Presentation on theme: "Geriatric Sensory Processing and Fall Prevention"— Presentation transcript:
1Geriatric Sensory Processing and Fall Prevention The link between Fall Risk and Sensory DeclineAna Hernando, OTR, MOT, MBAPlease note: material maybe presented that is not printed in this manual. Feel free to use the note pages at the end of the manual
2Geriatric Sensory Processing and Fall Prevention IntroductionFall Statistics What’s up with the numbers?Autonomic Nervous System What’s automatic about falling?Sensory Processing Getting your 3 senses worthFactors to FallingCNS -Illness and DiseasePharmacology What’s in the fine printEnvironmental and Mindset External and Internal PerceptionsKinesiology- Gift of muscle memory and exercise
3Fall Prevention/ Fall Risk Reduction Fall AssessmentsABCSCurrent TrendsValidity and ReliabilitySelection ProcessFall Prevention/ Fall Risk ReductionTherapy ImplicationsTreatment PlansDischarge PlanningMultidisciplinary CommunicationMedical TeamFamily and CaregiversDocumentation
4Introduction CMS Definition of Fall- “Fall” refers to unintentionally coming to rest on the ground, floor, or other lower level, but not as a result of an overwhelming external force (e.g., resident pushes another resident). An episode where a resident lost his/her balance and would have fallen, if not for staff intervention, is considered a fall. A fall without injury is still a fall. Unless there is evidence suggesting otherwise, when a resident is found on the floor, a fall is considered to have occurred. CMS Manual Department of Health and Human Services Centers for Medicare and Medicaid Services August 17, 2007
5Introduction CMS guidelines for fall intervention Educate staff Repair equipmentDevelop and revise policies and proceduresResident directed approachMay include implementing specific interventions as part of the POC .
6Statistics 1:3 age 65+ fall each year Leading cause of injury death Most common cause of hospital admission for trauma for 65+Death related to falls is increasing30% of falls result in significant injuryLeading cause of fractures in elderlyFear of falling increases fall riskMen >women in fall related deathsWomen>men falls resulting in injury90% of hip fractures resulted from a fall
7Autonomic Nervous System Conveys sensory input and impulsesProvides information to the subconscious mindParasympathetic Nervous SystemConserves energy, slows down heart rateSympathetic Nervous SystemBurns energy, fight or flight response to dangerGoldberg, 2007
8Autonomic Nervous System Dysautonomia-FaintingUnexplained loss of consciousnessOrthostatic hypotension ( blood pressure reduction during standing, POTS)Postprandial hypotension (blood pressure reduction after a meal)
10Sensory Processing: Left and Right Hemispheres Uses Logic and ReasonThinks in WordsDeals in parts and specificsWill analyzeTake things apartSequential thinkingTime boundExtrovertedOrdered and controlledIndividualalityUses intuition and emotionsThinks in picturesDeals in wholes and relationshipsWill synthesizePut things togetherHolistic thinkingTime freeIntrovertedSpontaneous and freeGroup mentality
11Sensory Processing SPACE TIME We need to have these three systems, working together, simultaneously.And that’s why we present simultaneous sensory input of light, sound and motion.
12Visual & Vestibular Motor Planning & Coordination Body awareness, proprioceptive inputWalking, sitting, transfers, balance
14Visual & Auditory Abstract Thought, Reasoning, & Coping Skills It’s the ability to think in pictures and in words.Abstract Thought, Reasoning, & Coping SkillsProblem solvingHumor
15Sensory Processing SPACE TIME We need to have these three systems, working together, simultaneously.And that’s why we present simultaneous sensory input of light, sound and motion.
