Arthritis is responsible for reduced flexibility, mobility, and strength, particularly in the legs... and that translates into an increased risk for falling. Factor in other factors such as reduced balance capability plus the effects of medications and what is produced is a recipe for disaster.

Patients with arthritis affecting the legs are particularly at high risk for falls. Also, patients with arthritis are often treated with antidepressant medications to counteract both the depression that comes with lifestyle alteration but also as an adjunctive medicine for pain control. Antidepressants and related drugs such as hypnotics (sleeping pills) increase the risk of falls.

Also, patients taking other types of medicines such as blood pressure medicines, diabetes medicines, fluid pills, and so on can become dizzy particularly with sitting up or standing up quickly.

With age, falls also become more common.

Footwear can affect the ability to walk properly. And patients who require the use of canes or walkers already have an increased risk for falling.

Another issue is declining vision that is often present in older patients with arthritis.

The consequences of falls are sobering. "Older women and men whose fragile bones break are more likely to die in the five to 10 years after their fractures compared to other people their age," according to a study published in the Feb. 4 issue of the Journal of the American Medical Association.

For the research, Dr. Jacqueline Center, associate professor and senior research officer at the Garvan Institute of Medical Research in Sydney, and colleagues studied "32,000 people living in Dubbo, Australia. The investigators found that "between 1989 and 2007, 952 women and 343 men experienced low-trauma fractures. Some time after their fracture, 461 of the women and 197 of the men died."

The researchers also discovered that, "for hip fractures, the standardized mortality ratio was 2.43 for women and 3.51 for men." In other words, the risk for death was two and a half times more common for women and three and a half more common for men!

And, "for vertebral fractures, the ratios for women and men were 1.82 and 2.12, respectively." Overall, "for major fractures, the ratio for women was 1.65 and for men it was 1.70."

These numbers are frightening!

The cost of fractures due to osteoporosis alone in the United States in 2005 exceeded $19 billion.

In addition to fractures, other problems that occur with falls including soft tissue injuries, activity avoidance, and fear of another fall carry another hefty price tag.

The fear of falling leads to a vicious cycle of activity avoidance and social isolation which further diminishes quality of life.

The keys to dealing with this potentially lethal problem include:

•Recognizing that a patient is at risk

•Asking them whether they think they are at risk or if they fear falling

•Starting an exercise program to help with strengthening of the legs

•Referring them to physical therapy for proper training in balance and gait.

•Dealing with the issue of polypharmacy (too many drugs... and drug interaction)

•Footwear guidance

•Vision testing

In my own practice, I have found the fear of falling among my older patients to be a leading cause of reduced activity and social isolation. It is important to recognize this problem and deal with it aggressively in order to help patients maintain their independence.