Presentation Outline. Meet Gloria, Robert and Alfred So, you live in Wisconsin?! Fall Risk Equation Treatment/Prevention what works and what doesn t!
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2 Presentation Outline Meet Gloria, Robert and Alfred So, you live in Wisconsin?! Fall Risk Equation Treatment/Prevention what works and what doesn t! Their stories. Bottom Line
3 Robert Gloria Alfred
4 Did you know?
5 Did you also know? A fall usually represents the initial event in an adults life that can possibly lead to: Beginning of serious decline New or worsening medical illness Baraff LJ, Della Penna R et al. Practice guideline for the ED management of falls in community dwelling elderly persons. Ann emerg Med. Oct 1997; 30:
6 So, you live in Wisconsin? 3 things you may want to know: 1) Are we falling? 2) Are we aging? 3) Are you at risk?
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8 Fall Related Hospitalizations in WI for those 65+
9 Aging Population in WI
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13 UW Family Medicine Clinics 2014 Screening for Falls Patients Screened 70% - Response Rate Positive for Falls!
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15 Why Do Some People Fall More Than Others? Because of the increase in risk factors contributing to poor.. BALANCE!
16 Our Senses & Balance Vision Proprioceptive: the ability to sense stimuli from our bodies regarding position, movement and equilibrium Inner ear
17 You fell It is time to investigate.
18 Falls Assessment: Questions we ask. Where did you fall? Time of day? What were you doing? How were you feeling? What were you wearing? Carrying anything Shoes, slippers Using walker or cane Recent illness, new medications Heavy meal, hydration, alcohol Any witnesses trauma Seek medical attention; any injuries
19 Falls Assessment Continued Office Exam Orthostatic Vital Signs Visual Acuity, Hearing Evaluation Walking Test (timed 3 meter walk) Physical Exam (including feet!) Mental Status Exam (Cognitive Screen) Labs, Imaging (if needed) Medication Review Spouse or family input
20 Traditional Risk Factors Categories Intrinsic Medical Conditions Lifestyle Choices Cognition Modifiable risk factors YOU CAN change Non-modifiable risk factors YOU CAN T change Extrinsic Internal & External environment
21 Falls The Equation FALL = Intrinsic + Extrinsic Factors
22 Falls As We Age INTRINSIC CAUSES *Physiologic changes of aging *Medical Illnesses *Multiple medications Polypharmacy *Social factors *Mental status function
23 Risk Factors: Age-Related Medical Conditions Glaucoma, Macular Degeneration Hearing Loss Diabetes Peripheral Neuropathy Arthritis Osteoporosis Heart Disease Stroke Incontinence Musculoskeletal stiffness and weakness
24 So, when you combine age related physiological changes and. = FALL RISK!
25 Multiple Medication Madness Source: The Dartmouth Atlas of Medicare Prescription Drug Use, October
26 HIGH RISK Medications Source: The Dartmouth Atlas of Medicare Prescription Drug Use, October
27 Most Common Medications that Contribute to Falls Benzodiazepines (e.g. Lorazepam, Alprazolam, Clonazepam) Non-benzodiazepine hypnotics (Zolpidem = Ambien) Antidepressants Diuretics (water pill) Vasodilators (blood pressure medications) Pain Pills Muscle Relaxers Herbals interfere with medications, common side effects The AGS 2012 Beers Criteria Update Expert Panel JAGS :
28 A common scenario.
29 Low Back Strain NSAIDS Hypertension Calcium Channel Blocker Lower Extremity Edema Diuretic water pill
30 Herbals be careful! Prescription drug: Herbal Interactions Anticoagulants, nonsteroidal anti-inflammatory medications, antiplatelet agents: garlic, ginkgo, St. John s wort, ginseng, saw palmetto, ginger, cranberry Anticonvulsants: ginkgo, St. John's wort, valerian Digoxin: St. John's wort, ginseng, ginger Herbal supplements and common side effects: Echinacea: fatigue, dizziness, headache and gastrointestinal symptoms Garlic: nausea, burning sensation in mouth, throat, halitosis and body odor Ginkgo biloba: nausea, dyspepsia, headache and heart palpitations Ginseng: anorexia, rash, changes in blood pressure and headache St. John's Wort: photosensitivity, dry mouth, dizziness and confusion
31 Medications Start LOW Go SLOW Low dose and titrate slowly Start only one new medication at a time Frequent medication reconciliation review your medications with your doctor! Are there any medications you do not absolutely need? Know why are you taking the medication? Not just the pink or white pill
32 Intrinsic Risk Factors: Lifestyle & Behavior Exercise Alcohol use Nutrition Hydration
33 Fear of Falling: Warning Signs Need to touch or hold onto things or people Walks very slowly Takes small steps Limited movement Expresses a fear of falling Cycle of Fear
34 Social Factors Contributing to Falls 1) Role Strain Bereavement, Depression Caring for ill partner Widowed, Single, Retirement 2) Individual Capacity Coping Ability, Fear of Falling 3) Support Systems Family, Community
35 Falls As We Age EXTRINSIC FACTORS
36 Home Extrinsic Factors Furnishings too low or too high
37 Slick or Irregular Floor Surfaces Poor Floor patterns
38 Loose Carpeting, Rugs
39 Clutter! Avoid it!!
40 Lack of grab bars (bathroom) and handrails (stairs)
41 Poor illumination and/or glare Remember - Use Nightlights!
42 Footwear Better Choice! Not so good
43 Eyeglasses Single, Bifocal, Trifocal, Progressive Lens!
44 FALLS Intervention and Prevention What Works and What Doesn t
45 What works in falls prevention in the Community The more the stronger the evidence Intervention Exercise with BALANCE training Vitamin D (people with low vitamin D blood levels) Occupational therapy interventions Multidisciplinary assessment with individualized/targeted interventions Evidence effectiveness (adapted from Gillespie et al 2012, Waldron et al 2012 & Lord 2011)
46 What works in falls prevention in the Community The more the stronger the evidence Intervention Expedited first cataract surgery Restricted use of multifocal eyeglasses (particularly for mobile, active individuals) Podiatry Intervention (treatment of corns, bunions, nail trimming) Insertion of Pacemaker (when medically indicated) Withdrawal of high risk medications Evidence effectiveness
47 Intervention & Prevention: Lifestyle & Behavioral Risk Factors Mental activity and focus training think/concentrate before and after you stand, step, turn, reach, etc. Exercise!! BALANCE classes Ø Stepping On Ø Tai Chi Ø Yoga
48 Assistive Devices just a few tips
49 Intervention & Prevention: Assistive Devices Reachers Pole (for standing)
50 Canes a few facts 10% of >65 use canes Carry cane opposite to weak leg Size to middle of wrist Look forward, not down Pivot on stronger leg Stairs Good leg goes first UP stairs Bad leg goes first DOWN stairs Wear backpack or shoulder bag
51 Walkers they are not all the same USTEP Walker Movement Disorders
52 Walking Sticks!! (Trekking Poles)
53 Robert Gloria Alfred
54 Falls : The Bottom Line Falls are the result of complex multifactorial interactions between intrinsic and extrinsic factors. A good history and focused physical can tease out many of these conditions. Start Low Go Slow with medications Talk to your doctor if you have had any near falls or falls Balance, Balance, Balance - keep working on it!
55 Resources: Fitness, Balance Classes Wisconsin Institute for Healthy Aging: UW Health Research Park Fitness Classes:
56 Thank you!
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