Balance Brain Health and Fall Prevention Majid Fotuhi

Balance, Brain Health, and Fall Prevention Majid Fotuhi, MD Ph. D Ingleside at King Farm & Rockville Office on Aging Rockville, MD September 12, 2014

Objectives § The impact of falls § Why do falls occur? § How to prevent falls? § How walking well can protect your brain 2

Falls Are Costly § Every year, 32 -42% of people aged ≥ 70 experience falls worldwide 1 § Fall frequency increases with age and frailty 1 § #1 reason for entry into long-term care facilities § Leading cause of injury-related death in older adults – every 35 minutes 2 1. 2. 3 WHO Global Report on Falls Prevention in Older Age. WHO; 2007: France. Sward D. Legisbrief. 2010; 18(21). National Conference of State Legislatures; Washington, DC.

Rate Per 100, 000 Population Fatal Fall Rates by Age and Sex National Center for Health Statistics, 2001. WHO Global Report on Falls Prevention in Older Age. 2007. 4

What Happens When We Fall? 5

Hip Fractures § Hospital stays extended to 20 days 1 § Older persons are likely to remain in the hospital for the rest of their lives 2 § 20% die within 1 year subsequent to falls 3 1. 2. 3. 6 The economic cost of hip fracture in the U. K. Health Promotion. The University of York; 2000: England. WHO Global Report on Falls Prevention in Older Age. WHO; 2007: France. Zuckerman JD. N Engl J Med. 1996; 334(23): 1519 -1525.

Post-fall Syndrome § § § Dependence Loss of autonomy Confusion Immobilization Depression WHO Global Report on Falls Prevention in Older Age. WHO; 2007: France. 7 Restriction in daily activities

Objectives § The impact of falls § Why do falls occur? § How to prevent falls? § How walking well can protect your brain 8

Why Do Falls Occur? Mechanical Medical Frailty 9

Mechanical § You slipped, tripped, or lost your balance. § Ex: Falls caused by the environment like a slip and fall on ice or a loose rug. 10

Medical • Toes • Back • Brain • Eyes 11

Frailty 12

Objectives § The impact of falls § Why do falls occur? § How to prevent falls? § How walking well can protect your brain 13

How You Can Reduce Your Fall Risk • Neurological Assessment (Ready) • Check Your Balance (Set) • Action (Go!) 14

Neurological Assessment Mental fogginess / OSA Conditions that impact walking ability 15 Circulation

Check Your Balance 16

Action: 6 Steps to a Stable Stride 1. Get Sharper 2. Eat Well 3. Get Fit 4. See Well 5. Check Your Home 6. Sleep Well 17

Walking Reduces Your Risk of Dementia 6 Action Steps 1. Get Sharper 2. Eat Well 3. Get Fit 4. See Well 5. Check Your Home 6. Sleep Well 18 Fall Less & Walk Better Protect Your Brain

1. Get Sharper Stimulate Your Brain 19 Cognition Better decisions Faster reactions Better coordination

2. Eat Well § Heart-healthy diet § Avoid obesity 20

Less Brain Volume in Patients with Obesity and/or Sleep Apnea 21 Am J Respir Crit Care Med. 2002; 166: 1382– 1387.

3. Get Fit § Leg strengthening: - 15 squats, twice a day § Balancing act: - Stand on one foot for 15 seconds, then the other - Twice a day - With your eyes closed: even better! 22

Physical Therapy § If your balance is poor, see a physical therapist soon. They consider – functional limitations – environmental hazards – Provide you with guided and progressive therapy – Multi-component exercise, which are: • beneficial for bone health and maintaining functional ability • the most effective physical therapy approach for prevention of falls and fractures Karinkanta S, et al. Nat Rev. 2010; 6: 396 -407. 23

4. See Well § Vision: – Provides sensory input for controlling posture – Provides information about the size and position of obstacles in our paths – Allows you to safely negotiate steps and stairs Elliott DB. Optom Vis Sci. 2014; 91(6): 593 -601. 24

Age-related Vision Changes Cataracts Normal Glaucoma 25 Normal

5. Check Your Home https: //www. youtube. com/watch? v=n. FX 3 qa. YXDUg 26

6. Sleep Well If urinary issues If use sleep meds If sleep apnea 27 fix bladder take only as-needed use CPAP

Action: 6 Steps to a Stable Stride 1. Get Sharper 2. Eat Well 3. Get Fit 4. See Well 5. Check Your Home 6. Sleep Well 28

Objectives § The impact of falls § Why do falls occur? § How to prevent falls? § How walking well can protect your brain 29

Walking 1 Mile a Day… Reduces Your Risk of Alzheimer’s ~50% Raji C, et al. Presented at: RSNA 96 th Annual Meeting; Chicago, IL: 2010. 30

Brain Fitness Program § A multidisciplinary program devoted to: • Reducing risk for Alzheimer’s disease and stroke • Making your brain feel 3 -5 years younger § Each patient receives a § comprehensive brain assessment § personalized treatment plan 31

Neur. Expand’s Unique Integrative Approach Comprehensive Diagnostics to Evaluate Brain Health 32 Customized Treatment Program to Maximize Brain Performance

Better Fitness 33

Better Memory 34

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