Things You May Not Know About Dizziness and Balance Disorders

That are Killing Thousands of People and Costing Us a Fortune!

 

[Click here to find out what all this means and what can you do about it?]

IS THERE A PROBLEM?

 

  • “Over 90 million Americans 17 years of age and older have experienced a dizziness or balance problem.”7

  • U.S. doctors reported 5,417,000 patient visits in 1991 because of dizziness or vertigo.10

  • In 1994, 11 million physician visits for dizziness were recorded.

  • Current statistics show that approximately 13 million Americans over the age of 65 suffer from some type of dizziness or balance problem that significantly interferes with their lives.6

  • Dizziness is the leading cause of falls for the elderly and a common symptom affecting about 30% of people over the age of 65.9

  • “A majority of individuals over 70 years of age report problems of dizziness and imbalance, and balance-related falls account for more than one-half of the accidental deaths in the elderly.”8

  • More than one-third of Americans aged 65 and older will experience a fall each year,13 and nearly 16,000 of those people will die as a result of those falls, according to the U.S. Centers for Disease Control and Prevention.2,5

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    HOW BAD IS IT?

     

  • Falls are the leading cause of injury deaths among individuals who are over 65 years of age.1,6,14

  • Falls are the leading cause of ER visits (24%).

  • There are 9 million fall-related visits to the ER in the U.S. each year.

  • In the over 75 age group, 75% of visits to the emergency room are for injuries associated with falls.6

  • Falls are responsible for 70% of accidental deaths for people over 75 years old.

  • In 2000, falls among older adults accounted for 10,200 deaths and 1,600,000 emergency room visits.1

  • In 2003, over 1.8 million older adults were treated in emergency departments for fall injuries, more than 421,000 were hospitalized, and a total of 13,700 persons aged >65 years died from falls (a 55% increase from 1993).2,14

  • In 2005, the last year for which statistics are available, 433,000 people over 65 were admitted to hospitals after falling, and 15,800 died as a direct result of the fall.14

  • Adults aged 75 years and older who fell at least once during the past three months had an increased risk of being admitted to a long-term care facility over a 1-year period.2

  • This is by no means a problem affecting only the elderly, as the number one cause of nonfatal injuries in all age groups is from falls.6

  • Approximately 5.8 million persons aged >65 years, or 15.9% of all U.S. adults in that age group, fell at least once during the preceding 3 months, and 1.8 million (31.3%) of those who fell sustained an injury that resulted in a doctor visit or restricted activity for at least 1 day.14

  • Even when those injuries are minor, they can seriously affect older adults’ quality of life by inducing a fear of falling, which can lead to self-imposed activity restrictions, social isolation, and depression.16

  • A recent study determined that 31.8% of older adults who sustained a fall-related injury required help with daily activities, and among them 58.5% were expected to require help for at least 6 months.18

  • In 1988, disequilibrium was the second most common diagnosis for a Medicare hospital admission, with an average stay of 4.3 days.

  •  

    WHAT ARE THE SEQUELAE?

  • Approximately 300,000 Americans over 64 break their hips each year—three-quarters of them women. They are two to five times more likely to die within a year than seniors of the same age without a break. And with baby boomers by the millions heading for these fragile years, the number of fractures could double by 2040.4

  • Remarkably, 29% of older people who break a hip die within a year, according to research by the University of Maryland School of Medicine commissioned by the Globe. That's higher than the one-year death rate from stroke. And unlike stroke deaths, the rate of hip fracture is rising—up from 24% found by other researchers in the late 1980s.4

  • Current studies now show that up to 33% of older adults with a hip fracture die within a year.3

  • Nearly 50% of elderly patients admitted for hip fractures become chronic patients.

  • Hospital admissions for hip fractures among the elderly have increased from 231,000 admissions in 1998 to 332,000 in 1999.1

  • Researchers found the risk of death increased more than twofold for women and more than threefold for men following a hip fracture.5

  •  

    WHAT’S IT COSTING US?

