Falls in the Elderly Dr/Rehab F Gwada

Out lines: Definition of falls Incidence of falls Risk factors of falls Consequences of falls Assessment Prevention & intervention

Definition of Falls Falls is an event which result in a person coming to rest on the ground or another lower level with or without loss of consciousness or injury.

Incidence of Falls One of every three adults the seventh leading cause of death, Among people aged over 65 years One of every three adults over 65 years fall in every year

Where are people likely to fall? For people 65 years old or older….. Nursing Home 10% Home 60% Public Places 30%

Cont. unfamiliar environment injury rates are more higher with 10 ~ 25% of nursing home, or long-term care facilities resulting in fracture, or sever tissue injuries (Rubenstein, 1999) Falling will tend to occur within the first few days or first weeks upon entering a nursing home, Why? That may be due to: unfamiliar environment person who admitting in has more chronic illness, medications, and immobility due to long time sitting or in bed. 24% of nursing home falls are due to the weakness and gait problems of the residents. 16% of nursing home fall caused by environmental hazards. Higher use of psychotropic drugs (e.g. antidepressants) have been associated with risk of falling.

Fall Injuries in Older Adults Up to 20-30% of falls in older adults result in an injury requiring medical care Most fractures in Medicare population are due to falls Falls in older adults are the second leading cause of SCI and traumatic brain injury(TBI) Men have a higher rate of fatal falls (due to TBI) Women are more likely to have non-fatal falls CDC Falls Among Older Adults: An Overview (2009) www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

Cont. Falls is a major cause of severe nonfatal injuries and common cause of hospital admissions (40%) for traumatic injuries among older adults. Approximately 30~ 50 % of falls result in minor soft tissue injuries. Overall, 20~30% of those who fall suffer from moderate to severe injuries that limit mobility and independence, even the risk of death

Unintentional Fall Death Rates by Gender, Age 65 +, U.S. 1996 Falls are one of leading cause of deaths among people 65 years and older. Fall related deaths for men and women increase with advancing age. More than 60% of fall related death are occurred to the persons aged 75 years or older. Men aged over 85 years (128.3 per 100,000) were almost ten times higher for men in 65-74 (11.5 per 100,000). Men showed consistently higher death rates than women. Source: National Center for Health Statistics, Vital Statistics

Unintentional Fall Age-Adjusted Death Rates, Age 65 +, gender and race U.S. White, Men Black, Men White, Women For both men and women, death rates were higher for whites than for blacks. White men have the highest death rate (30 deaths per 100,000), followed by white women (19 deaths per 100,000) , black men (17 deaths per 100,000) and black women (10 deaths per 100,000) in 1998. Black, Women Source: National Center for Health Statistics, Vital Statistics

Consequences of Falls Mortality Morbidity Fractures Soft tissue injuries Head trauma Joint distortions and dislocations Loss of confidence - fear of falling Restricted activity In 2000, estimated fall-related injury cost was $20 billion. By 2020, the costs are projected to reach $44 billion.

Fractures 3% of all falls cause fractures. Approx. 95% of hip fractures in older people aged over 65 years are the result of a fall People who have a hip facture are 5 ~20% more likely to die in the first year following the injury than any other reason in the same age groups

Common Types of Fractures Hip Fracture (pelvis, hip, femur) Forearm (Wrist) Fracture Spine Fracture Ankle Fracture Upper arm, hand

a psychological result of a fall (Fear of (Falling Loss of self confidence Fear of not being able to get up after a fall Decrease of physical activity level and quality of life result in recurrent fall occurrence Physical injury is not the only impact of a fall.

Mechanisms of Fall Contributing factors Intrinsic : Aging, poor balance Extrinsic : Home hazards Occurrence of falls No injuries Fall Outcomes A fall is not usually caused by a single factor. Most falls by older persons result from the numerous, or complex interaction of intrinsic ( personal or host) factors, and extrinsic (environmental) factors. Soft tissues injures, trauma Disability, reduced quality of life Fractures Loss of Confidence

Risk factors of falls A-Intrinsic risk factors: Age Related changes Visual function Neurological function Musculoskeletal function Diseases (medical problems). Female sex .

A: Most Common Intrinsic Fall Risk Factors Muscle weakness History of falls Gait deficit Balance deficit Visual deficit Chronic illness (Arthritis, Parkinson’s Disease, hypertension) Impaired Activities of Daily Living Depression Cognitive Impairment Age >65 years American Geriatrics Society (2001), Guideline for the Prevention of Falls in Older Persons, JAGS, 49:664-672.

Relative risk ratio (RR) or Odd Ratio (OR) of Fall From selected 16 studies, the most common risk factors for falls were listed. Muscle weakness was significantly related to fall events from 10 out of 11 studies. Also, history of fall was consistently associated with risk of recurrent falls. <a href=“http://…/RiskofFalling.htm> Click the image to enlarged image</a> ‘American Geriatrics Society (AGS) Panel on Falls in Older Persons’ Guidelines for the Prevention falls in older persons. (JAGS, 2001;49:664-672) J Am Geriatr Soc. 2001

B:Extrinsic or Environmental Factors Medications :such as laxative ,antihypertensive, Narcotic , antidepressants Home hazards Clutter, loose rugs, slippery or uneven floor Poor lighting on stairs and hallways Lack of bathroom safety, e.g. grab bars in bathtub Improper Footwear Improper assistive devices Busy street or elevated walkways

Assessment 1-History of falls Environmental assessment: location, floor surface, lighting…….. Symptoms ' dizziness or vertigo, palpitation, chest pain '' Previous fall '' during past year '' Activity at time of falls . Review current & past medications . Chronic medical conditions

2-Physical examination Visions and hearing ability Vestibular function. Cardiovascular examinations 'arrhythmias , heart failure . Neurological examination 'mental status, mood and behavior. Musculoskeletal; examinations muscle weakness severe arthritis, limited range of motion , foot problems. Cognitive function evaluation Mobility evaluation . Balance &Gait transfer (wheel chair patient ) 3- Laboratory /diagnostics testing complete blood count , X-ray , ECG

Intervention & Prevention— Assessment & management of chronic conditions, vision, & hearing Encourage health with exercise & nutrition Osteoporosis screening Medication review (reduce if possible) Mental activity & focus training Education to improve home environment Confidence training for fear Home Safety – Reducing hazards Wear appropriate footwear(Firm back and cover with adjustable fastening, ankle support and non-slip sole) Use assistive devices

Assistant Devices Hip pads Mobility aids Cane Walkers Wheelchairs Bathroom aids Elevated toilet seats Grab bars

Environmental modification: Provide adequate lighting in rooms and hallways with switches located at room entrance Use nights keep flashlights, Arrange furniture so that pathway are not obstructed Provide stable furniture along pathway for balance and support Provide nonskid rugs and carpets runners on slippery floors ,

Use elevated toilet seat or install toilet safety frame Apply nonskid mat on tub floors Provide handrails on both sides of bathroom

Intervention Programs Exercise or physical therapy to increase/gain muscle strength, balance, and gait Exercise programs composed of endurance, balance, gait training, strength training, and Tai Chi

Tai Chi Tai chi is a Chinese exercise system that uses slow, smooth body movements to achieve a state of relaxation of both body and mind. Its benefits  Improve and maintain health.  Help in achieving a state of physical and mental relaxation.   Strengthen the cardiovascular and  immune systems

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