2. Understanding An Aging Population Keirsten D. Montgomery University of Pittsburgh: School of Nursing Spring 2003

3. Objectives Demographics –Understanding target population Statistical Data –Understanding scope of the problem Risk Factors –Falls Prevention –Related literature and data

4. The Aging Population Dramatic increases in aging population from 1996 to projected 2025 –Age 60 – 64 1996: 70 million 2025: 100 + million –Age 80+ 1996: 30 million 2025: 80 million US Department of Commerce: Economics and Statistics Administration Global Aging into the 21 st Century – 2000

5. The Graphic Triangle US Department of Commerce: Economics and Statistics Administration Age: 2000 – 2000 Brief

6. The Oldest Old The oldest old has the fastest growing population trends –85+: 38% between 1996 and 2000 US Department of Commerce: Economics and Statistics Administration The 65 years and over population – 2000 Brief

7. Geographical Proportions of 65+ population by state –Florida (18%) –Pennsylvania (16%) –West Virginia (15%) –Iowa (15%) –North Dakota (15%) –Rhode Island (15%) US Department of Commerce: Economics and Statistics Administration Age: 2000 – 2000 Brief

8. The State Breakdown US Department of Commerce: Economics and Statistics Administration Age: 2000 – 2000 Brief

9. Medical Perspectives Epidemiological Transition 196619811991 PneumoniaCancer TuberculosisHypertensionCV Accidents CV accidents Senile disease Infectious Dis.AccidentsPulmonary US Department of Commerce: Economics and Statistics Administration Global Aging into the 21 st Century – 2000

10. Disability Statistics 1 in 5 Individuals will suffer from some kind of disability Data shows that half of senior 65 + have a disability US Department of Commerce: Economics and Statistics Administration Disabilities Affect One-Fifth of all Americans – 2000 Census Brief

11. Fall Risk In The Elderly WISQARS injury report forms – http://www.cdc.gov/ncipc/default.htm

12. Fall Risk Assessment OccurrenceMedical Expenses 1 in 3 65+ / year6% of all Medical Exp. MortalityMorbidity 10,000/year 340,000 broken hips/year Associated Press (2003) Researchers study why elderly fall, ways to minimize damage. The Winston Salem Journal

13. Fall Risk Assessment Rubenstein; Powers & MacLean. (2001). Quality indicators for the management and prevention of falls and mobility problems in vulnerable elders. Annals of Internal Medicine

14. Risk Factors Physical –Age –Cognitive impairments –Visual impairments –Muscle weakness –Gait and balance disturbances –Fall History 1)Jensen; Lundin-Olsson; Nyberg & Gustafson. (2002). Fall and injury prevention in older people living in residential care facilities: A cluster randomized trial. Annals of Internal Medicine 2)American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. (2001). Guideline for the prevention of falls in older persons. The Journal of the American Geriatrics Society 3)Rubenstein; Powers & MacLean. (2001). Quality indicators for the management and prevention of falls and mobility problems in vulnerable elders. Annals of Internal Medicine

15. Risk Factors Medical –Polypharmacy –Orthostatic Hypotension –Stroke or Myocardial infarction –Parkinson’s disease –Arthritis –Osteoporosis –Psychiatric conditions –Urinary incontinence 1)Jensen; Lundin-Olsson; Nyberg & Gustafson. (2002). Fall and injury prevention in older people living in residential care facilities: A cluster randomized trial. Annals of Internal Medicine 2)American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopedic Surgeons Panel on Falls Prevention. (2001). Guideline for the prevention of falls in older persons. The Journal of the American Geriatrics Society 3)Rubenstein; Powers & MacLean. (2001). Quality indicators for the management and prevention of falls and mobility problems in vulnerable elders. Annals of Internal Medicine

16. Risk Factors Environmental –Poor lighting –Loose rugs –Beds/toilets without handrails –Surface preparation –Physical/perceived obstacles 1)Jensen; Lundin-Olsson; Nyberg & Gustafson. (2002). Fall and injury prevention in older people living in residential care facilities: A cluster randomized trial. Annals of Internal Medicine 2)American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. (2001). Guideline for the prevention of falls in older persons. The Journal of the American Geriatrics Society 3)Rubenstein; Powers & MacLean. (2001). Quality indicators for the management and prevention of falls and mobility problems in vulnerable elders. Annals of Internal Medicine

17. Results of Falls Hospitalization Premature Nursing Home Placement Increased dependency –Assisted living –Self Imposed Feelings of Inadequacy Rubenstein; Powers & MacLean. (2001). Quality indicators for the management and prevention of falls and mobility problems in vulnerable elders. Annals of Internal Medicine

18. Fall Prevention Strategies Staff Education Evaluation Exercise Environmental Modifications Assistive Devices Supply or Repair Assistive Devices Change in Medication Regimen Rubenstein; Powers & MacLean. (2001). Quality indicators for the management and prevention of falls and mobility problems in vulnerable elders. Annals of Internal Medicine

19. Choosing An Ambulation Aid Sloan; Haslam; and Foret. (2001). Teaching the use of walker and canes. Home Healthcare Nurse

20. Aging Population’s Rejection of Walkers and Assistive Devices Emphasize qualities which they consider demeaning to the person –Aging, diminishing competence, dependence Believe falls are inevitable No perception of need (Denial) PRIDE Lack feeling’s of safety while using assistive devices COST Aminzadeh & Edwards. (1998) Exploring senior’s view’s of the use of assistive devices in fall prevention. Public Health Nursing

21. Actual Responses: Healthcare Workers and Seniors Aminzadeh & Edwards. (1998) Exploring senior’s view’s of the use of assistive devices in fall prevention. Public Health Nursing

22. General Characteristics of a Walker Use –Weak, elderly individuals who present with mild balance problems Purpose –Widens the base of support –Transfers weight bearing to upper extremities –Allows extra-sensory and proprioceptive feedback Types –Standard or two/four wheeled walkers Sloan; Haslam; and Foret. (2001). Teaching the use of walker and canes. Home Healthcare Nurse

23. General Characteristics of a Walker Advantages –Increased stability, support –Elderly do not imply “age” stigma Misuses –Improper Height –Improper Use –Improper sit – to – stand transfers –Improper Use on Stairs Sloan; Haslam; and Foret. (2001). Teaching the use of walker and canes. Home Healthcare Nurse

24. Data on Injuries Related to Walker Data found relates to malfunctioning apparatus on walker –Example: A PT FELL DUE TO A WALKER LEG BREAKING DURING USE. THIS INCIDENT ALLEGEDLY RESULTED IN A BROKEN HIP AND CRACKED RIB Data does exist to support suggestion that walkers can be the obstacle –Example: AN 81-YR-OLD, 150 LB, FEMALE PT TURNED SIDEWAYS, FELL AND TIPPED OVER IN AMBULATOR. WAS NOT BEING MONITORED AT TIME OF EVENT. PT WAS NOT HURT AND DID NOT NEED MEDICAL HELP. PT HAS ALZHEIMER'S. DEVICE NOT RETURNED. MFR DATE APPROX 5/93 http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmdr/search.CFM