Haley GladfelterUniversity of Findlay

DPT May 2012gladfelterh@findlay.edu

Cindy Nagel MA, BSN, RNBCTrauma Program Manager

St. Rita’s Medical Centercdnagel@health-partners.org

What is considered a fall Staggering statics about falling in older

adults Dangers of falling What to do if you fall How to prevent and protect yourself from

falling Balance exercises

A fall, as defined by The Technical Assistance Program (TAP) of the Ohio Department of Health includes:◦ An intercepted fall is still a fall.

An episode where and individual lose his or her balance but catches themselves before they fall.

◦ A fall without an injury is still a fall. If you fall but do not acquire an injury it is still

considered to be a fall. ◦ A fall to the ground where the individual is found

on the ground and or acquired an injury.

The Ohio Department of Health (ODH) and The Ohio Prevention Partnership reports:◦ Falls in older adults 65 and older have reached

epidemic proportions◦ Falls and fall-related injury seriously affect older

adults’ quality of life and present a substantial burden to the Ohio health-care system.

◦ They surpass all other mechanisms of injury as a cause of ER visits, hospitalization and death and are higher than rates for all other injuries combined.

Fall-related ER visit and hospitalization rates increased 61% and 51% respectively from 2002 to 2009.

In 2009, there were 4 fall-related ER visits for every 100 Ohio older adults and 10 fall-related hospitalizations for every 1,000 Ohio older adults

From 2000 to 2009, Ohioans aged 65 and older experienced a 125% increase in the number of fatal falls and 112% increase in the fall death rate.

On average, 2.3 older Ohioans suffered fatal falls each day in 2009.  

Ohioans 65 and older accounted for approximately 82% of fatal falls in 2009; while they represent only 14% of the population.

Risk for suffering serious injury after a fall increases dramatically with advancing age. Females 85 years and older account for half of fatal falls, while they account for only 3% of the female population

http://www.odh.ohio.gov/sitecore/content/HealthyOhio/default/vipp/~/link.aspx?_id=6A91950F498E4D048648B21DA985BEE7&_z=z

Falls among older adults cost Ohio and its residents $4.2 billion in 2003, more than two-thirds (68 percent), of the total annual costs of nonfatal, hospital-admitted falls. Direct medical costs represent only a fraction (8%) of the total cost.

Medical $ 327,366,900

Work-Loss $ 116,513,800

Quality-of-Life $ 3,728,623,600

Total Costs $ 4.2 billion

Costs Associated with Falls Among Older Adults, Ages 65+, Ohio, 2003

In older adults◦ Falls are the leading cause of injury- related

deaths◦ The most common cause of nonfatal injuries and

hospital admissions for trauma◦ The most common fractures are

Spine Hip, pelvis, and leg Forearm, upper arm, hand Ankle

The psychological consequences of any fall, whether injury-causing or not, can be severe, resulting in◦ Fear ◦ Decreased quality of life from self‐imposed

restriction of activities, ◦ Social isolation and depressive symptoms. ◦ These “near-miss” falls can put someone at risk

for future falls as well if they are not adequately assessed and managed by a health care professional.

Biological changes secondary to age◦ Decreased balance and coordination◦ Slowed reaction time◦ Overall decline in strength and conditioning◦ Sensation issues

Peripheral Neuropathy Decreased skin sensation

FALLS ARE NOT A NORMAL PART OF AGING!◦ Simple steps discussed later can significantly

decrease your risk of falling

If an upper extremity injury◦ Use elbow to push up to side sitting position◦ Then use good arm to push to kneeling position◦ Last use legs to help move to standing position

Stationary object can be used to help stand

If a lower extremity injury ◦ If lateral fall on side of hip

Try to roll onto your back Sit up to your bottom Then scoot backwards across the floor using good

leg Keep affected leg still if possible

◦ If you fall on your bottom Try to scoot along the floor on the opposite side of

the hip◦ Do not try to stand◦ Always have a phone at that can be reached at

floor level such as an end table.

http://www.familyhandyman.com/DIY-Projects/Home-Safety/http://www.mitrecontracting.com/railings/

Hand rails◦ Into and out of home◦ Going up and down

steps between levels in the home

◦ Hand rails on both sides is best, yet one side will still increase your safety significantly

