Primary care checkups for older adults often focus on blood pressure, cholesterol levels and other major disease indicators. But a significant danger to good health - balance and mobility deficiencies that can lead to falls - is frequently overlooked. Fortunately that is beginning to change thanks to a provision of the Affordable Care Act.
The act requires health insurance to cover balance training, exercise, and vitamin D supplementation for adults 65 and older who are at increased risk for falls. Physicians now are able to help patients with balance and mobility issues by referring them to a physical therapist.
Emmett Parker, PT, ATC, president of AccelAbility Physical Therapy, and governmental affairs chair for the Alabama chapter of the American Physical Therapy Association, is thrilled to see the requirement, which he believes was long overdue. “I’m not a fan of Obamacare in general, but they got that part right,” Parker says. “Falling is a significant problem for seniors that hasn’t received the attention it deserves.”
Falls are the leading cause for all injuries, both fatal and nonfatal, among older adults, according to the Centers for Disease Control and Prevention (CDC). Death rates for falls among that age group have risen dramatically in recent years. Even when senior falls are not deadly, they often lead to significant injuries, including fractures, and sometimes to ongoing disabilities. The direct medical cost of all falls was $30 billion in 2010, the CDC reports. “The tragedy is that so often deadly or debilitating falls could have been prevented by addressing balance deficits through physical therapy and exercise,” Parker says.
Part of the problem, Parker says, is that our culture has come to accept falls among seniors as a given, something that can’t be avoided. “So many people believe people just get old and fall when the truth is that they become inactive and develop deficiencies and fall,” Parker says. “Our bodies were designed to move and when we quit moving it creates problems. Fear of falling that leads to inactivity can actually cause an increase in fall risk. It’s a viscous circle.”
Other important strategies for fall prevention among seniors, in addition to staying active, according to Parker and the CDC, include
1) checking medications to make sure they don’t cause fogginess or dizziness,
2) annual vision screening and correction,
3) and avoiding fall hazards in and out of the home
It’s also critical for senior adults to keep their bones strong through strength training, proper calcium and vitamin D intake, and treatment of osteoporosis when it occurs to help avoid fractures if falls do happen.
Parker and other physical therapists are hoping that the insurance coverage change will motivate primary care physicians to more often include balance and mobility screening during their exams. Patients often fail to mention falls and the like. Of the one in three adults 65 years and older who fall every year, only about half tell their doctor, according to the CDC. “Unless a doctor specifically asks the patient about falls and mobility issues, the patient may not mention them,” Parker says.
Parker also points to a UAB clinical review published in the Journal of the American Medical Association September 18 on the importance of cultivating better mobility in seniors. The review concluded that physical activity and exercise are important in healthy aging and that seniors with mobility issues are more prone to functional decline. “Mobility problems tend to escalate and lead to increased fall risk,” Parkers says.
The UAB review suggested physicians ask their patients two simple questions during routine screenings: “Do you have difficulty climbing up 10 steps or walking a quarter of a mile?” and “Because of underlying health or physical reasons, have you modified the way you climb 10 steps or walk a quarter of a mile?”
When mobility or balance deficits are determined during a routine exam, physicians can then take the opportunity to suggest physical therapy and exercise. As a preventative measure physicians are encouraged to recommend appropriate exercise to all seniors, even those without apparent mobility or balance issues, to help them avoid developing them and avoid or better cope with future falls.
As fall prevention takes more of a center stage because preventative health care is being incentivized by the Affordable Care Act, Parker believes physical therapy will play a key role. “Regular exercise is critical for seniors but oftentimes mobility and balance deficits first need to first be addressed before the senior enters a regular program,” Parker says.
AccelAbility Physical Therapy recently invested in a state-of-the-art balance platform to help their physical therapists better pinpoint specific mobility and balance difficulties. “Everyone’s needs are individual,” Parker says. “And with this new technology we will have a better way of tracking individual progress and showing the effectiveness of various therapies.”
