Mitigating Falls and Risk In an Older Population

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1 Mitigating Falls and Risk In an Older Population Lisa Kournetas PT, DPT Objectives Recognize risk factors for falls in older adults Identify home safety suggestions necessary for fall prevention List measures for fall prevention for implementation in your facility 1

2 Facts and Statistics One third of all people over 65 will fall 1 Falls are the leading cause of accidental death in 65+ in the United States 2 Those who fall once are 2-3 times more likely to have recurrence 4 One third of older adults who fall, sustain a hip fracture and die within a year 1 60% of all nursing home residents will fall Implications of Falling Decline in Activities of Daily Living Decrease in social activity Decline in physical activity Physically inactive people lose muscle mass and strength more quickly than active people 2

3 Implications of Falling Cont d Decrease in quality of life Depression Fear Those who are afraid of falling usually fall Managing Fear Fear of nursing home placement Fear of not being able to get up after a fall Fear of falling leads to inactivity Fear leads to decreased self confidence 3

4 Implications of Falling Cont d Nursing home placement 50% of those who have a fall with injury need nursing home placement 50% of those are still in a NH 1 year later Implications of Falling Cont d Injury 20-30% of reported falls contain injuries which primarily include lacerations, fractures, and head injuries Falling is the most common cause of TBI 4

5 Implications of Falling Cont d Longer hospital stays Almost 2x longer than a medical condition admission Increased medical costs 3 In 2010, direct medical costs of falls was $30 billion Hip fractures cost $12 billion/year. 90% of these fractures are due to falls Total Lifetime Medical Costs of Fatal Fall Related Injuries (2005) 6 Males $160 million (7300 deaths) Females $189 million (8500 deaths) 5

6 Implications of Falling Cont d Decreased life expectancy 3 A hip fracture decreases life expectancy by 10-15% Death 3 25% of older adults who sustain injury from a fall die within 6 months Causes of Falls Causes of falls are multifactorial. There are both individual and environmental factors. Falls can be reduced by 30-40% by identifying risks and referring for interventions 6

7 Risk Factors-Internal Vision Depth Perception Blurred vision Double vision Hemianopsia Macular degeneration Cataracts Light sensitivity Visual acuity Risk Factors-Internal Hearing Delay in awareness of potentially hazardous situation Cues for changes in the environment Sensory Deficit Tingling Numbness Neuropathy Vitamin B deficiency 7

8 Risk Factors-Internal Vestibular BPPV VOR Vertigo Cognition Decreased safety judgment Poor problem solving skills Risk Factors-Internal Acute Illness Infection Fever Cold or sinusitis Dizziness COPD Hyperventilation Hypoxia 8

9 Risk Factors-Internal Diabetes Neuropathy Blood sugar Vision Blood Pressure Postural hypotension Hypertension Risk Factors-Internal Heart Rate Arrhythmia Bradycardia Tachycardia Muscle Tone and Body Composition Spasms Hypotonicity Loss of body muscle and fat to cushion bones 9

10 Risk Factors-Internal Proprioception Deficits in body awareness Gait and balance deficits Coordination Risk Factors-Internal Medications Side effects Dizziness BP changes Heart rate changes Drowsiness 10

11 Risk Factors-Internal Clothes Baggy Too long Shoes Worn Slippery soles Causing pain High heels Risk Factors-Internal Feet Pain Decreased sensation Wounds Muscle Weakness No ankle strategy Poor ROM 11

12 Risk Factors-Internal Incontinence Slip on urine/stool Up frequently at night Urgency Reflexes Aging slows a person s reaction time and makes it harder to regain one s balance following a weight shift or sudden movement Osteoporosis Osteoporosis Osteoporosis is a disease in which bones become fragile and porous, and more likely to fracture. The bone loses density. 12

13 Osteoporosis Cont d Statistics: Osteoporosis is responsible for 1.5 million fractures per year 7 300,000 hip fractures 700,000 vertebral fractures 250,000 wrist fractures 300,000 other fractures Osteoporosis Cont d 12 million Americans have osteoporosis 68% of these are women Every 1 out of 2 women and 1 out of 4 men over 50 will have an osteoporosis-related fracture in their lifetime 7 13

14 Risk Factors-Environmental Environmental factors play a role in half of all falls 2 Assistive Devices Not appropriate type Correct size Risk Factors-Environmental Home Assessment Clutter Floors Furniture Lighting Stairs Bathroom Kitchen 14

