Falls in the Geriatric PopulationRISK REDUCTION / FALL PREVENTION

PRESENTED BY: JOANNE PAULINO

What is a Fall?A fall is defined as any event that leads to an unplanned, unexpected contact with a

supporting surface.

Statistically speaking:

More than 1/3 of people age 65 or older fall each year. #1 cause of fractures, hospital admissions for trauma, loss of

independence, and injury deaths among older adults. Every 11 seconds, an older adult is treated in the emergency room for

a fall; every 19 minutes, an older adult dies from a fall.

Statistically speaking: Falls result in more than 2.8 million injuries treated in emergency

departments annually, including over 800,000 hospitalizations and more than 27,000 deaths.

In 2013, the total cost of fall injuries was $34 billion. The financial toll for older adult falls is expected to increase as the

population ages and may reach $67.7 billion by 2020.

Risk Factors Muscle weakness, esp. lower extremity

Poor: Strength Flexibility Endurance

Poor balance & gait Lack of exercise Neurological cause Arthritis Other medical conditions / ailments

Risk Factors

Orthostatic (postural) hypotension Dehydration Some medications Diabetes Neurological (e.g. Parkinson’s) An infection (e.g. UTI)

***Some people with orthostatic hypotension don’t feel dizzy when they stand up.

Risk Factors Slower Reflexes with age

Foot problems / Unsafe footwear

Sensory problems (e.g. Numbness in feet)

Risk Factors Poor Eyesight

Wearing multi-focal glasses while walking Poor depth perception Cataracts / Glaucoma Not taking time for eyes to adjust to light changes

Poor lighting

Risk Factors

ConfusionEven for a short while Can wake up in an unfamiliar environment

Risk Factors Medications

Cause side effects like dizziness or confusion.

The more medications the higher risk of a fall.

Risk FactorsCertain medical conditions: (e.g.)

Neurological diseases

Arthritis

CVA

Diabetes

Risk Factors

Environmental Crowded rooms Clutter in room or doorway Electrical cords Raised thresholds Slippery floors Carpets Poor lighting Stairs

Patient related Weakness Poor balance Impaired gait Vertigo Orthostatic hypotension (other cardiac condition) Poor vision Incontinence Depression Impaired cognition Older than 80 y.o. Taking more than four medications

The Inpatient Senior (More statistics)

50% of falls caused by need to use the bathroom.

2½ to 15% of patients admitted to hospitals fall during their hospitalizations.

Fifteen to thirty percent of falls result in injury.

4to 6% of falls result in serious injury. As many as 85% of patients were not

assisted with a device or person at the time of a fall.

HOW DO WE REDUCE RISKS OF FALLS?UNREALISTIC

Decrease patient to nurse ratio

Restrain patients

HOW DO WE REDUCE RISKS OF FALLS?REALISTIC Therapy

PT / OT / SLP Exercise

Education Communication Better medication management Eliminate environmental hazards

Provide safety equipment

Community Fall Prevention Evidence-based Programs

A Matter of Balance - 8-week structured group intervention to reduce fear of falling and increase activity levels.

FallsTalk - Screening and falls history documentation using custom workbooks and reports. FallScape - Provides state-of-the-art falls prevention interventions with the addition of multimedia training. The Otago Exercise Program - A series of 17 strength and balance exercises delivered by a Physical

Therapist in the home that reduces falls between 35 and 40% for frail older adults. Stay Active and Independent for Life (SAIL) - A strength, balance and fitness program for adults 65 and

older. The SAIL program is able to accommodate people with a mild level of mobility difficulty (e.g. people who are occasional cane users).

Stepping On - Aims to break the cycle of inactivity that leads to social isolation and loss of muscle strength and balance, increasing the risk of falling.

Tai Chi for Arthritis - Tai Chi for Arthritis helps people with arthritis to improve all muscular strength, flexibility, balance, stamina, and more.

Tai Ji Quan: Moving for Better Balance - A falls prevention program delivered in two one-hour sessions each week for 24 weeks. Each session consists of warm-up exercises; core practices, which include a mix of practice of forms, variations of forms, and mini-therapeutic movements; and brief cool-down exercises.

Physical/Occupational TherapyExercise

Concentrate on strengthening LEs, especially the ankle, and the trunk/core muscles affecting motor control.

Reduce joint pain/instability. Correct postural. Use sufficient intensity to improve muscle strength. Include dynamic balance training activities

Physical/Occupational TherapyBalance

Begin with controlling the center of gravity (COG) over the base of support (BOS).

