cause of swelling is stress fractures.
But swollen feet and ankles can be due to chronic heart and vascular diseases, kidney diseases, and obstruction of the lymphatic system. Therefore, if your feet swell excessively and there is no history of injuries, you must see your doctor right away.
Numbness and pins-and-needles sensation
Numbness and/or pins and needles sensation of the feet is related to nerve problems of many underlying causes. If your gait becomes unstable and you can’t feel the ground because of the numbness, you are at risk of falling.
Some of the common causes are:
A pinched nerve, for example, a herniated disk in the lower back.
Blood supply to a nerve in the foot is reduced or cut off as a result of peripheral artery disease (PAD). As well as foot numbness, the leg may be cold and painful.
Peripheral neuropathy is a complication of diabetes; as a result, the patient loses sensation in their feet.
A podiatrist or chiropodist is a trained specialist in footcare. He or she can diagnose your foot problem and advice the appropriate treatment. Most foot problems can be treated effectively, often as simple as a new pair of shoes.
Do you have pain, or swelling, or numbness in the feet? Or foot problems such as bunions, hammertoes or corns? If so, don’t suffer needlessly, go see a podiatrist.
Many of us would have no doubt that ice and snow are significant fall risks. Hence, we would think that fall injuries such as fractures are more prevalent in the winter months. But apparently, this assumption is wrong!
A recent study1 shows that a majority of falls occur during the warm months of May through October, and most of the falls happened indoors rather than out.
In this study, the circumstances of 544 patients treated at The Hospital of Central Connecticut for hip fracture from 2013 to 2016 were analysed.
The results show that:
More than 55 % of hip fractures occurred during the warm months of May through October. Significantly, May (10.5 %), September (10.3 %) and October (9.7 %).
Most hip fractures occurred indoors ((76.3 %), with only 23.6 % happened outside.
Outdoor fractures – More than 60% happened during the warm months. The leading cause was tripping over an obstacle, followed by accident involving a vehicle and falling on or down stairs.
Indoors fractures – More than 56% happened during warm months. The leading cause was tripping over an obstacle (especially throw rugs), followed by falling out of bed.
Because the study was centred at just one hospital in a particular location, therefore the results are not necessary representative nationally. However, we can still learn something from it.
Firstly, obstacles in the path of movement is the main fall risk whether indoor or out. Therefore, it is important to make sure the floor or ground is clear of clutters.
Thirdly, since throw rug was singled out as the leading cause of fall, shouldn’t it be banished from our home? And replaced with something more secure? Carers of elderly should take note.
Final thought: Most seniors probably prefer to stay indoor during the winter months. Having fallen several times on icy roads and pavements in the past, I definitely won’t venture out when the weather is not agreeable. This probably explains why icy ground and snow are not big fall risk factors. What do you think?
A preliminary study presented at the 2017 annual meeting of the American Society of Anesthesiologists in Boston. Study author Dr. Jason Guercio.