Diabetes is a health condition that can cause high levels of glucose in the blood. Diabetes occurs when the pancreas cannot produce enough insulin or the body becomes resistant to it.
Older adults who have diabetes are twice as likely to have a fall that results in an injury.
Risk factors for falls in older adults with diabetes
Peripheral neuropathy
Peripheral neuropathy occurs in around 50-70% of older adults with diabetes and causes changes in the motor components of the foot and ankle. This can result in postural instability, foot complications, altered gait, and muscle atrophy.
Foot complications
Foot pain and ulceration of the feet are common among people with diabetes.
Read more about foot care and safe footwear for falls prevention among older adults.
Impaired postural control
Postural instability is not specific to older adults with diabetes, however older adults with diabetes are at an increased risk of impaired postural control. This is due to diabetes causing a decrease in the functioning of the neuromuscular and sensorimotor systems.
Polypharmacy and insulin use
Older adults with diabetes will often take multiple medications to assist with controlling their diabetes and other related conditions.
In addition to the general challenges associated with medication interactions, there are some medications commonly taken by people with diabetes that can also increase falls risk. These include insulin, benzodiazepines, diuretics, antiarrhythmics, digoxin, and antidepressants.
Read more about medication management for falls prevention among older adults.
Sub-optimal glycaemic control
Hypoglycaemia (low blood sugar), hypoglycaemic unawareness, and severe hyperglycaemia have been identified to increase falls risk among older adults with diabetes.
Vision impairment
More than 30% of adults with diabetes have diabetic retinopathy. Diabetic retinopathy occurs when the blood vessels inside the retina are damaged and can cause blurred or distorted vision, glare sensitivity, and difficulty seeing at night, making it difficult to read, watch television and see people’s faces.
Read more about how you can support older adults with vision impairment.
How can I help older adults with Diabetes?
There are a number of strategies that can be implemented to address the diabetes-related risk factors for falls among older adults. These include:
- Glycaemic control, which is of particular importance to the prevention of peripheral neuropathy.
- Referral and involvement of older adults with diabetes in falls prevention exercise programs. These are effective in improving lower-limb strength, static balance, and gait among older adults with diabetes.
- The provision of education around foot care to older adults with diabetes.
Screening and health checks for older adults with diabetes
While supporting older adults with diabetes to reduce the risk of falls, there are several screening and health checks that should be completed.
- The Global Guideline for Managing Older People with Type 2 Diabetes recommends that a GP conducts a falls risk screening assessment at the older adults first visit, then annually or after the older adult has had a fall.
- As part of routine consultations, GPs should conduct falls risk screening and assessment and examine the older adult’s balance and mobility.
- Primary care practitioners should provide individualised falls prevention strategies as part of a diabetes care plan.
- All adults with diabetes should be screened and risk-stratified for potential foot complications. The frequency and intensity of this monitoring is dependent on the individual level of risk of the older adult.
- Medication reviews should be conducted at least once per year.
- Older adults with diabetes should receive a visual acuity assessment.
Who can I collaboratively work with to support older adults with Diabetes?
A multidisciplinary team for older adults with diabetes may consist of a GP, Diabetes Educator, Dietitian, Pharmacist, and Podiatrist.
More information
For more information, resources, and support about diabetes, visit the Diabetes WA website.
