There is little doubt that rheumatic diseases such as osteoarthritis (OA) and rheumatoid arthritis (RA) significantly increase the risk of falls, but historically there has been limited emphasis on the need to prevent falls from occurring in these patients. What can rheumatologists do? Start by assessing risk for the individual patient. Inform these patients about activities that have been shown to prevent falls and make referrals to providers who can facilitate their participation in these activities. In short, says Debra J. Rose, PhD, co-director of the Center for Successful Aging at California State University in Fullerton, “get the patient to embrace physical activity.” (Editor’s Note: The ACR offers free patient education fact sheets on rheumatoid arthritis, osteoarthritis, and exercise and arthritis that can be downloaded at www.rheumatology.org/public.)
Dr. Rose and other fall prevention experts say there are three key elements in any fall prevention program. They include assessment (including an environmental assessment of the home for an at-risk patient and pharmacy assessment/medication changes), patient education, and physical exercise. There are no specific guidelines for fall prevention in patients with rheumatic disease, but general recommendations for all patients at increased risk for falls can be adapted by rheumatologists. For patients with rheumatoid disease, exercise activities should focus on balance and mobility, says Dr. Rose. However, she says that all patients with RA or OA should exercise regardless of their degree of risk. Gail Davis, RN, EdD, professor of nursing Texas Women’s University School of Nursing in Denton and a member of the TR editorial board, says, “An exercise program for RA and OA patients should maintain and improve mobility and flexibility and improve strength.”
Dr. Davis says there are a number of outlying factors that can lead to higher risk including vision impairment, cognitive impairment, and drug reaction/interaction. The best approach, say Drs. Davis and Rose, is to understand general evidence-based recommendations for fall prevention risk and individualize a prevention plan for each patient. “This approach is time consuming at first, but it is proven to decrease risk in the long term,” says Dr. Davis. She recommends a multidisciplinary approach. A nurse practitioner working with the rheumatologist can do the initial clinical assessment with the patient. A pharmacist should then be asked to determine the possible impact of polypharmacy, depending on which medications the patient is taking. Referral to rehabilitation services with particular emphasis on physical therapy is the next step, says Dr. Davis. An occupational therapist will conduct a home visit to determine environmental risks for falling, such as poor lighting and loose carpeting and will make recommendations about equipping the home with assistive devices, such as hand rails in the bathroom and stairways and a raised toilet seat.
