Falls in home-dwelling elderly Mieke Deschodt Center for Health Services and Nursing Sciences Katholiek Universiteit Leuven

2 Falls incidence  In home-dwelling elderly  28% - 35% of people aged 65 or older fall at least ones a year  32% - 42% of people aged 75 or older  15% - 50% with two or more fall incidents per year (Masud & Morris, Age Ageing 2001; Tinetti, NEJM 2003; Milisen et al., Tijdschr Gerontol Geriatr 2004)

3 Falls incidence  In institutionalized elderly (e.g. nursing home)  30-70% at least one fall incident a year  15-40% with 2 or more fall incidents  Average number of falls per bed  1,4 in somatic institutions  2,2 in psychogeriatric institutions (NVKG & CBO richtlijn, 2004)

4 Fall incidents per season

5 Fall incidents per daily period

6 Indoor versus outdoor

7 At home versus not at home

8 Locations indoor

9 Impact on the older person  Physical impact (40% - 60%)  Minor injury: 30% - 50%  Bruises, cuts, tissue damage  Major injury: 10% - 15%  Fracture: 5% - 10%;  Hip fracture: 1% - 2%;  Soft tissue injury and head injury: 5% (AGS panel on falls prevention et al., JAGS 2001; Masud & Morris, Age Ageing 2001; Milisen et al., Tijdschr Gerontol Geriatr 2004; Tinetti, NEJM 2003)

10 Impact on the older person  Psychological impact:  Fear of falling again: 32% - 63%  Loss of self-confidence, loss of independency, social isolation, depression,… causes an increased risk of falling and a longer hospitalisation (AGS panel on falls prevention et al., JAGS 2001; Masud & Morris, Age Ageing 2001; Milisen et al., Tijdschr Gerontol Geriatr 2004; Tinetti, NEJM 2003)

11 Impact on the older person  Increased risk of mortalilty  Involuntary injury = 5th cause of death in people aged 70 years or older  Fall accidents = most important cause of involuntary injuries  Most important risk factor in older persons with osteoporosis for having a hip fracture  Hip fracture  20% becomes immobile  only 14% - 21% regains full ADL-independency  25% - 33% mortality risk in the first year (AGS panel on falls prevention et al., JAGS 2001; Masud & Morris, Age Ageing 2001; NVKG richtlijn & CBO, 2004)

12 Financial consequences  Increases use of sources  Institutionalisation = 3 x more ofter in fallers  Hospital admission as a result of falling increases 6 times from the age of 65  Fall injury = most expensive category of all traumata in elderly (Englander et al., J Forensic Sciences 1996; Masud & Morris, Age Ageing 2001)

13 Increased age and institutionalisation before the fracture are the most important decisive factors for the additional cost (Haentjens et al. Disabil Rehabil 2005) (Kneuzing, schaafwonde, …) €10.528

14 Falls  Fall incident = result of a combination of  Intrinsic risk factors  Extrinsic risk factors  Multifactorial problem multidisciplinary solution

15 Effectivity  Multifactorial evaluation followed by multifactorial interventions targeting on identified risk factors  In older persons with increased risk = most effective  25% to 39% reduction of fall incidents  Little/no proven effect on incidence of severe injuries  the risk profile of the older person has no influence on the effectivity  cave older persons with severe cognitive problems (e.g. dementia) (Gillespie et al., Cochrane 2003; Tinetti, NEJM 2003; Chang et al., BMJ 2004; Kannus et al., Lancet 2005)

16 Inability to get up after a fall incident  1 year follow-up of 90 women en 20 men (90+) at home and in an institution  60% fell at least 1x/year  82% of falls occured when the person was alone  80% were unable to get up without help  > 95% has a personal alarm system, +/- 80% does not use the alarm system  30% had lain on the floor for an hour or more  Pressure ulcers, dehydration, hypothermia, pneumonia, hospital admission, moving into long term care, death  Older persons need training in strategies to get up from the floor after a fall incident (Fleming et al. BMJ 2008)

17 Inability to get up after a fall incident  Cognitive impairment is the only characteristic that predicted lying on the floor for a long time  Need for developing an automatic fall detection system that is not depending on the (cognitive) capacities of the older person (Fleming et al. BMJ 2008)  Building and validating a camera system for fall detection in home-dwelling elderly

18 Camera system  Alarm can be generated independently  No action needed of the person in contrast to the personal alarm system  In cases where the person is not fully conscious after the fall, there will still be an alarm  Because of the alarm a care provider can quickly come to help  Preventing that the faller lies on the floor for a long time  The system can reduce the fear of falling and enables for older people to live longer independently at home.

19 Camera system  Unlike accelerometers, gyroscopes, or alarm buttons, a camera system is fully contactless  elderly people do not have to take along or wear the alarm button and so they can't forget it  The system is not battery-operated  After a fall incident the circumstances can be studied carefully with the camera images, so that preventive steps could be taken to prevent similar falls