1 Working together to prevent falls Developed by: Goulburn Valley Health Service Format: PowerPoint presentation Availability: Download presentation <PDF version > <PowerPoint version> This detailed PowerPoint presentation (56 slides) covers a range of falls prevention aspects: the magnitude of the problem, consequences, costs, who is at risk, specific risk factors and strategies to address each risk factor, what to do if you do fall and information on falls and balance clinics. It has been included in its complete format. However, given the amount of information it is advisable that this information be presented over a number of sessions, or condensed to meet specific target group needs. Note: also see booklet for seniors < ‘Stepping into falls prevention’ > (Downloadable) ------ In 2009 the Department of Health funded Northern Health, in conjunction with National Ageing Research Institute, to review falls prevention resources for the Department of Health’s website. The materials used as the basis of this generic resource were developed by Goulburn Valley Health under a Service Agreement with the Department of Human Services, now the Department of Health. Other resources to maintain health and wellbeing of older people are available from www.health.vic.gov.au/agedcare Falls and older people Stepping into falls management
Transcript
1
Working together to prevent falls
Developed by: Goulburn Valley Health ServiceFormat: PowerPoint presentation Availability: Download presentation <PDF version > <PowerPoint version>
This detailed PowerPoint presentation (56 slides) covers a range of falls prevention aspects: the magnitude of the problem, consequences, costs, who is at risk, specific risk factors and strategies to address each risk factor, what to do if you do fall and information on falls and balance clinics. It has been included in its complete format. However, given the amount of information it is advisable that this information be presented over a number of sessions, or condensed to meet specific target group needs.
Note: also see booklet for seniors < ‘Stepping into falls prevention’ > (Downloadable)
------
In 2009 the Department of Health funded Northern Health, in conjunction with National Ageing Research Institute, to review falls prevention resources for the Department of Health’s website. The materials used as the basis of this generic resource were developed by Goulburn Valley Health under a Service Agreement with the Department of Human Services, now the Department of Health. Other resources to maintain health and wellbeing of older people are available from www.health.vic.gov.au/agedcare
Falls and older peopleStepping into falls management
Kellogg, 1987 An unintentional event that results in a person
coming to rest on the ground, or another lower level, not as a result of a major intrinsic event such as stroke or epilepsy) or an overwhelming hazard (such as being pushed).
The extent of the problem
An estimated one in three people aged
65+ suffer a fall at least once a year,
about half of those suffer multiple falls
For people aged 75+, and those in
residential care the figure increases to
one in two people
The extent of the problem
Falls are the leading cause of unintentional injury and death among people aged 65 years and over
Health care costs for Australia for falls related injuries in 2001 was estimated to be $498 million dollars
Of those admitted to hospital following a fall about 50% will die within 12 months
Consequences of falls
Physical injury
Emotional trauma
Psychological problems
Social consequences
Financial impact
Consequences of falls
70% of falls result in an injury
One third of people who fall require
medical treatment
Major injury such as dislocation or
fracture occurs in 13% of falls
Consequences of falls
Approximately 1-2% result in
a fractured femur or hip
Of those who suffer fractured femurs
50% will not fully recover, and 30%
will die within 12 months
People at risk of falls
Advanced age Female Those living alone Those with one or more diseases People with acute illness People on multiple medications (4 or
more) People with walking (gait) problems
People at risk of falls
People suffering increased postural sway
People with decreased mobility
Cognitively impaired people
Previous history of falls
Home bound
Decreased vision
When do falls occur?
Statistics show that most falls occur in
the daytime when people are more
active, around 11am and between 4pm
and 6pm
Where do people fall?
49% of falls take place in and around
the home
17% of falls take place in the urban
environment
14.8% occur in residential care
environments
Areas where falls occur at home
WC Laundry
Living
Living
Kitchen Meals
PantryDining
Bathroom
BedroomEntry
Garage
50%
9% 7%
4%
25%5%
Source:
Victorian Injury Surveillance System
Causes of fallsAn internal cause, such as a disease or condition that affects the person individually, eg vision impairment, or muscle disease
An external cause such as an unsafe environment
Risk taking behaviour such as climbing an unsafe ladder
Falls usually have more than one cause
Causes of falls Chronic disease Acute illness 4 or more medications Poor balance and gait Impaired vision Lack of physical activity Hazards in the home and community Foot disorders Unsafe footwear
Falls & chronic illness
Regular medical checkups, and
referral to specialist services to:
Prevent worsening of the condition
Restore lost ability
Keep as well and active as possible
What can you do?
