THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 618.7

Guest: Dr. Carol Frey, Assoc. Prof. Orthopedic Surgery, USC, Dir. of Foot and Ankle Ctr.,            Orthopedic Hospital, L.A. California

Topic: Study on seniors, shoes and falls

Host/Producer: Steve Girard

NEMA: A new study puts new importance on seniors picking out the right shoes. With us today is Dr. Carol Frey, a Professor of Orthopedic Surgery at USC Medical School, and Director of the Foot and Ankle Center at Orthopedic Hospital in Los Angeles.

FREY: Well, basically what we did is we looked at 185 seniors, and we basically defined seniors as 55 years or older, and we collected information on age, weight, and whether they exercised or not, or used assistive devices...and if the patient had sustained a fall in the last year. And what we found that... is that there were 79 individuals in this group who had not sustained a fall, and 106 seniors who had actually sustained a fall. We looked at the demographics of the differences between those two groups, and there really wasn't a whole lot of differences in the number of females or males...or average weight, or even the average age. I mean the average age was 65 in the group that had not fallen, and 67 in the group that had fallen. And their weight was 161 in both groups. So, there wasn't a lot of difference in demographics, but we had to do that to have a control group. But the one difference we did see is that the group who fell, versus the group that did not fall, is that even though both groups said they exercise to some extent - about 60% said they exercised - there was a lot more seniors who weight lifted in the group that did not fall, which was interesting because we feel that maybe doing work with weights and what have you actually increases your balance, and your stability on your feet. So that was one thing we saw as far as the demographic data was concerned. But out of the group of people who had fallen, we asked them, "...what did they feel was the primary cause for the fall?"...and shoe problems was the number one reason they gave. 28% said it was because of the shoes. And then 21% said they tripped over some obstacle, they tripped over something. 14% said they slipped...about 12% said they were in a rush. Other reasons stated was that there was a hole in the ground...they felt dizzy, they were weak, they were tired...they had pain, or it was dark. And those reasons were given as well, but to a lesser extent. So we thought it was very interesting that when we asked the seniors themselves "Why do you think you fell"?...the number one reason they stated was a shoe problem. And problems with the shoes included most commonly that the shoe dragged or caught on something...catches or drags...and actually an equal number said that the shoe was slippery. Poor fit was cited in 10% of those cases, and in some cases they said the shoe was just too heavy or had no give. But basically the big problem was that the shoe was either too slippery, or it caught or it dragged.

NEMA: Sometimes it's a matter of someone losing balance for some other reason, and then because of the slippery shoe not getting hold, or the sneaker catching prematurely...they are not able to get their feet in a position to stop the fall...

FREY: that's a very important point...that the shoe may be the principal cause...the number one principal cause cited by the senior, but let's say there's another cause...like you trip over an extension cord or something of this nature, and the may be a secondary cause in that for some reason you weren't able to regain your balance quickly enough because the shoe is catching. So, it may be a secondary cause in many cases as well. But the real interesting point is that the majority of the people at the time of the fall were wearing athletic shoes or an oxford type shoe. 42% actually had an athletic shoe on. And this is what has been recommended in the past by physicians or care givers as sort of the sturdy shoe. You know, Wear an athletic shoe or a running shoe, and you should be in good shape. That is not the best shoe, in many circumstances, for an older individual.

NEMA: Was there a most common surface where these folks fell?

FREY: Well, it wasn't...although surface is a very important consideration, what we had more noted here is location. And 47% of the people actually fell outside of the home, that was the number one location. Outside the home...you know, walking on the street, or actually taking the garbage out. In the home was the second largest, so in the home is a very, very common location for a fall. But we segregated kitchen and bedroom out of that, so bedroom made up a significant portion, and then kitchen made up a significant portion...and it got very close to the same number as the people who had fallen outside. But the point is that these falls happen while you're doing very normal activities, like walking...just plain walking. Or walking downstairs or doing something that you would very commonly do. Most of the falls occur doing very common things in very common locations, including around the home or inside the home.

NEMA: Is there a specific type of shoe for a certain surface?

