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Fatigue Can Cause Frequent Falls!

Dr. Rein Tideiksaar - June 01, 2015 10:58 AM

Most falls in elders occur during walking. According to a recent report, fatigue (or feeling tired) can lead to problems with walking, such as:

•    Not lifting the feet off the ground (shuffling).
•    A decrease in how fast one walks (walking speed).
•    A change in step length and step width (taking small, hesitant steps).

These waking changes can result in tripping and/or impaired balance and, as a result, an increased likelihood of falling.

Other complications of fatigue, which may further increase the risk of falling, include:

•    Reduced physical function with everyday activities.
•    Reduced alertness and increased forgetfulness.
•    Depression and social isolation (decreased contact with other persons).

Fatigue is a common complaint among elders; up to 50% of elders report periods of feeling tired or weak (sometimes to the point of exhaustion) at one time or another.

Unfortunately, fatigue is often ignored by many elders because of the mistaken belief that ‘being tired’ is a natural progression of normal aging. As a result, persons may not receive the proper intervention (or treatment), which could reverse feeling tired. 

Feeling tired and being at greater risk of having a fall makes sense to most elders. A simple cure to alleviate fatigue would be simply to rest for a day or so. But what if that doesn’t solve the problem? What if one is still tired? And is struggling with walking and/or balance? And falling? If an elder has:

•    Trouble initiating normal activity due to perceived generalized weakness?
•    An inability to maintain activity (easy fatigability)?
•    Any difficulty with concentration, memory, and emotional stability (ie, mental fatigability)?

Then time to take action! So how does one proceed? The first step is to understand what fatigue is.

What is ‘Fatigue’?
Fatigue (also described as feelings of tiredness, reduced energy, and reduced strength) is generally a sign or symptom of an underlying health conditions, such as:

Cardiovascular/Pulmonary  
•    Increasing fatigue, especially following physical activity, is a feature of heart and lung illnesses; most often heart failure and chronic obstructive pulmonary disease.

Endocrine
•    Fatigue is a common complaint of both hypo and hyper thyroid disease. Hyperthyroidism, in particular, may also result in decrease muscle strength, resulting in symptoms of fatigue and weakness.
•    As many as 50% of postmenopausal women complain of fatigue.

Nutrition   
A diet lacking sufficient amounts of calories, protein, and/or essential vitamins may lead to fatigue. Specifically, vitamin B12 and vitamin D deficiencies are common.
•    Vitamin B12 deficiency (due to stomach absorption problems or “tea and toast” diets) can result in fatigue, weight loss, nerve problems, memory loss, and depression.
•    Vitamin D deficiency is associated with an increased incidence of falls and cognitive decline. Deficiency can cause nonspecific symptoms, such as fatigue, loss of muscle strength, bone and muscle pain, joint pain, poor balance, and low mood.

Psychological
•    Fatigue is common in persons with depression. Features include fatigue being present throughout the day, fatigue being present upon awakening, fatigue that improves later in the day, and fluctuations in mood.

Situational Factors
•    Fatigue may develop (even in healthy elders) who experience: inadequate sleep, insufficient rest, over activity, poor physical conditioning, stress, changes in diet, etc.

Medications
Finally, medication side effects play a big part in causing fatigue.
•    Major medications associated with fatigue include nonsteroidal anti-inflammatory drugs, antipsychotics, antidepressants, sleep medications, and pain medications. Alcohol use can be a cause of fatigue.
•    All blood-pressure medications may slow down the pumping action of the heart as well as depress the nervous system.
•    Statins (used to treat high cholesterol) are associated with muscle weakness, severe muscle aches throughout the body, and fatigue. 

What’s next?

A Visit to the doctor
If you’re tired and fatigued, the best thing that you can do is to talk to your doctor. He or she will take a detailed history of your complaints, perform a physical examination and, if needed, order lab tests and other diagnostic tests. This will help determine whether your fatigue is situational (such as too much activity, stress, etc.) or something bigger that you need to be concerned about.

Exercise regularly
Lack of exercise leads to loss of leg strength and poor balance. An exercise program that includes strength and agility (such as yoga, Tai Chi or strength training) will build strength and improve balance and, at the same time, reduce fatigue.

Maintain vision
Poor vision can make walking around much more difficult. Every day movements like judging stairs or negotiating curbs, for example, can lead to falls. Elders should have their vision checked regularly to ensure the proper strength and fit of glasses and contacts so that they can see clearly.

Know your medications.
Could one or more of your medications be making you feel tired?  Feelings of fatigue with the start of taking a medication may be a clue.
•    The stopping of the medication followed by a clearing of feeling tired supports the diagnosis.
•    Check the safety information that comes with your medications. You may see "extreme tiredness" listed as a side effect. That's an important sign that fatigue could be drug-induced.

If you suspect that your symptoms might be linked to a medication you're taking, talk to your doctor or health care provider right away. It's important that you do not discontinue the drug on your own.

Remove walking hazards

The home environment should be checked regularly for any tripping and slipping hazards (door sills, electrical cords in walking areas, sliding rugs, slippery flooring, etc.) that can interfere with safe walking. Additional lighting on stairways and walkways, and wearing supportive footwear (not slippers or walking around in socks because it increases the risk of slips and falls) are other safety recommendations.

Click here to read Dr. Rein Tideiksaar’s blog, “Stay Steady! Fall Prevention & Assessment Strategies”.

Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Doctor’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592. If you have any questions about preventing falls, please feel free to email Dr. Tideiksaar at drrein@verizon.net

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