15 Prevention Education MAKE SURE TO INCLUDE FAMILIES IN EDUCATION SESSIONS!!! Educate residents, caregivers, and families of all of the risk factors for falls Recognizing risk factors and monitoring them is the #1 way to prevent falls Partner with trained healthcare professionals to help implement the fall prevention program in you facility Therapists, nurses, doctors, pharmacists, maintenance Environmental Education Outdoor Safety Tips 8 Use a walker or cane in bad weather Wear warm boots with rubber soles for added traction Floor surfaces in public places Use a shoulder bag or backpack to leave hands free Check curb height before stepping down Watch inclines in sidewalks or curbs Stay off of gravel or grass whenever possible 15

16 Environmental Education Indoor Safety Tips Remove all clutter Avoid walking in socks, slippers, or barefoot Keep cords and wires out of walkways Make sure stairwells are well lit and have handrails Install grab bars in the shower and near the toilet Use a rubber mat in the shower Keep a flashlight at bedside Use bright light bulbs Environmental Education Indoor Safety Tips Cont d Install a light switch near entry points to all rooms Do not use step stools! Carry a portable phone Arrange to have someone contact you daily Monitoring company (Lifeline) 16

17 Prevention A proactive program of assessments and appropriate intervention can prevent falls in older adults Perform quarterly or bi-annually for AL/IL residents TUG, functional reach, sit-to-stand test, 30 second chair stand Vision screens Be aware that falls can occur after getting a new glasses prescription until the person adjusts to it Hearing screens Prevention Medications Eliminate medications with no indications Decreases dosages when appropriate Eliminate meds where the side effects out-way the benefit Reduce sedatives, medications with BP or HR effects, psychoactive drugs 17

18 Prevention Exercise Keep your residents moving! Group or individual classes Focus on strength, ROM, and balance HEP Tai Chi Water Aerobics Prevention Tai Chi Li, et al. showed a 55% reduction in fall risk 5 Randomized controlled trial Coordinated movement of arms and legs Postural alignment Weight shifting 18

19 Tai Chi Tai Chi 19

20 Prevention Exercise Barnett, et al: Stay Safe, Stay Active Weekly group moderate intensity exercise program with a HEP 40% less falls Found people were a third less likely to suffer an injury if a fall occurred Prevention Physical and Occupational Therapists Assistive device training and assessment Home safety evaluation Balance and coordination Vestibular rehab Incontinence programs Exercises for strength and ROM Electrical stimulation for neuromuscular re-education Standardized balance tests TUG, BERG, STS, Tinetti, DGI 20

21 Prevention Fall Training Train residents how to get up after a fall The force and direction of a fall can impact whether or not there will be a resulting fracture Distance of femur from the floor Direction of the fall Putting hands out to decrease the force of a fall Type of surface you fall on can affect fractures Trochanteric hip pads Alarms, etc. At home: Baby monitors Chair alarms Motion detectors Door alarms for elopement risk 21

22 Alarms, etc. Silent vs. audible Wheelchair Pad alarm Tab alarm Anti-tippers Anti-rollback Voice recordable alarms Lap buddy Drop seat Cushion Pommel, wedge, anti-thrust, Dicem Seatbelts Velcro, buckle, alarming Alarms, etc. Motion detectors Bed Pad alarm Floor mats Alarmed or non-alarmed Bolster/winged mattresses 22

23 Alarms, etc. Bed Pad alarm Floor mats Alarmed or non-alarmed Bolster/winged mattress Roll belt Low bed Restraints Physical or chemical Not a restraint if the patient demonstrates they can self release Lap buddy, seat belt, roll belt, lap tray Must try several other interventions first Must have a doctor s order which specifies use of restraint and reason for use Use a schedule 23

24 Nursing Homes Pharmacy review Alarms All falls should be reviewed by a falls committee Refer resident to therapy when appropriate Do not leave wheelchair in bathroom or near bed Fall Trends Toileting schedule Activities Prior employment Naps Give tray last at meals 24

25 Presenter Lisa Kournetas PT, DPT References 1. Retrieved Sept 2, Retrieved Sept 2, Fuller, G.F. Falls in the Elderly. Am Fam Physician. 2000Apr1;61(7): Retrieved Sept 2, Li, F, et al. Tai Chi and Fall Reductions in Older Adults: A Randomized controlled trail. Journal of Gerontology Feb;60A(2): Retrieved Sept 2, Retrieved Sept 25, Retrieved Sept 25,

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