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Falls and older people Stepping into falls management

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Presentation on theme: "Falls and older people Stepping into falls management"— Presentation transcript:

1 Falls and older people Stepping into falls management
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

2 Stepping into falls management
Working together to prevent falls Falls and older people Stepping into falls management

3 What is a fall? 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).

4 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

5 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

6 Consequences of falls Physical injury Emotional trauma
Psychological problems Social consequences Financial impact

7 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

8 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

9 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

10 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

11 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

12 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

13 Areas where falls occur at home
9% 7% 4% WC Laundry Kitchen Meals Living Pantry Dining Bathroom 50% Living Entry Bedroom Garage Source: Victorian Injury Surveillance System 5% 25%

14 An 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

15 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

16 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

17 What can you do?

18 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

19 Acute illnesses Examples: Chest infections Urinary Tract infections
Diarrhoea Surgical procedures

20 Acute illness in the community
Seek medical treatment Community services Ask family, friends and neighbours to help out Ensure adequate diet and fluids Aids

21 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

22 Urinary Tract Infections
Symptoms Mental confusion Frequency Urgency Foul smelling urine Incontinence Burning or scalding when passing urine Peeing razor blades or barbed wire

23 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) Continence clinic brochure

24 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

25 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 Options for seeking assistance: - Personal alarm - Cordless phone

26 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

27 Dizziness Dizziness needs to be properly investigated by a doctor or specialist
Causes: Medications Chronic disease Acute illness Psychological disorders If you are dizzy you need to get up safely Diseases/illnesses causing dizziness include: Acute illnesses such as labyrinthitis (inner ear problems) and chronic diseases such as Menieres disease. Blood pressure medication can cause dizziness/light headedness Stemetil is a medication often given to people who are dizzy, but should not be used over long periods (eg < 6 months).

28 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

29 Color contrasting

30 Color contrasting

31 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

32 Hearing problems Medical examination Audiology referral
Hearing aids (Wear them!!!) Specialist referral Raise awareness of the problem amongst carers/family and friends

33 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

34 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

35 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

36 Balance and gait disorders
Medical assessment Physiotherapy Prescribed walking aids Ensure safe environment Occupational therapy home assessment Exercise Physio brochure In rural areas: Rural Allied Health Therapeutic equipment suppliers

37 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

38 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

39 Staying active exercise & 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

40 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

41 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 Grip – Parkinsons and other chronic conditions (Podiatrist sometimes necessary) In rural areas: Rural Allied Health Team

42 Shoe sole to ground contact
Flat Shoe Court Shoe Shoes with greater ground contact help to reduce the risk of falls

43 Nutrition and falls Optimal nutrition is important to reduce
the risk of falling and to enhance recovery if a fall occurs. The incidence of falls has been linked to: Vitamin deficiencies Protein-calorie deficiencies

44 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

45 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

46 Strategies to reduce nutrition related falls
Referral to dietician Medical review Assistance with shopping Assistance with meals eg Meals on Wheels

47 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

48 Vitamin D and calcium A diet with mg 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

49 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

50 Treatment of fear for falling
Assessment of medical condition Identification of fears Counseling and education Physiotherapy Behaviour modification and treatment of fears and phobias

51 Hazards in the home Rugs & mats Slippery & damaged floors
Electrical cords Poor lighting Unsafe bathrooms Steps and stairs Hazardous gardens and paths Furniture Ladders

52 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 Checklists and booklets

53 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

54 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

55 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

56 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 Hip protector information

57 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

58 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

59 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 from

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