  • The average length of stay in the hospital for unintentional falls among older adults was 4.9 days.12

  • The average charge per hospitalization was $30,160 per person (which does not include costs related to physician care, rehabilitation, or long-term disability).12

  • 71% of these charges were paid for by Medicare, and 52% were discharged to skilled nursing facilities.12

  • In 2000, direct medical costs for fall-related injuries totaled approximately $19 billion.17

  • 5% of falls lead to bone fracture, resulting in approximately 300,000 hip fractures annually, with an estimated cost of $20.2 billion for the treatment of fall-related injuries.11

  • The total cost of fall injuries among older adults is expected to hit $54.9 billion in 2020.2

  •  

    WHAT’S THE PROPER THERAPY?

  • 50% of patients complaining of dizziness in a primary care setting are not diagnosed.

  • 70% of patients complaining of dizziness in a primary care setting get a prescription for meclizine (antivert).

  • Meclizine has the slowing effect on reaction time equal to a blood alcohol level of .04 to .06.

  • Reduced reaction time is a leading cause of falls in the elderly.

  • Meclizine and most medication geared toward treating the symptoms of dizziness and disequilibrium (vestibular suppressant, anti-emetics, anti-cholinergics, sedatives, and tranquilizers) hinder the natural vestibular compensation process.

  • Vestibular abnormalities are found in 50% of people who fall.

  • Vestibular evaluations, including auditory evoked potentials, electronystagmography, and videonystagmography, are over 90% sensitive for auditory nerve, brainstem, or cerebellar pathology causing dizziness.

  • Vestibular evaluation generally costs about one-half of an MRI with contrast.

  • MRI exams have a very low yield for patients undergoing examinations for dizziness.

  • Vestibular disorders are responsible in 85% of patients complaining of dizziness.

  • All that is dizzy is not vestibular. Visual and somatosensory input, as well as efficient brainstem integration, also contribute to normal balance function.

  • In patients with chronic balance problems, only vestibular rehabilitation has shown to improve balance function and performance when compared with medical therapy or general exercises.

  • Therapy directed toward a specific diagnosis resulted in resolution of symptoms in 85% of patients, while general vestibular rehabilitation exercises resulted in complete resolution in 64%.

  •  

    WHAT CAN WE AS PHYSICIANS DO ABOUT IT?

  • Falls increase disability among older adults, and those injured during a fall often do not return to their pre-fall level of functioning.2

  • Consider that half of all falls among the elderly result from untreated or mistreated vestibular problems (vertigo).6

  • Annually, more than 64,000 individuals who are over the age of 65 years of age sustain traumatic brain injury as the result of a fall.1

  • More than 450,000 people receive head injuries each year. Fifty-eight percent of people who have had a traumatic brain injury complain of dizziness one to three months after the injury.

  • Fear of falling is the #1 fear of the elderly.

  • Patients are looking for a place that will diagnose and treat their balance disorders and improve the quality of their lives.

  • According to the National Institutes of Health, 42% of people will visit their doctor because of dizziness at least once in their lifetime.

  • We have an aging population with the baby boomers.

  • The number of people turning 60 each day in 2006 was 7,918 (almost 3,000,000 people a year), and that number is constantly growing.

  • Now you can offer a new service that’s beneficial to your community and your bottom line.

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    [Click here to find out what all this means and what can you do about it?]

     

     

    REFERENCES:

     