What you need to know about your chronic illness
How your condition will affect you What treatments are available What assistance can be provided to you The signs and symptoms of a flare-up What to do if you suffer a flare-up What can be done to reduce the risk of
your condition/s causing a fall
Acute illnesses
Examples:
Chest infections
Urinary Tract infections
Diarrhoea
Surgical procedures
Acute illness in the community
Seek medical treatment
Community services
Ask family, friends and neighbours to help out
Ensure adequate diet and fluids
Aids
Continence & bladder problems
Incontinence (loss of bladder or bowel control)
Frequency (Needing to pass urine often)
Urgency (Needing to go in a hurry)
Nocturia (Needing to go to the toilet more than
twice per night)
Urinary Tract infections
Urinary Tract InfectionsSymptoms
Mental confusion
Frequency
Urgency
Foul smelling urine
Incontinence
Burning or scalding when passing urine
Incontinence, frequency & urgency
These conditions may require referral to: Doctor Continence Clinic (for advice,
continence aids, and exercises to help bladder control)
Physiotherapist (for exercises to help bladder control)
Urologist (for a specialist opinion)
Postural hypotension
A drop in blood pressure after standing up
Causes: Dehydration Cardiac disease Drug side affects Prolonged bed rest Dysfunction in the nervous system Certain chronic & acute illness
How to get up safely
Sit on the edge of the bed or chair with feet on the floor for a few minutes before getting up
Stand up slowly using both arms to push up for support
Make sure you have good balance and do not move off if you feel lightheaded or dizzy
Use support when bending down and stand back up slowly
Reducing falls from postural hypotension
Regular medication reviews Inform doctor of any side affects from
medications (prescribed or other) Ensure adequate fluid intake Treatment and control of associated
diseases
DizzinessDizziness needs to be properly investigated by a doctor or specialist
Strategies for preventing falls due to impaired vision
Annual check ups with optometrist Specialist referral for eye problems Ensure the environment is safe Occupational therapy home assessment Vision Australia referral Colour contrasting Adequate lighting Glare reduction
Color contrasting
Color contrasting
Seeing well
Keep your glasses in reach Remember to wear your glasses Turn your light on at night before you get
up so that you can see where you are going
Bifocals are not recommended
Hearing problems Medical examination
Audiology referral
Hearing aids (Wear them!!!)
Specialist referral
Raise awareness of the problem
amongst carers/family and friends
Medications
80-90% of people over 65 use medications
Some medication can cause or contribute to falls
Older people can have altered sensitivity to medications
Side effects from drugs are greater when multiple medications are used
Medication risks
Multiple medications (4 or more)
Medication side affects
Use of medications associated with an
increased risk for falls (eg sleeping tablets)
Difficulty taking medications/incorrect use
Lack of information or instructions
Falls management & medications
Regular review of medications Keep a medication list Use of Webster packs or dosettes Use the same doctor if possible Assistance with medications e.g. District Nurse Obtain information on side effects Inform doctor of any side effects suffered Inform doctor about herbal medications being taken Discuss any medication changes with your
doctor
Balance and gait disorders
Medical assessment
Physiotherapy
Prescribed walking aids
Ensure safe environment
Occupational therapy home assessment
Exercise
Walking aids
If you have a walking aid, remember to use it (Correctly!!!!!)
