18 West Virginia Medical Journal www.wvsma.org Original Research Article | Vivian M. Minkemeyer, MSIII Medical Student, Joan C. Edwards School of Medicine, Marshall University Matt Meriweather, MSIII Medical Student, Joan C. Edwards School of Medicine, Marshall University Franklin D. Shuler, MD, PhD Professor, Orthopaedic Trauma Vice Chairman, Orthopaedic Research Medical Director, Senior Fracture Program, Marshall University, Department of Orthopaedic Surgery Saurabh P. Mehta, PT, PhD Assistant Professor, School of Physical Therapy Marshall University Zain N. Qazi, MD Orthopaedic Research Fellow Marshall University Corresponding Author: Vivian M. Minkemeyer, Marshall University, Department of Orthopaedic Surgery, 1600 Medical Center Drive, Suite G-500, Huntington, WV 25701. E-mail:minkemeyer@ marshall.edu Abstract West Virginia is ranked second nationally for the percent of its population ≥65 years of age. The elderly are especially susceptible to falls with fall risk increasing as age increases. Because falls are the number one cause of injury-related morbidity and mortality in the West Virginia elderly, evaluation of fall risk is a critical component of the patient evaluation in the primary care setting. We therefore highlight fall risk assessments that require no specialized equipment or training and can easily be completed at an established ofice visit. High quality clinical practice guidelines supported by the American Geriatric Society recommend yearly fall risk evaluation in the elderly. Those seniors at greatest risk of falls will beneit from the standardized therapy protocols outlined and referral to a balance treatment center. Patients with low-to-moderate fall risk attributed to muscle weakness or fatigue should be prescribed lower extremity strengthening exercises, such as kitchen counter exercises, to improve strength and balance. Introduction In the state of West Virginia, falls are the number one cause of injury for persons over the age of 65. 1 Per annum, 30% of those over 65 will experience a fall, and up to 50% of those over 85 will experience a fall. 2 It is therefore concerning that our population is old and getting older. Currently 16.0% of West Virginia’s population is 65 and older; second highest in the country (Florida is irst with 17.3% ≥ 65 years of age). 3 Additionally our population over the age of 65 is expanding, with the number of people over the age of 85 increasing at an even faster rate. 3 This data indicates that falls are an escalating health threat for our state. As the fall risk increases, so do the healthcare expenditures for the resultant injury related morbidity and mortality. The national cost attributed to fall-related injuries in seniors was a staggering $12.6 billion in 2005 and over $30 billion in direct medical costs in 2010. 4,5 The one year mortality among the elderly over the age of 60, after hospitalization due to a fall-related fracture, is 25%. 6 Given the increased risk of morbidity and mortality, as well as the costs to society following a fall, the need for targeted screening and intervention for this population is paramount. 6 Muscle weakness is the most prominent modiiable risk factor for falling. 2,7-9 The mechanism of neuromuscular activation declines in seniors and produces decreased production of power and reduced mobility. 10-13 The senior therefore experiences easy fatigue of lower extremity muscles during mobility tasks which poses challenges with locomotion due to balance and gait impairments. 14-16 Perceived dificulties with locomotor activities discourage the elderly individual from participating in these activities, worsening neuromuscular activation and muscle function. 17 This cyclical process can lead to irreversible changes creating a signiicant risk for falling and sustaining injuries that can further worsen their overall health status. 18 Since lower extremity weakness is a statistically signiicant risk factor for falls, screening for such weakness becomes an instrumental tool in breaking the establishment of this negative feedback loop. 14 Screening for, and identifying, fall risk is important because many interventions have a positive effect on increasing balance and reducing fall and injury risk. 7,19-26 This paper provides evidence-based strategies to screen more people in the risk assessment process. 27 Thus, inding a simple, reliable, and eficient fall risk assessment tool for West Virginia healthcare providers is critical for identifying and treating those elderly who are at greatest risk for falls. Patients over the age of 65 should be assessed yearly for fall risk. 28 The initial fall risk assessment should include three questions to determine previous fall history: (1) Has the patient had two or more falls in the past 12 months? (2) Have any acute falls required an emergency room visit? and (3) Has the patient had any dificulty with walking or balance? 1 The strongest predictors for falls were a prior history of falls, poor vision, anxiety, nervousness or fear of falling, and antipsychotic medication use. 29 Therefore, inquiry concerning other fall risks (i.e. medications, vision, heart rate and rhythm) should be considered prior to asking a patient to perform a fall risk assessment test. 30 The guidelines from the American and British Geriatric Societies describe four of the most widely accepted fall risk assessment tests that can be used to evaluate gait and balance: the Timed Up and Go Test, Get Up and Go Test, the Berg Balance Primary Care Fall Risk Assessment for Elderly West Virginians