Posts Tagged ‘Hip fractures’

Part 2: Cataracts as a risk factor for hip fractures

Sunday, December 16th, 2012

This is not the kind of cataract I'm writing about

I recently found an article in JAMA, the Journal of the American Medical Association, that struck home. I've had both eyes surgically redone, i.e., had cataract surgery on first my left eye, then my right. The first hint was the inability to correct my vision to 20/20. Then I started noting oncoming lights had halos. I got mildly uncomfortable driving at night, but had no major difficulty until some time after my first laser operation. Then I started to note that street signs were hard to read.

Our ophthalmologist at the time reassured me that having a cataract was common and that the surgery would be very helpful.

It certainly was, although my right eye required a brief in-office touch-up after a few months.

Now it's my wife's turn. She's always had incredible vision; even after needing bifocal and then trifocal glasses her far vision corrected to better than 20/20. She had her left eye's cataract done about two years ago and was very happy with the result.

Then about three months ago she started having problems with driving at night. It's time for the right eye to have its turn. I took over the night driving chores and we had no difficulty on our 30-day, 4,000 mile drive to the far northwest and then across British Columbia and most of Alberta. She'll see our new ophthalmologist in a few days.

This is an ocular cataract.

There's lots of background information on the National Eye Institute's (part of the NIH) website (updated from when I first wrote this post) https://nei.nih.gov/health/cataract and a similar website for the UK sent me by a British reader:  http://www.lasereyesurgeryhub.co.uk/cataracts/    I'll go through the basics: First a cataract is a change in the lens, the clear part in the front of your eye that you use to focus an image or light on the retina in the back much like you focus a camera. It can develop in one eye or both; roughly 50% of us will have to deal with at least one cataract if we live long enough, as the majority of cataracts occur as part of aging. You may have small cataracts when you are in your 40s and 50s without noticing significant visual loss.

The University of Maryland has a website with cataract risk factors; besides age as the primary risk factor, you may be more prone to developing a cataract if you are diabetic (either type 1 and 2), have excessive sun exposure, are African American, smoke (a pack a day doubles your risk), drink heavily, have a disease treated chronically with corticosteroids (AKA steroids), suffer a physical injury to an eye or even if you are nearsighted. Researchers think a diet rich in antioxidants (e.g., green,leafy vegetables) may help prevent cataracts.

If you have a cataract, your vision will not be as sharp and you may notice things seen change color to a brownish shade

Surgery is the most common treatment for significant cataracts and is regarded as a safe and effective procedure with 90%  of patients experiencing improved vision post operatively according to the National Eye Institute.

So what is this leading up to? The JAMA article dated August 1, 2012, is titled "Risk of Fractures Following Cataract Surgery in Medicare Beneficiaries. I was initially puzzled by this, but as I read the article, the actual title, in my opinion, should have been "Reduced Risk of Hip Fractures ..." Clear vision helps prevent falls and in a 5% random sample of Medicare beneficiaries (that meant 1,110,640), 410,809 had cataract surgery. When compared to those who did not, patients undergoing such an operation had a 16% decreased incidence of hip fracture in the following year.

I'm pleased with the results of my own cataract removal surgery. Are you about to have such a procedure?

 

Hip fractures and falls and cataracts, oh my! Part 1

Tuesday, December 11th, 2012

One of the most dreaded complications of older age is a broken hip.Patients suffering this injury have a 20% chance of dying in the following year and, among survivors, 25% remain in a nursing home for a year or more.

fractured right hip

The Cleveland Clinic website has a two-page article on hip fractures and osteoporosis that mentions a surprising fact: 60% of falls occur in our homes and only 10% in nursing homes or other institutions. If you are 65 or older you have a one third chance of having a fall in any given year. I'm 71 and only a few months younger than my wife so I was quite interested in finding out what we can do to prevent falls and diminish the risk of breaking a hip.

To start with we can single out older women, and particularly Caucasian women as being in the group most likely to have a fall and complications if they do fall. Three fourths of all hip fractures occur in women.That certainly does not leave out us guys or other ethnic groups, but, overall, we're talking about $20 billion being spent each year on the treatment of injuries from and complications of falls. If you start with osteoporosis, as many of elderly women and especially Caucasian do, you are more at risk for a hip fracture if and when you do have a fall.

The CDC article on "Hip Fractures Among Older Adults," says that hip fracture rates in older adults (men over 85 and women over 75) went down significantly between 1990 and 2006 for unknown reasons. Although there were well over a quarter million hospital admission for hip fractures in 2007, there hadn't been the steady increase in that number as had been predicted in 1990.

Why is that? Perhaps it's due to some of the lifestyle and diet changes that some of us have made.

any kind of weight-bearing exercise works, including walking

I started with the CDC's recommendations: exercise regularly (we do so, but don't get enough weight-bearing exercise so we'll start walking more), ask your pharmacist and your personal physician to review your medication list (I had to decrease the dose of my blood pressure pill after losing 30 pounds {deliberately} four years ago), see your eye doctor yearly (we do) and make home safety improvements.

They also mention dietary and supplement changes to ensure you get enough calcium and vitamin D plus getting screened for osteoporosis and treated if necessary. We're on top of that one also.

But safety hazards around the home was well worth reviewing. There's been a tangle of garden hoses on our garage floor for the last few months. I just went into that area, picked up one potential fall-inducer, drained it outside and stored it in our backyard shed. I can think of two more areas that have caused one or the other of us to stumble. We kept the big dog bed in our bedroom for nearly three months after our dog died; that's now in the basement. And there's a pile of give-away "stuff" in the garage; it could be re-evaluated and moved on to a new home or at least moved to allow us to leave the car more safely.

AARP in an online article "New Strategies for Preventing Falls," also mentions tai chi as one modality of balance exercise that may help. We took a introductory class, purchased two posters and two books for home use; it's time to start using them.

I'll talk about cataracts in my next post.