Diabetes and Falls Prevention: Researchers Work with Seniors

Diabetes and Falls Prevention: Researchers Work with Seniors

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Photo: Grace Quezon exercises at Old Dominion University's Student Recreation Center, a program to help diabetic patients reduce their risk of falling as they age. (Stephen M. Katz/The Virginian-Pilot)

NORFOLK, Va.--Diane Newlon is using weights and rubberized exercise bands at Old Dominion University to ward against a phenomenon that will afflict one in three people her age - 65 and older - every single year, at an average hospitalization cost of $34,000.

This $30 billion-a-year medical ailment is not a heart attack or a stroke or cancer, but a more pedestrian event -- falling down.

Diabetes and Higher Risk

As a diabetic, Newlon's risk is 17 percent higher, which is why this day in late October the Norfolk retiree is walking heel-to-toe, balancing herself on one foot, and doing lunge exercises to strengthen her thigh muscles.

She's one of hundreds of subjects that a team of researchers in Hampton Roads has been studying since 2008 to find ways to reduce their risk of falling.

Led by diabetes expert Aaron Vinik , MD, PhD, at Eastern Virginia Medical School and exercise science professor Sheri Colberg-Ochs, PhD, at ODU, the work has been published in national journals and was presented at a Gerontological Society of America conference in Washington, D.C., this month.

Ebola has snared the public's interest in medical news lately, but the more boring fall category is the leading cause of both fatal and nonfatal injuries among older people.

Diabetes, particularly the type related to obesity and lack of activity, also has dire health consequences. Parts of South Hampton Roads are included in the so-called diabetes belt, a swath of the South and Midwest where rates are higher than the national norm.

The EVMS/ODU studies have pinpointed factors that make diabetics more susceptible to falling:
Neuropathy that causes numbness in the feet and hands. Slower reaction times. Changes in blood sugar levels and heart rate that make them faint. Vision changes.

The researchers enlisted emergency medical officials in Virginia Beach, Va., to gather details of 4,000 falls in older people who called 911. They found diabetes the second most common disease among the group, exceeded only by high blood pressure.

Vinik said there are some characteristics of the gait of diabetics that put them at added risk. For instance, they often walk in a more flat-footed fashion because of the lack of feeling in their toes, giving them a swaying motion that's hard to stop midfall.

Exercises That Can Help

The local researchers have identified specific exercises that can reduce that risk, such as strengthening upper leg muscles and making the ankle and toe joints more flexible and the muscles around them stronger by using rubberized resistance bands.

That can keep people from tripping on rugs and sidewalk curbs. Exercises that strengthen the core, such as yoga, pilates and tai chi, give people a better sense of their body's position, enabling them to catch themselves if they're off balance.

The researchers have created lists specific to people with diabeties for health care providers and exercise instructors:

Inspecting their feet for blisters after exercise. Trying cycling and swimming instead of walking if there's concern about foot ulcers. And chair exercises to improve flexibility and strength for those unable to walk far or bike.

The study of diabetics under way at the ODU Student Recreation Center last week zeroes in on another aspect: Can people do these exercises at home with as much success as a trainer-led program?

The group at ODU is being led by Rachel Simmons, an ODU research student and exercise instructor who takes participants through various steps using weighted balls and rubberized exercise bands.

"OK, stand on one leg, and raise a ball with one arm," she tells Newlon and two other diabetics. "Hold the weight and stand. If you want to make it more difficult, raise the ball over your head. Now stand on your right foot and transfer the ball from one hand to the other."

Another set of those with diabetes is doing the same number of classes over 12 weeks at home using Wii Fit, a video game with exercises and balance activities. All of the study subjects have Type 2 diabetes and are ages 60 to 79.

The researchers want to find methods that will work in different environments. The gait-and-balance studies, which received some funding from the American Diabetes Association, also included work by ODU physical therapy professor Steven Morrison, PhD.

Diet, Too

While improving nerve function in diabetics is difficult, increasing muscle mass and improving balance can help counter nerve loss. "Part of instability comes from weakness," Colberg-Ochs said.

Some diabetic patients she's worked with have used a combination of exercise and diet to stabilize their blood glucose to the point where they no longer need medication to control it.

Newlon was diagnosed with diabetes several years ago and has adjusted her diet. She's had more difficulty exercising regularly, though, so the stationary biking warm-ups and strength and balance exercises have helped her.

"I feel stronger," she said. "I know that this will help me know what to do if I lose my balance. I'll be able to catch my fall, so I won't just go, plop, down on the floor."

Elizabeth Simpson wrote this article for the Virginian-Pilot through a Journalists in Aging Fellowship, a collaboration of New America Media and the Gerontological Society of America, with support from AARP.