Program Director: Lewis A. Lipsitz, M.D.
Faculty: Farzaneh Sorond, M.D., Ph.D.
Program Importance and Goals
- Falls are a leading cause of disability and death in older adults, occurring annually in one-third of community-dwelling seniors and in 50 percent of people living in nursing homes.
- Falls result in nearly 300,000 hip fractures annually. Fall-related injuries result in estimated costs of $12.5 billion to $17.5 billion per year for medical care, extended treatment facilities, and the value of lost productivity.
- Syncope (fainting) is one important cause of falls. Characterized by a sudden loss of consciousness due to inadequate blood flow to the brain, syncope is especially common among frail seniors living in nursing homes.
- The principal goal of the Institute for Aging Research SAFE Program is to promote rigorous, cutting-edge research into the causes and treatment of falls and syncope in older adults.
- Although recent research studies have identified several risk factors for falls and new interventions to reduce this risk, there are very few research programs in the United States probing the actual cardiovascular or postural control mechanisms of falls and syncope in senior patients.
The Institute's researchers discovered that postprandial hypotension causes syncope and falls. This condition is associated with low blood pressure after meals, which results in inadequate blood flow to the brain, and ultimately causes small strokes that impair walking, balance and memory.
The Institute's researchers are now studying risk factors and mechanisms of low blood flow to the brain and ways to increase blood flow in order to prevent these small strokes. They have found that certain medications to treat high blood pressure (ACE inhibitors), activation of a certain gene (HIF-1), and cocoa can increase brain blood flow in seniors.
The Institute's researchers recently received a five-year grant from the National Institute on Aging to study low brain blood flow and other causes of falls in 800 seniors over age 70 who are living within a five-mile radius of Hebrew Rehabilitation Center.
The Institute's researchers are currently recruiting over 200 senior African Americans in Boston, and are studying whether cardiovascular risk factors are associated with walking problems and falls. African Americans are particularly at risk for small strokes, most likely because of their high rate of hypertension, diabetes and other risk factors for cardiovascular disease. As the next step in their research, they plan to obtain MRI brain scans of these people to identify the areas of the brain that are affected by cardiovascular risk factors.
Previous investigators at the Institute for Aging Research were the first to show that muscle weakness is reversible in people up to 100 years of age through weight-lifting exercises. Exercises that increase muscle strength can prevent falls and improve mobility.
The Institute's researchers are studying ways to improve balance in older adults who are at risk for falls by stimulating the soles of the feet with very low levels of vibration. They have found that imperceptible levels of vibration can reduce postural sway and improve balance in seniors with diabetes, strokes or sensory problems. They hope to design and build portable insoles that can be worn inside shoes, which can test this exciting technology for its long-term effect in preventing falls.
The study of falls and syncope over the past 20 years has resulted in the establishment of several exercise programs for residents and community dwelling seniors who live within Hebrew SeniorLife's continuum of care.
The Institute's research into cardiovascular causes of falls has resulted in changes in medical practice such as avoiding hypotensive medications before meals and encouraging exercise after meals. The HSL Falls Committee has also resulted from the Institute's research.
The SAFE Research Program is unlike any other in the U.S. because it uniquely studies cardiovascular, cerebrovascular and postural control mechanisms of falls in the laboratory, while other programs are still exploring clinical, functional and environmental risk factors for falls, using epidemiologic approaches. Most other programs exclude falls due to syncope. There are few centers in the world that are rigorously studying cerebral blood flow in elderly people and testing pharmacologic approaches to improving cerebral blood flow.