FREY: Yes. And the point was that when people were on a carpeted surface, for example, actually the athletic shoes with the heavy lugs...or rubber treads on the bottom of them...they tend to catch. Particularly if it was a running shoe design, where the rubber lugs or tread kind of curls up over the tip of the toe...which it will do on a running shoe. that's a very dangerous situation, that combination of the rubber, heavy lugs or rubber heavy sole with a heavy tread on a carpeted situation...because it really tends to catch, and the shoe will stop, or stop moving...but the client or the senior doesn't stop moving, and that's when they fall forward. The toe catches on the carpeted surface, the shoe doesn't give and the senior just keeps going and it creates this fall situation. And on more slick surfaces, you want some tread, you want to make sure you're not wearing a very slick, leather sole that has no tread on it at all. The danger with he leather sole is that when you first buy a leather soled shoe, it's very slick and can cause slips...and you want to make sure you have abrasion patterns on it, before you wear it on any kind of surface that would be what you consider slippery or wet. Any smooth surface.

NEMA: The survey pointed to ill fitting shoes as one of the big causes of falls for seniors....why is that?

FREY: One of the problems with shoes that don't fit on the foot well is that they may be the right size, but they may be slip-on type shoes or slippers...or shoes that weren't laced, and had a tendency to just fall off the foot. Clogs would be in that category as well. Clogs and slippers are very dangerous shoes for older folks. it's much better to have a shoe that not only fits in that it's your right size, but also that it stays on the foot, and therefore a lacing pattern is much better and is recommended for older folks.

NEMA: Many seniors have gotten in the habit of wearing slippers in and around the house...

FREY: Slippers are not a good shoe to do a lot of walking in. Nor are the clogs...they just don't stay on the foot. you're spending a lot of energy and also muscle power to grip the shoe and try to keep it on. it's much better to get a shoe that not only fits well, but also stays on the foot without much effort. So therefore, a lace up shoe or a Velcro shoe.

NEMA: Now some of the athletic shoes I see seniors wear are real running type shoes, and they have a thick but airy sole meant for cushioning the pounding that runners have to withstand...and they've been recommended for seniors to give them some extra cushioning and comfort...

FREY: Well that's another thing we saw as well....is that you think, Gee, it's a well cushioned shoe, I should be very comfortable. But one of the problems with the cushioning is that it's kind of like walking on a trampoline, or walking on pillows. So, it's important to select a shoe that not only reduces the incidence of tripping and slipping, but also it gives you enough cushioning that you're comfortable, but not so much that it feels like you're walking on pillows...and can cause you to be unstable just doing normal, everyday activities.

NEMA: Seems that a tie-up shoe with a leather sole that has a little bit of wear on it is the best all around choice for older folks who have to walk on carpet, wood floors, tiles, and outdoors on sidewalks..

 

FREY: that's actually a very good recommendation. Needs to have a little abrasion pattern, or wear pattern on the leather so that it doesn't have an ultra slick bottom. But in addition to that, a lightweight walking shoe, which has a rubberized sole, a little wedge, rubberized sole that isn't too much greater than 15 millimeters. Not much more than a half of an inch. that's really as thick as you want to go with that cushioning system or the rubber sole, because anything more than that and it really starts to make you unstable when you're walking.

NEMA: Getting the right shoes should really be a high priority for seniors...

FREY: it's sort of interesting that there's a number of factors that have been implicated as contributing to the number of falls in the senior population, and many of these factors are very difficult and very expensive to alter. Such as changing your entire home. Or physiological factors are sometimes hard, if you have Parkinson's, or if your eyesight's not quite as good as when you were 20...now those things are very difficult to change, expensive to alter. But a very easy and economical factor that you can change is shoe wear. And so that's why we kind of focus in on shoe wear, cause that's something very easy...that if a senior's given information that they can become an informed consumer and know what type of shoes to wear and what kind to buy, it's just an easy thing that can be done to help them prevent a fall and maybe lose their independence from an injury they may suffer from a fall.

NEMA: Thanks to Dr. Carol Frey, a professor of orthopedic surgery at the University of Southern California.

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