16Learning CNS Function Modulation Thresholds Habituation Sensitization Genetic EndowmentPersonal Life Experiences
17Quick Review of Cranial Nerves CN1 SmellsCN2 SeesCN3, 4, and 6 Moves eyes, constricts pupils, accomodatesCN5 Chews and feels front of headCN7 Moves the face, tastes, salivates and criesCN8 Hears and regulates balanceCN9 Tastes, salivates, swallows, monitors carotid body and sinusCN10 Talks, communication to and from thoraco-abdominal visceraCN11 Turns head, lifts shouldersCN12 Moves tongue
18Factors to Falling CNS -Illness and Disease Vertigo-Central vs. peripheralTinnitus CN8Parkinson’s reduced muscle strength (force) and power (force x velocity)Shingles is latent in cranial nerve ganglia, dorsal root ganglia and autonomic ganglia along the entire neuraxis.Neuropathies
19Factors to FallingPharmacology :US geriatrics population : 40% take 5-9 medications and 18 % take 10+BenzodiazepinesAntipsychotic agentsNon-benzodiazepine sedative-hypnoticsAntidepressants and anticonvulsantsAnti-arrhythmicsDiureticsBeta-blockers, vasodilators, neuroleptics
20Side effects of XanaxChanges in appetite; constipation; decreased sexual desire or ability; diarrhea; dizziness; drowsiness; dry mouth; light-headedness; nausea; tiredness; weight changes.Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); behavior changes; blurred vision; burning, numbness, or tingling; chest pain; confusion; dark urine; decreased coordination; decreased urination; fainting; fast or irregular heartbeat; hallucinations; loss of balance or muscle control; memory or attention problems; menstrual changes; muscle twitching; new or worsening mental or mood changes (eg, depression, irritability, anxiety; exaggerated feeling of wellbeing); overstimulation; red, swollen blistered, or peeling skin; severe or persistent dizziness, drowsiness, or light-headedness; shortness of breath or trouble breathing; suicidal thoughts or actions; tremor; trouble speaking; yellowing of the eyes or skin.
21Side Effects of Coumadin pain, swelling, hot or cold feeling, skin changes, or discoloration anywhere on your body;sudden and severe leg or foot pain, foot ulcer, purple toes or fingers;sudden headache, dizziness, or weakness;unusual bleeding (nose, mouth, vagina, or rectum), bleeding from wounds or needle injections, any bleeding that will not stop;easy bruising, purple or red pinpoint spots under your skin;blood in your urine, black or bloody stools, coughing up blood or vomit that looks like coffee grounds;pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating;dark urine, jaundice (yellowing of the skin or eyes);pain in your stomach, back, or sides;urinating less than usual or not at all;numbness or muscle weakness; orany illness with diarrhea, fever, chills, body aches, or flu symptoms.
23Factors to FallingEnvironmental and MindsetMOBILIZE 2010 study;765 participantsmedian age 7846.7% fell outside- 23% sidewalks, 14% curbs/streets, 13% outside stairs, 6% parking lots.KinesiologyMuscle weaknessLimited ROM and poor biomechanicsReaction time
24Continuous cycle Fall Injury Fear Immobility Depression Illness Muscle weakness
25Fall ABCS A- Age >85 years old B- Bone issues C-Coagulation S-Surgery
26Fall Assessments and Screens Current TrendsMorse Fall ScaleHendrich II Fall Risk ModelTimed Up and Go (TUG)Berg BalanceTinetti Balance Scale6 Minute Walk TestSurvey Of Activities and Fear of Falling in the Elderly (SAFE)Adult Sensory ProfileValidity and Reliability-Case studies and participants vary by setting.Selection Process- How do you choose?
27Morse Fall ScaleVariables Score History of Falling No (0) Yes (25) Secondary Diagnosis No (0) Yes (15) Ambulatory Aid Bed Rest/ Nurse assist (0) Cruches/cane /walker (15) Furniture (30) IV or IV Access No (0) Yes (20) Gait Normal/bedrest/immobile (0) Weak (10) Impaired (20) Mental Status Knows own limits (0) Overestimates or forgets limits (15)
28Morse Fall Scale Risk Level MFS Score Action No Risk Good basic nursing careLow to Mod risk Standard Fall preventionHigh risk High fall preventions
29Hendrich II Fall Risk Model To be completed by Nurse
40Fall Risk Reduction Discharge Planning Should be address at beginning of therapyForward thinking and problem solvingWHAT HAPPENS NEXT?Structured, scheduled regular exercise/activity
41DocumentationS: Pt is 75 yo referred to OT/PT home health after recent fall at dtr’s home in the living room resulting in decreased mobility, increased pain with standing, and decreased independence with bathing.PLOF: Pt lives with dtr in one story home and approximately 4 inch threshold step for entry. Pt has a pet lap dog that is very friendly and runs around the house. Dtr works approximately 10 hrs a day out of the home. Pt has walker but it was her husband’s, whom is now deceased. Prior to her fall pt was independent with ADLs and CGA for walking. Pt was not driving but does go to Sunday services and to the grocery store with her dtr. She usually goes to the beauty shop every 2 weeks. She is a member of the Rotary Club but reports she is not very active.PMH: HTN, CHF, UTI, GAD, Depression
42DocumentationO: ADL’s LB Bathing: Mod A UB Bathing: Min A LB Dressing: Mod A UB Dressing: S Grooming: S Toileting: Mod A Transfers: Min A with RW Balance Sitting s/d fair+/fair, Standing s/d fair/fair-. Pain 5/10 with movement Fear of Falling 7/10 in bathroom. BUE Strength grossly 3/5A: Pt is pleasant lady whom states her desire is to get back to what she was doing but states she is afraid to fall again. She demonstrates decreases in her balance for both sitting and standing. Her self reported pain and fear levels are strong indicators for risk of repeat falling. Her history of depression, fall history and fear of falling indicate she is a fall risk. Pt would benefit from skilled OT to increase her participation level for ADLs, increase her overall mobility, decrease her c/o pain and fear to return her to PLOF.
