The Pulse

In a recent CDC Morbidity and Mortality Weekly Report, Moreland & Lee (2021) analyzed 2018 U.S. data which revealed individuals 65 and older had 2.4 million emergency department visits and more than 700,000 hospitalizations due to unintentional injuries. Greater than 90% of these injuries were related to falls. This shows the importance of an effective interdisciplinary fall prevention and balance program for the geriatric population.

Muscle strength decline is associated with normal aging and may be accelerated by illness, disease, or injury. Decreased physical activity resulting from COVID-19 mitigation efforts is exacerbating the incidence of muscle disuse atrophy in older adults. Strength declines may lead to functional and mobility deficits with increased risk of falls, injury, or death. According to the CDC, each year three million adults are treated in emergency departments for injuries related to falls. By 2030 fall deaths are anticipated to rise to seven per hour. Accurate assessment of strength using validated tests and objective measures is crucial to creating an appropriate treatment plan and achieving outcomes that reduce fall risk.

Patient Information: Male, Age 79

Diagnosis: Right Ankle Fracture / Gastrointestinal (GI) bleed

History: This gentleman was referred to a skilled nursing facility for rehabilitation services due to weakness and reduced functional mobility after hospitalization for a right ankle fracture (from a fall) and a GI bleed. Prior to hospitalization, he used a rolling walker to ambulate and lived in a 2-story home with a roommate who helped with household tasks.

Over the past several years, the body of evidence on the effectiveness of virtual reality (VR) in rehabilitation has significantly expanded. VR has been studied for a variety of diagnoses including stroke, Parkinson’s disease, multiple sclerosis, dementia, burns, pain, and total knee arthroplasty. VR helps enhance patient involvement and motivation while increasing the repetitions and duration of exercise. Benefits addressing ADL performance, balance, gait, pain, and cognition have been reported.

Patient Information: Male, Age 72

Diagnosis: Muscle Weakness / General Debility

History: This gentleman had a fall and was hospitalized due to a femur fracture. He experienced multiple medical complications and surgeries and was admitted to a skilled nursing facility. He was transferred to this skilled nursing facility for long-term care two and half months after his fall and was referred to therapy due to weakness, balance deficits, inability to walk and inability to perform self-care. Prior to his fall he lived at home and was independent with all mobility and activities of daily living (ADLs).

Patient Information: Male, Age 75

Diagnosis: Peripheral Vascular Disease / Falls / Muscle Weakness

History: This gentleman was referred to a skilled nursing facility with severe debility after hospitalization due to a fall at home. Following the fall, he laid on the floor for two days before being discovered by his home health nurse. At the time of hospital admission, he suffered from acute renal failure, altered mental status, and infected wounds on both legs. Prior to the fall, this gentleman lived alone, walked with a straight cane, and was independent with all self-care, household and community activities.

Patient Information: Male, Age 96

Diagnosis: Fall / Compression Fracture

History: This gentleman was referred to a skilled nursing facility following hospitalization due to a fall in his garage which resulted in a thoracic compression fracture of the spine. Prior to the fall, he lived at home and was independent with ambulation, driving and mowing his yard.

Patient Information: Female, Age 77

Diagnosis: Esophageal Cancer / Muscle Weakness

History: This woman was referred to a skilled nursing facility for rehabilitation services due to weakness and a decline in functional mobility after hospitalization due to esophageal cancer and feeding tube placement. Prior to her hospitalization she was living alone in a senior living apartment with an elevator and was independent for transfers and activities of daily living with her manual wheelchair due to prior bilateral below knee amputation.

Patient Information: Female, Age 76

Diagnosis: Chronic Obstructive Pulmonary Disease (COPD) / Chronic Heart Failure (CHF) / Diabetic Neuropathy

History: This woman was referred to home health therapy services due to numerous falls, poor balance, and a decline in functional mobility. Over several months she became wheelchair-dependent in part due to fear of falling. Prior to this decline, she was independent with transfers and able to walk with a rolling walker to the dining room for meals in her assisted living facility.