The Cascade Effect of Multiple Chronic Conditions: Why Co-Morbidity Can Lead to Increased Risk of Falling in Older Adults

As an older adult with any one of a number of chronic conditions, it’s hard enough to get from place to place and task to task without taking one wrong step and landing on the floor, possibly causing serious injury sure to make life more challenging. Perhaps you have arthritis, and your stiff, painful joints make it all too easy to stumble and lose your balance. Or you may have cognitive impairment from dementia or Alzheimer’s disease and can no longer accurately judge the relationship between your foot and the floor. Then, add one or more additional chronic conditions and every step becomes — quite literally — a balancing act. According to our research, seniors with three or more chronic conditions had 15 percent more serious falls.

“It’s a cascade effect,” says Paul Adams, Senior Director of Product Management for Philips Lifeline. “We’re talking about a cascade of debilities.”

For example, hypertension can lead to heart failure, renal failure, and diminished eyesight. “It starts off as a single issue, and then there’s a snowball effect,” he says. “As these conditions pile up, someone may feel overwhelmed by their condition, as well as dizzy, disoriented and nauseous from medications they’re taking. If you have hypertension, you may be taking a diuretic, forcing you to get up during the night to go to the bathroom. Half-asleep, you’re already off-balance. Add to that dizziness and disorientation from other meds you’re taking, and you have a really dangerous situation.”

As another example, he points out that a person with heart disease may also have asthma. (Many recent studies suggest that asthma can increase the risk of heart diseases.) So along with feeling weak and perhaps dizzy from the heart condition, an older adult may move too quickly and carelessly, because the medication to counteract asthma is often a stimulant.

A Grab Bag of Meds Compounds the ‘Cascade Effect’

One of the greatest challenges for older adults with multiple conditions can be managing a grab bag of meds and the accompanying possible side effects. Medications often have side-effects that can cause dizziness or disorientation and, as with the conditions themselves, the effects compound to make a fall all too likely.

Adams points out that patients with co-morbidity (two or more chronic conditions) should be sure to work with a primary care physician who is aware of all their conditions and medications and any possible contraindications when mixing the various meds.

“It can be a real problem to have different medical teams without a single, primary care physician at the lead,” he says. “It’s important to treat people with chronic conditions holistically, and not look at each illness as a discrete condition. That’s why you need one physician who will ‘own’ all the illnesses.”

Losing Your Sense of Place in the Space Around You

Dr. Bijan Najafi, Professor of Surgery, Medicine and Engineering at the University of Arizona and Director of iCAMP, and his team at iCAMP are experts in motion. The team approaches the risk of falling in older adults from a unique perspective: how they move through space. Patients can lose the proper perspective of how their feet and ankles relate to the space around them, thus misjudging just how high to raise their feet or missing the presence of any obstacles in their path. In this case, again, chronic conditions, and especially multiple chronic conditions, are often the culprits leading to the lost perception.

“For instance, nerve damage to the lower extremities from diabetes can make it difficult for someone to feel the surface beneath their foot, making it difficult for them to judge how to move through the space,” says Dr. Najafi. “Then if you add the effects of a stroke or Alzheimer’s on the brain’s ability to properly judge how to move, you have an even greater problem.”

He adds that the problem can then compound further, because the person often reduces or eliminates daily physical activity because of a fear of falling, causing rigidity, muscle weakness, and possibly depression, making proper movement even more difficult.

“We had a patient who was a dog lover and loved to walk her dog,” he says. “But she had some trouble lifting her foot and one day nearly fell over the dog’s leash. After that she was afraid of falling, so stopped walking the dog and developed depression. That led to rigidity and a greater risk of falling.”

Dr. Najafi and his team work with patients to help them regain the confidence that they’re moving appropriately to avoid a fall. They use a number of different exercises to retrain a patient’s brain to correctly perceive the relationship of the foot and ankle to the space around them.

“By regaining that confidence, a patient can resume regular activities and further reduce the risk of falling,” he says.

Managing Multiple Chronic Conditions=Reduced Risk of Falling

“The key is properly managing multiple conditions well enough to maintain an independent lifestyle — without the fear of falling,” says Adams

He points out that, thanks to medical alert devices, older adults can now feel comfortable enough even to leave their home to continue daily activities.

“We now have a device that can track a person in 6 ways, giving us an accurate location. That gives them the security they need to walk out their front door,”

If You Suffer from 2 or More Chronic Conditions

Seniors do not need to play the victim and can take steps to proactively manage their health and risk for falls. Begin with these three tips:

  1. Work with one primary care physician who views you holistically, “owning” your conditions and managing multiple meds. And be sure your doctor knows about all the meds you’re taking.
  2. Make any necessary changes to the home — including simple modifications like ramps and bathtub rails — to help prevent falls.
  3. Join a community that can offer access to experts and other people who suffer from your condition. For example, an organization like the American Lung Association can provide invaluable help to people with asthma or COPD.

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