43Documentation P: Pt will participate in OT 2 times a week for 4 weeks. LTG: Pt to perform bathing using AE as needed with less than 2/10 self report of fear of falling.LTG: Pt to increase dynamic standing to good to perform self care tasks with decreased c/o pain to 1/10 to facilitate mobility.LTG: Pt to complete morning ADL routine with Mod I to reduce burden of care.LTG: Pt to complete toilet hygiene with 90% accuracy to increase health and reduce risks of UTI.LTG: Pt will demonstrate understanding of fall recovery plan.STG: Pt to complete 1 set 10 reps of BUE exercises without s/s of fatigue.STG: Pt to perform 30 min of dynamic sitting balance tasks with <5/10 fear of falling.STG: Pt to increase toileting to min A.STG: Pt will verbalize sequencing steps for fall recovery plan with 75% accuracy.STG: Family will verbalized understanding of fall recovery plan with 100% accuracy.STG: pt and family to demonstrate understanding of fall risk reduction recommendations.
44Multidisciplinary Communication Medical Team-What do the therapists need to know?What do the nurses need to know?What do the CNA’s need to know?What do the doctor’s need to know?How do we share information?
52ReferencesCumming, R.G., Le Couteur, DG. (2003). Benzodiazepines and risk of hip fractures in older people: a review of the evidence. CNS Drugs. 17(11), Freiberger, E., Haberle, L., Spirduso, W.W., Rixt Zijlstra, G.A. (2012). Long-term effects of three multicomponenet exercise interventions on physical performance and fall-related psychological outcomes in community-dwelling older adults. J Am Geriatr Soc. 60(3), Goldberg,S (2007). Clinical neuroantaomy made ridiculously simple.Miami: MedMaster Inc. Hanney, W.J., Kolber, M.J., Beekhulzen, K.S. (2009). Implications for physical activity in the population with low back pain. Am J Lifestle Med. 3(1), Hendrich, A. L., Bender, P.S., Nyhuis, A. (2003). Validations of the Hendrich II Fall Risk Model: A large concurrent case/control study of hospitalized patients. Applied Nursing Research. 16(1), Inouye, S.K., Brown, C.J, Tinetti, M.E. (2009). Medicare nonpayment, hospital falls, and unintended consequences. New England Journal of Medicine. 360, Kelsey, J.L., Berry, S.D., Proctor-Gray, E., Quach, L., Nguyen, U.S.D.T., Li, W., Kiel, D.P., Lipsitz, L.,A., Hannan, M.T., (2010). Indoor and outdoor falls in older adults are different: the maintenance of balance, independent living, intellect, and zest in elderly of Boston study. J Am Geriatric Soc. 58(11), Kim, E.A., Mordiffi, S.Z., Bee, W.H., Devi, K., Evans, D. (2007). Evaluation of three fall-risk assessment tools in an acute care setting. Journal of Advanced Nursing. 60(4), Kim, J.S., Lee, H. (2009). Inner ear dysfunction due to vertebrobasilar ischemic stroke. Semin Neurol. 29(5), Muir, S.W., Montero-Odasso, M. (2011). Effect of vitamin D supplementation on muscle strength, gait, and balance in older adults. J Am Geriatri Soc. 59(12), Painter, J.A., Allison, L., Dhingra, P., Duaghtery, J., Cogdill, K., Trujillo, L.,G., (2012). Fear of falling and its relationship with anxiety, depression, and activity engagement among, community-dwelling older adults. The American Journal of Occupational Therapy. 66(2), Ruddock, B. (2004). Medications and falls in the elderly. CPJ/RPC. 137(6), Wong, J. Philip, J., Hilas, O. (2012). Management of dizziness and vertigo. US Pharmacist.