Do not leave clutter on the floor◦ News papers and

magazines can increase risk of falls

http://www.boomer-livingplus.com/article/an_ounce_of_prevention

Remove all throw rugs◦ Throw rugs are a HUGE

cause of falls in older adults◦ The rug can slip under your

feet or a toe can get caught◦ One small ruffle in the rug

can cause you to lose your balance and fall

Furniture arrangement◦ Critical during nighttime

hours When arising from bed you

could be slightly dizzy and disoriented

Arrange furniture to ensure that there is always a clear pathway to enter and exit a room.

http://info.aia.org/aiarchitect/thisweek08/0801/0801p_lighting.cfm

Increase lighting in the home◦ Dull lighting can affect

how your view your surroundings leading to falls

◦ Can be a simple as increasing the bulb watt

Be mindful of small dogs and cats◦ Small dogs and cats can

end up under your feet causing you to lose your balance

http://acmedical.com/blog/?Tag=Adaptive%20home%20remodeling

http://www.seabridgewalkinbathau.com/avalon-walkin-shower.html

Bathroom Features◦ Grab bars

Should be installed in the shower and beside the toilet

◦ “Walk in showers” with a seat Removes the risk of falling

while stepping into a tub shower

The seat allows for you to shower without the risk of slipping and falling

◦ Elevated toilet seat Decreases the risk of falling

while getting up and down from the toilet

1. Increase Physical Activity◦ 15 minutes of daily activities can increase muscle

strength, and balance. Walking Biking Swimming Tia Chi

2. Yearly Eye Examinations ◦ Age related disease can increase risk of falling

Cataracts Macular degeneration Diabetic retinopathy

◦ Early detection is the key!!

3. Review Your Medications◦ Ask your doctor if the medicine your are taking can

cause dizziness or drowsiness.◦ Discuss if your are taking your medicine safely

Decrease risk of mixing medicine or taking too much medication.

4. Remove Environmental Hazards ◦ Increase lighting ◦ Remove all throw rugs◦ Watch for slippery floor

Linoleum Wood floors Tile

◦ Eliminate unsteady furniture

5. Think, Plan, Slow Down◦ Many falls are caused by rushing

Slow down and think though task you are performing before completing the task

Be mindful of all safety concerns/fall risks and plan your tasks accordingly

6. Always Have Emergency Phone◦ It is very important that you always have a cell phone or

life alert device for emergency situations◦ Always have a phone that can be reached from the floor

level (end table) ◦ BE PREPARED!

4 way hip Calf raises (going up on toes) Single leg standing

◦ All the above should be done by standing at a stationary table or counter top for support.

Side-walking Mini squats against a wall Toe taps at household objects

Fall risks are a serious danger for older adults. The following precaution may significantly decrease you risk of falling. ◦ Remove environmental hazards and add

additional safety features to your home.◦ Have annual eye examinations and asking your

doctors about your medications.◦ Think, plan, and slow down before implementing

and completing a task.◦ Always be prepared by having an emergency

phone ready.◦ Stay active with at least 15 minutes of exercise

daily

http://www.nsc.org/nsc_events/Nat_Safe_Month/Documents/2012_Falls_Preventionpublic.pdf

http://www.odh.ohio.gov/sitecore/content/HealthyOhio/default/vipp/~/link.aspx?_id=6A91950F498E4D048648B21DA985BEE7&_z=z

St. Rita’s Medical Center◦ Trauma Services and Injury Prevention

Program Cindy Nagel MA, BSN, RNBC 419-226-9150 cdnagel@health-partners.org

University of Findlay◦ DPT Class of 2013

Haley Gladfelter 419-204-7342 gladfelterh@findlay.edu

Ohio Injury Prevention Partnership. Falls Among Older Adults. Revised April 19, 2012. Available at:http://www.odh.ohio.gov/sitecore/content/HealthyOhio/default/vipp/~/link.aspx?_id=6A91950F498E4D048648B21DA985BEE7&_z=z.Accessed May 16, 2012.

National Safety Council. Preventing Slips, Trips and Falls. Revised 2012. Available at:http://www.nsc.org/nsc_events/Nat_Safe_Month/Documents/2012_Falls_Preventionpublic.pdf. Accessed May 16, 2012.