    1. An Act: Keeping Seniors Safe from Falls Act of 2004, 108th CONGRESS, 2d Session S. 1217, in the House of Representatives, November 19, 2004. To direct the Secretary of Health and Human Services to intensify programs with respect to research and related activities concerning falls among older adults.]
    2. Englander F, Hodson TJ, Terregrossa RA. Economic dimensions of slip and fall injuries. Journal of Forensic Science 1996;41(5):733–46. Also, the September 21, 2007 issue of Advanced Data: From Vital and Health Statistics, No. 392 entitled "Fall Injury Episodes among Non-institutionalized Old Adults: United States, 2001-2003" reveals some challenging statistics about health care utilization. "This report presents national estimates of nonfatal medically attended fall injury episodes for non-institutionalized adults aged 65 and over based on data from the National Health Interview Survey for 2001-2003. The NHIS is one of the major data collection systems of the Center for Health Statistics (NCHS) and is a continuous survey of a nationally representative sample of the U. S. civilian non-institutionalized household population. The following facts were cited in this survey:]
    3. Nader Paksima, D.O., M.P.H., et al. Predictors of Mortality After Hip Fracture. In Bulletin of the NYU Hospital for Joint Diseases. Vol. 66. No. 2. Pp. 111-117]
    4. The Boston Globe: Hip Fractures A Mortal Test For Elders And For Medicine, 2006]
    5. Mortality Risk Associated With Low-Trauma Osteoporotic Fracture and Subsequent Fracture in Men and Women, Dana Bliuc; Nguyen D. Nguyen; Vivienne E. Milch; Tuan V. Nguyen; John A. Eisman; Jacqueline R. Center, JAMA. 2009;301(5):513-521.]
    6. Dizziness and Falls, Oct 24th, 2008 by Dr. A. R. Scopelliti - EzineArticles.com Expert Author]
    7. A Report of the Task Force on the National Strategic Research Plan, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, April 1989, p. 12.
    8. A Report of the Task Force on the National Strategic Research Plan, National Institute on Deafness and other Communication Disorders, National Institutes of Health, Bethesda, Maryland, April 1989, p. 74.
    9. Colledge N, Lewis S, et al. Magnetic resonance brain imaging in people with dizziness: a comparison with non-dizzy people. J Neurol Neurosurg Psychiatry. May 2002; 72(5):587-9.
    10. Vital and Health Statistics, The National Ambulatory Medical Care Survey, 1991 Summary, National Health Survey, Series 13, No. 116, DHHS Publication No. (PHS) 94-1777, May 1994, p. 21. See Table R.
    11. University of Virginia Health System, Vestibular and Balance Center, Feb. 14, 2003.]
    12. Arizona Department of Health Services: Cost of unintentional falls for patients in Arizona study for the 8,985 hospitalizations due to unintentional falls among older adults:]
    13. Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil 2001;82:1050-6.
    14. CDC. Fatalities And Injuries From Falls Among Older Adults--United States, 1993-2003 and 2001-2005. MMWR 2006;55:1222-4. CDC.
    15. Morbidity and Mortality Weekly Report, March 7, 2008 / Vol. 57 / No. 9, Self-Reported Falls and Fall-Related Injuries Among Persons Aged >65 Years -- United States, 2006, JA Stevens, PhD, KA Mack, PhD, LJ Paulozzi, MD, MF Ballesteros, PhD, Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC.]
    16. Vellas BJ, Wayne SJ, Romer LJ, Baumgarner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age Ageing 1997;26:189-93.
    17. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj Prev 2006;12:290-5.
    18. Schiller JS, Kramarow EA, Dey AN. Fall injury episodes among noninstitutionalized older adults: United States, 2001-2003. Adv Data 2007;392:1-16.
    19. Koch H, Smith MC: Office-based ambulatory care for patients 75 years old and over: National Ambulatory Medical Care Survey, 1980 and 1981. NCHS Advance Data No 110, US Department of Health and Human Services, Public Health Service, National Center for Health Statistics. Washington, DC, 1985, p 6.
    20. Sloane PD, Blazer D, George LK. (1989). Dizziness in a community elderly population. J Am Geriatr Soc 37:101-108
    21. Nashner L. (undated). The case for balance centers. Neurocom Int. Literature.
    22. Bebout JM. (1989). The aging of America: Will the healthcare, and hearing professions react in time? Hear Jnl 42(1) January:7-12.
    23. Weindruch R, Kroper S, Hadley E. (1989). The prevalence of dysequilibrium and related disorders in older persons. ENT Jnl 68(12):925-929.
    24. Kroenke K, Lucas CA, Rosenberg ML, Scherokman B, Herbers J, Wehrle PA, Boggi, JO. (1992). Causes of persistent dizziness: A prospective study of 100 patients in ambulatory care. Annals of Internal Medicine 117(11):898-929.
    25. Kroenke K, Arrington ME, Mangelsdorff AD. (1990). The prevalence of symptoms in medical outpatients and the adequacy of therapy. Arch Internal Medicine 150:1685-1689.
    26. Allison L. (undated). Identifying and managing elderly fallers. Neurocom International Inc., Literature 1-8.
    27. Fife TD, Baloh RW. (1993). Disequilibrium of unknown cause in older people. Ann Neurology 34(5):694-702.