Falls and Mobility in Aging Gait, balance & exercise programs Environmental hazard modification Cardiovascular disorder treatment Intervention Options Postural hypotension treatment Medication modification 2 or more falls, 1 fall with injury Cardiac eval if symptoms suggest syncope Vitals-Orthostatics if indicated Do Falls Assessment Lower extremity strength Targeted neuro exam Timed Up & Go test Visual assessment Fall reported in last year Brief Fall History Chronic conditions Circumstances Medications ETOH Intake Mobility Each year, thousands of Americans over the age of 65 fall Falls and Mobility in Aging with serious injury, fracture, or death. Chang, T.T. and David A. Ganz. Quality Indicators for Falls and Mobility Problems in Vulnerable Elders. JAGS 55-S327-S334, 2007. Reference Supported by a grant from the DW Reynolds Foundation ABNORMAL Single fall with no injury Perform Timed Up & Go test Consider recommending exercise program NORMAL

Falls and Mobility in Aging *Refer to Ophthalmology Orthostatic hypotension (Abnormalities are found in 20-40% of age 65 and older *Perform Timed Up and 10 feet < 10 seconds. Decreased visual acuity found on vision screen muscle strengthening *Review medication list *Eliminate HIGH RISK therapy for gait and *Evaluate as indicated if abnormalities are Medication Review *Reduce NUMBER of medications when possible and Home Safety for possible causes balance training, 2. Gait and Balance Evaluation *Refer to physical Go test (TUG) medications evaluation *Psychoactive meds (eg. benzodiazepines, tricyclic antidepressants, sedatives) *Antidepressants (SSRIs) *Peripheral neuropathy Orthostatic hypotension Decreased visual acuity High Risk Medications *Anticonvulsants Depressive symptoms (Refer to Beer’s list) Cognitive impairment 1. Use of more than 4 *Antiarrhythmics *Anticholinergics Gait and Balance Abnormalities: medications *Parkinson’s *Arthritis include: *CVA Evaluation & Treatment Falls and Mobility in Aging Risk Factors Restricted mobility due to injury and fear of falling (post fall anxiety syndrome) Increased risk for death - (75% of the deaths due to falls occur in the 14% of the population age 65 and older) Decreased activities of daily living (ADLs) – due to loss of self-confidence and self-imposed functional restrictions Increased nursing home placement Consequences