The Time Is NOW to Prevent Falls

By Jason Kraus, BS

Let’s start with some basic facts:

• Every year, more than 1 out of 4 Americans age 65+ falls
• Falls are the leading cause of fatal and nonfatal injuries among older adults
• The cost of treating injuries caused by falls is projected to increase to over $101 billion by 2030
• Falls result in more than 3 million injuries treated in emergency departments annually, including over 800,000 hospitalizations
• In 2015, the total cost of non-fatal fall injuries was $50 billion
• Each year about $754 million is spent on medical costs related to fatal falls
• For older adults in the U.S., fall death rates went up by 30% from 2007 to 2016, and researchers predict there will be 7 deadly falls every hour by 2030
• People with mild hearing loss are nearly 3x as likely to fall, with each 10 decibels of hearing loss increasing falls risk
• The majority (60%) of falls happen in the home, 30% in a public setting, and 10% in a health care center

These statistics from the National Council on Aging¹ paint a pretty grim picture, but it’s from a 10,000-foot view. Let me bring it closer to home with my personal story.

My Father passed away in 2005. But a couple years before that he fell. Not once, not twice, but probably 6 or 8 times. Some were minor, others led to major problems, broken femur, broken wrist, broken leg. He ended up confined to a wheelchair and his family—my mother, brothers, and sisters and me—were all at wits’ end as to how to take care of him those last 18 months.

Fast forward to 2011 when I was president of OHI (Orthotic Holdings, Inc). I led the company in the acquisition of Arizona AFO. The Moore Balance Brace came as part of that acquisition—it’s a custom-designed balance ankle-foot-orthotic designed to reduce the risk of falls in elderly patients.

I spent the next 9 years with the brace’s designer, Dr. Jonathan Moore, working together to educate practitioners around the globe on how and why the utilization of these types of modalities could really make a difference in people’s lives. But I was left with nagging questions: Could something have been done for my dad? Could he have remained ambulatory that last year-and-a-half of his life? Could his quality of life and the quality of my family’s life been different had I known in 2005 what I learned in 2011? My Dad had been treated by many practitioners—podiatrist, physiologist, primary care doctor, occupational therapist and a whole host of others—and not one time do I recall anyone recommending him for a comprehensive assessment.

I never thought about that until I was reviewing the recent JAMA article: Lower-Limb Factors Associated with Balance and Falls in Older Adults: A systematic review and clinical synthesis.² Not unsurprisingly, Dr. Moore was one of the authors.

The article, which was a review of 81 peer-reviewed published studies, was written by what amounts to a think tank of fall prevention experts and I encourage you to read it for yourself. Basically, the article painted a high correlation between foot and ankle problems and the incidence of falls in older adults. In fact, it identified 8 pathways of lower limb-related influences on fall risk in this population, 6 of which support a direct link to fall risk.

What jumped out at me, and it may seem obvious, but there was no recommendation to check for foot problems in annual checkups. Sure, it’s in today’s diabetes care protocol, but not for everybody else…yet we all age. And it wasn’t always in the diabetes care protocol. I started out in podiatry in the late 1970s and utilization of prevention modalities in the treatment of the at-risk diabetic population was really quite low and the complications, especially amputations began to climb. But then the training in podiatry schools and residencies evolved to include prevention protocols, and ultimately third-party reimbursements caught up to where we are today: patients with diabetes represent between 15% and 20% of revenue in a podiatric practice environment.

And I would argue, with the data that we see, that falls management and treating patients with balance deficits could approach those revenue numbers in the years to come. How can I say that? We’re halfway through a generational change in how healthcare is delivered and paid for in this country. We’re moving from a fee-for-service model to a fee-for-value model that is an outcomes-based payment system. The benefit of this transition is that finally, finally, the ability to prevent serious and life-altering injury is becoming worthy of third-party reimbursement.

And then there is the large and growing patient population that will need falls risk mitigation: Every day, 10,000 people in the United States turn 65—they’ve been doing so for nearly a decade and will continue to do so for at least the next decade. And those who survive to 75 and 80 years of age face an exponential increase in risk from when they were at 65. So you’ve got a very large addressable market that’s literally walking through your clinic doors everyday.

And finally, today’s business environment is witnessing the acquisition of podiatric practices by private equity backed consolidators and healthcare systems. If you bring these ancillary services into your practice now, your valuation at your exit will be more significant.

While falls and preventing them could be complex, the protocol builds on 3 pillars:

• Perform an assessment
• Identify modifiable risk factors
• Implement appropriate interventions and protective devices

If you do those 3 things, you’ll inevitably be able to help your patients in ways I wasn’t able to help my dad or my family all those years ago.

Jason Kraus, BS, has been in the medical device industry for more than 40 years and is co-founder of Orthotica Labs, which was established in 2022.

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This Guest Perspective was excerpted and modified from a longer talk given by Mr. Kraus at the lerEXPO event: Introducing Balance AFOs into Your Clinical Practice, sponsored by Orthotica Labs. The program also included talks by Michael King, DPM, and Jonathan Moore, DPM, both of whom were authors on the article mentioned here as reference 2. The 2-hour program comes with 2 CEUs. Find it at lerEXPO.com/past-events.