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New Footwear Reduces Falls In The Elderly Population
A new gait-stabilizing device called the Yaktrax Walker has shown to reduce the risk of injurious falls during winter months in older adults who are fall-prone, reports a study in the Journal of the American Geriatrics Society.
Yaktrax Walker is a plastic netting sized to conform to the bottom of a boot or shoe. Participants in the study were asked to wear the device outdoors over their normal winter footwear and kept a diary of any falls.
A total of 43 outdoor falls were reported by participants in the study group who wore their usual winter footwear, compared with just 19 falls in the group using the Yaktrax device. There were 10 minimally injurious falls in the usual winter footwear group but only 1 minimally injurious fall in the Yaktrax group.
According to the study, falling is the leading cause of accidental death - the sixth leading cause of all deaths in older people. The average estimated cost for fall-related hospitalizations is almost $20,000. The Yaktrax Walker costs around $20 a pair.
Complete article below.
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July 14, 2005 — The Yaktrax Walker ([YW]; YakTrax, Port Orchard, Washington), a simple gait-stabilizing device, may reduce outdoor falls during winter in the elderly, according to the results of a prospective, randomized study published in the June issue of the Journal of the American Geriatrics Society.
"Falls may occur more frequently in the winter in northern latitudes because of more hazardous environmental conditions and suboptimal vitamin D status," writes Fergus Eoin McKiernan, MD, from the Marshfield Clinic in Wisconsin. "Improving gait stability in these conditions should result in fewer falls and injuries."
In this study, 109 northern U.S. community-dwelling, fall-prone persons age 65 years and older were randomized to wear either YW or their usual winter footwear outdoors during the winter of 2003–2004. Mean age was 74.2 years.
Study participants completed fall diaries, documenting 93 indoor slips, 13 indoor falls, 714 outdoor slips, and 62 outdoor falls during 10,724 diary days. Although risk of indoor slips or falls was comparable in both groups, the relative risk (RR) of outdoor slips for YW was 0.50 (P < .04) for all diary days and 0.61 for days when participants walked only on snow and ice. For YW, the RR of outdoor fall was 0.42 (P < .03) for days when walking was only on snow and ice, and the RR of injurious falls per day walked on snow and ice was 0.13 (P < .02).
Of 19 outdoor falls, 12 occurred when subjects assigned to wear the YW were not doing so. No serious injury or fracture occurred in either group. The number needed to treat for the YW to prevent one nonserious injurious fall in one winter was six. Given that the cost of one pair of YW is less than $20, the author suggests potentially large cost savings for those who wear the YW.
Study limitations include likely underestimation of the reported magnitude of outdoor fall reduction with YW and possible lack of generalizability to elderly patients who were more or less fall-prone than those in this study.
"YW may reduce the risk of outdoor winter falls, and of nonserious injurious falls, in older community-dwelling people with a history of previous falls," the author writes. "Targeting the most appropriate fall-reduction intervention to the right population should yield the best rate of therapeutic return. Under appropriate environmental conditions, YW appears to be an inexpensive means of preventing falls and nonserious injurious falls in fall-prone, ambulatory, community-dwelling older people during the winter."
The Marshfield Clinic Research Foundation Physician Research Fund funded this study. Yaktrax provided the YW devices free of charge and provided Marshfield Clinic Research Foundation with $20 per study subject in compensation for study participation. The study subjects received their blinded compensation after study completion.
J Am Ger Soc. 2005;53:943-947
Clinical Context
According to the author of the current study, falls are not only the leading cause of accidental death but also the sixth leading cause of all deaths among adults age 65 years and older in the United States. Falls lead to significant morbidity, including soft tissue injury, skeletal fractures, and hip fractures. It is reported that falls precede 90% of hip fractures and 25% to 40% of vertebral compression fractures. Falls and fall-related injuries contribute to rising health care costs because they necessitate medical treatment, often including hospitalization. More importantly, falls, specifically fractures, lead to significant disability and loss of independence among the elderly.
Many factors increase the risk of falls, including common medical conditions and medications and environmental conditions. One particular focus of research regarding the elderly has been development of interventions to reduce falls in hazardous winter conditions. The current study sought to determine whether the YW, a nonmedical gait-stabilizing device, prevents outdoor falls and injurious falls in fall-prone, ambulatory elderly persons during winter.
Study Highlights
- 109 study participants (mean age, 74.2 years) were enrolled in this prospective, randomized, interventional trial during the winter of 2003–2004 in Wisconsin. They were randomized to wear either the YW under appropriate environmental conditions or their usual winter footwear outdoors.
- The YW consists of a molded thermal plastic elastomer netting sized to conform to the external length and width of a boot or shoe, to provide multidirectional gait stability under outdoor winter conditions.
- Participants maintained a fall diary, recording all indoor and outdoor slips and falls throughout the study, the surface on which the fall occurred, footwear worn at the time of the slip or fall, and any fall-related injuries. 95% of diaries and satisfaction surveys were completed and returned.
- Indoor slip and fall rates served as controls in comparing groups' tendency to fall. Rates for both groups were comparable.
- There were 93 indoor slips, 13 indoor falls, 714 outdoor slips, and 62 outdoor falls. Age, sex, and footwear assignment did not influence indoor slip and fall rates.
- The RR for outdoor slip with the YW was 0.50 (P < .04) for all diary days and 0.61 (P = .14) for only days walked on snow and ice; for outdoor fall with the YW for only days walked on snow and ice, 0.42 (P < .03); and for injurious falls with the YW per day walked on snow and ice, 0.13 (P < .02).
- 12 of 18 outdoor falls occurred when participants randomized to wear the YW were not wearing it. No serious injury or fracture occurred in either group.
- The number needed to treat for the YW to prevent 1 nonserious injurious fall in 1 winter was 6.
- Overall, this study demonstrated that a gait-stabilizing device such as the YW can prevent outdoor falls and nonserious injurious falls in fall-prone, ambulatory elderly persons when applied correctly and worn under appropriate environmental conditions.
Pearls for Practice
- Falls are the sixth leading cause of all deaths among persons age 65 years and older in the United States. Falls cause significant morbidity, including soft tissue injury, skeletal fractures, and hip fractures, and result in financial burdens, significant disability, and loss of independence.
- The YW stabilizes gait, which can prevent outdoor falls and nonserious injurious falls in fall-prone, ambulatory elderly persons in winter, resulting in fewer fall-related injuries and fatalities.