Only used prescribed walking aids Make sure you know how to use your
walking aid Have your walking aid within reach at all
times
Lack of physical exercise
Reduced activity leads to: Reduced muscle tone and bone density Loss of strength Poor balance and coordination Reduce mobility Increased frailty Reduced quality of life
Staying activeexercise & training
Strength and Balance training Hydrotherapy/water exercise Exercise programs Tai Chi Walking for 30 minutes most days of the week Dancing Ask you doctor or physiotherapist for an
exercise program that is suitable for you
Reducing falls from foot disorders
Purchase of properly fitting shoes Referral to podiatrist for treatment of foot
disorders Referral to podiatrist for advice on
purchasing of shoes Referral to a specialist for treatment of foot
disorders
Reducing falls from unsafe shoes
Purchase safe footwear: Flat sole Broad rounded heel Flexible sole Good grip Lace ups if possible or velcro fasteners Shoes that are enclosed at the front and back Avoid scuffs, thongs, high heels, and sling backs Don’t wear socks without shoes
Shoe sole to ground contact
Shoes with greater ground contact help to reduce the risk of falls
Flat Shoe Court Shoe
Nutrition and falls
Optimal nutrition is important to reduce the risk of falling and to enhance recoveryif a fall occurs. The incidence of falls has been linked to: Vitamin deficiencies Protein-calorie deficiencies
Nutrition and falls
Effects from under-nutrition include: Reduced muscle mass Weight loss Iron deficiency (aenemia) Balance and gait abnormalities Vision disorders Hypotension Decrease in folic acid can lead to confusion
Eating and drinking
It is important to have enough diet and fluids,
especially in hot weather
Make sure that you eat and drink enough
according to your doctor’s or dietitian’s advice
If you are having problems with chewing,
swallowing, or with your appetite, tell your
doctor or dietitian
Strategies to reduce nutrition related falls
Referral to dietician
Medical review
Assistance with shopping
Assistance with meals eg Meals on Wheels
Vitamin D and calcium
Vitamin D and calcium deficiencies are common in nursing home, hostel and house bound older people
Vitamin D and calcium are essential for healthy bones
Vitamin D and calcium A diet with 1200-1500mg of calcium per day
is recommended 20 minutes of direct sun exposure 4-6 times
per week to the face and hands is required to absorb adequate vitamin D (Vitamin D cannot be absorbed through a window). Avoid peak heat times (10.00am-3.00pm)
Supplements are advised for people not receiving adequate amounts
Fear of falling
50% of people who fall will suffer fear of
further falls
Fear of falling causes people
to restrict their activities
Strategies for fear of falling
Seek help from doctor, social worker or
physiotherapist
Treatment of fear for falling
Assessment of medical condition
Identification of fears
Counseling and education
Physiotherapy
Behaviour modification and treatment of fears and phobias
Hazards in the home Rugs & mats Slippery & damaged floors Electrical cords Poor lighting Unsafe bathrooms Steps and stairs Hazardous gardens and paths Furniture Ladders
Hazards in the home
Home Safety Checklist to identify areas
that need to be addressed
Occupational therapy home assessment to
identify and advise on changes needed to
optimise home safety
Home maintenance assistance
Risk taking behaviour
Store things you need at a good
height to reduce the need to use
step ladders or chairs to reach
things
Avoid risky activities
Hazards in the community
Footpaths Gutters and kerbing Stairs and steps Floors and flooring material Slips involving fruit and vegetables on floors Concrete and other man made surfaces Elevators and lifts Supermarkets and shopping centres Alcohol
Hazards in the community Use footpaths Avoid rough or uneven surfaces Report hazards in the community Allow enough time to cross intersections Use pedestrian crossings if possible Wear a hat and sunglasses to reduce glare Be alert, watch for hazards Ask the bus driver to wait until passengers are seated
before taking off
Hip protectors
Hip protectors can be used to protect people
who have weak bones, and people who have
many falls
Hip protectors are plastic shields that slip into
pockets in specially made underwear
If you want more information about hip
protectors ask your nurse or physiotherapist
What to do if you fall
Stay calm
Decide if you will try to get up
If you can’t get up try to keep warm
Make a loud noise to get help
Always tell someone if you have had a
fall even if you don’t hurt yourself
Falls and Balance Clinics
Falls and Balance Clinics are specialist clinics
which provide assessment for falls.
A typical team would include:
Nurse
Physiotherapist
Occupational therapist
Geriatrician or Rehabilitation specialist
Acknowledgement
In 2009 the Department of Health funded Northern Health, in conjunction with National Ageing Research Institute, to review falls prevention resources for the Department of Health’s website. The materials used as the basis of this generic resource were developed by Goulburn Valley Health under a Service Agreement with the Department of Human Services, now the Department of Health. Other resources to maintain health and wellbeing of older people are available fromwww.health.vic.gov.au/agedcare