Progress by challenging the control of balance and postural stability by engaging visual, vestibular, somatosensory and cognitive systems.

Create postural reaction and ankle, hip and step movement by changing stimuli, surfaces, secondary tasks to mimic functional activities, resistance, direction and velocity of movement.

Physical TherapyGait Training

Appropriate and accurately adjusted assistive devices Challenge and advance with changes in surfaces/terrain, elevations, time/rhythm,

distance, physical load, attention, postural transition (start, stop, direction), and amount of support.

Occupational Therapy Environmental Interventions

Take into account the person–environment fit. Tripping hazards

Reduce clutter and allow turning space.

Understand clients’ fall experiences and beliefs about causes of falls. Understand the meaning of home, activities and roles, and sense of control. Consider risk-taking behaviors and encourage protective adaptations.

e. g. Grab bars

Assess and practice safe mobility strategies.

SLP Therapy Writing Sequencing Goals for Assistive Devices

Errorless learning - provide cues to minimize errors instead of relying on trial and error learning.

Spaced retrieval therapy - Helps improve memory impairment by having pt learn specific information by slowly increasing the time before having the person recall.

Vanishing cues - promote independence by reducing cues.

Conclusion Interdisciplinary Open communication Educate patients, family Awareness, assessment, training, Continued research

Bibliography Cumbler, E. U., Simpson, J. R., Rosenthal, L. D., & Likosky, D. J. (2013). Inpatient

Falls: Defining the Problem and Identifying Possible Solutions. Part I: An Evidence-Based Review. The Neurohospitalist, 3(3), 135–143. http://doi.org/10.1177/1941874412470665

Davis, J. C., Bryan, S., Best, J. R., Li, L. C., Chun Liang, H., Gomez, C., & ... Liu-Ambrose, T. (2015). Mobility predicts change in older adults' health-related quality of life: evidence from a Vancouver falls prevention prospective cohort study. Health & Quality Of Life Outcomes, 13(1), 1-10. doi:10.1186/s12955-015-0299-0

http://www.apta.org/EvidenceResearch/EBPTools/ http://www.healthinaging.org/aging-and-health-a-to-z/topic:falls/info:causes-and-symp

toms/

http://nihseniorhealth.gov/falls/aboutfalls/01.html Kuczynski, C., & Piersol, C. V. (2014). Effectiveness and Acceptability within a

Skilled Nursing Facility Setting. Physical & Occupational Therapy In Geriatrics, 32(2), 152-168. doi:10.3109/02703181.2014.914618

Bibliography Lam, J., Liamputtong, P., & Hill, K. (2015). Falls, Falls Prevention and the Role of Physiotherapy and

Exercise: Perceptions and Interpretations of Italian-Born and Australian-Born Older Persons Living in Australia. Journal Of Cross-Cultural Gerontology, 30(2), 233-249. doi:10.1007/s10823-015-9263-z

Lin, S., Chang, K., Lee, H., Yang, Y., & Tsauo, J. (2015). Problems and fall risk determinants of quality of life in older adults with increased risk of falling. Geriatrics & Gerontology International, 15(5), 579-587. doi:10.1111/ggi.12320

Mat, S., Tan, M. P., Kamaruzzaman, S. B., & Ng, C. T. (2015). Physical therapies for improving balance and reducing falls risk in osteoarthritis of the knee: a systematic review. Age & Ageing, 44(1), 16-24.

Rolenz, E., & Reneker, J. C. (2016). Validity of the 8-Foot Up and Go, Timed Up and Go, and Activities-Specific Balance Confidence scale in older adults with and without cognitive impairment. Journal Of Rehabilitation Research & Development, 53(4), 511-518. doi:10.1682/JRRD.2015.03.0042

Salot, P., Patel, P., & Bhatt, T. (2016). Reactive Balance in Individuals With Chronic Stroke: Biomechanical Factors Related to Perturbation-Induced Backward Falling. Physical Therapy, 96(3), 338-347. doi:10.2522/ptj.20150197

Vlaeyen, E., Coussement, J., Leysens, G., Van der Elst, E., Delbaere, K., Cambier, D., & ... Milisen, K. (2015). Characteristics and Effectiveness of Fall Prevention Programs in Nursing Homes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal Of The American Geriatrics Society, 63(2), 211-221. doi:10.1111/jgs.13254