Haley Gladfelter University of Findlay DPT May 2012 Cindy Nagel MA, BSN, RNBC Trauma Program Manager St. Rita’s Medical Center

 What is considered a fall  Staggering statics about falling in older adults  Dangers of falling  What to do if you fall  How to prevent and protect yourself from falling  Balance exercises

 A fall, as defined by The Technical Assistance Program (TAP) of the Ohio Department of Health includes: ◦ An intercepted fall is still a fall.  An episode where and individual lose his or her balance but catches themselves before they fall. ◦ A fall without an injury is still a fall.  If you fall but do not acquire an injury it is still considered to be a fall. ◦ A fall to the ground where the individual is found on the ground and or acquired an injury.

 The Ohio Department of Health (ODH) and The Ohio Prevention Partnership reports: ◦ Falls in older adults 65 and older have reached epidemic proportions ◦ Falls and fall-related injury seriously affect older adults’ quality of life and present a substantial burden to the Ohio health-care system. ◦ They surpass all other mechanisms of injury as a cause of ER visits, hospitalization and death and are higher than rates for all other injuries combined.

 Fall-related ER visit and hospitalization rates increased 61% and 51% respectively from 2002 to  In 2009, there were 4 fall-related ER visits for every 100 Ohio older adults and 10 fall-related hospitalizations for every 1,000 Ohio older adults  From 2000 to 2009, Ohioans aged 65 and older experienced a 125% increase in the number of fatal falls and 112% increase in the fall death rate.  On average, 2.3 older Ohioans suffered fatal falls each day in 2009.

 Ohioans 65 and older accounted for approximately 82% of fatal falls in 2009; while they represent only 14% of the population.  Risk for suffering serious injury after a fall increases dramatically with advancing age. Females 85 years and older account for half of fatal falls, while they account for only 3% of the female population

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 Falls among older adults cost Ohio and its residents $4.2 billion in 2003, more than two-thirds (68 percent), of the total annual costs of nonfatal, hospital-admitted falls. Direct medical costs represent only a fraction (8%) of the total cost. Medical$ 327,366,900 Work-Loss$ 116,513,800 Quality-of-Life$ 3,728,623,600 Total Costs$ 4.2 billion Costs Associated with Falls Among Older Adults, Ages 65+, Ohio, 2003

 In older adults ◦ Falls are the leading cause of injury- related deaths ◦ The most common cause of nonfatal injuries and hospital admissions for trauma ◦ The most common fractures are  Spine  Hip, pelvis, and leg  Forearm, upper arm, hand  Ankle

 The psychological consequences of any fall, whether injury-causing or not, can be severe, resulting in ◦ Fear ◦ Decreased quality of life from self‐imposed restriction of activities, ◦ Social isolation and depressive symptoms. ◦ These “near-miss” falls can put someone at risk for future falls as well if they are not adequately assessed and managed by a health care professional.

 Biological changes secondary to age ◦ Decreased balance and coordination ◦ Slowed reaction time ◦ Overall decline in strength and conditioning ◦ Sensation issues  Peripheral Neuropathy  Decreased skin sensation  FALLS ARE NOT A NORMAL PART OF AGING! ◦ Simple steps discussed later can significantly decrease your risk of falling

 If an upper extremity injury ◦ Use elbow to push up to side sitting position ◦ Then use good arm to push to kneeling position ◦ Last use legs to help move to standing position  Stationary object can be used to help stand

 If a lower extremity injury ◦ If lateral fall on side of hip  Try to roll onto your back  Sit up to your bottom  Then scoot backwards across the floor using good leg  Keep affected leg still if possible ◦ If you fall on your bottom  Try to scoot along the floor on the opposite side of the hip ◦ Do not try to stand ◦ Always have a phone at that can be reached at floor level such as an end table.

Projects/Home-Safety/  Hand rails ◦ Into and out of home ◦ Going up and down steps between levels in the home ◦ Hand rails on both sides is best, yet one side will still increase your safety significantly  Do not leave clutter on the floor ◦ News papers and magazines can increase risk of falls

livingplus.com/article/an_ounce_of_prevention  Remove all throw rugs ◦ Throw rugs are a HUGE cause of falls in older adults ◦ The rug can slip under your feet or a toe can get caught ◦ One small ruffle in the rug can cause you to lose your balance and fall  Furniture arrangement ◦ Critical during nighttime hours  When arising from bed you could be slightly dizzy and disoriented  Arrange furniture to ensure that there is always a clear pathway to enter and exit a room.

p_lighting.cfm  Increase lighting in the home ◦ Dull lighting can affect how your view your surroundings leading to falls ◦ Can be a simple as increasing the bulb watt  Be mindful of small dogs and cats ◦ Small dogs and cats can end up under your feet causing you to lose your balance

emodeling shower.html  Bathroom Features ◦ Grab bars  Should be installed in the shower and beside the toilet ◦ “Walk in showers” with a seat  Removes the risk of falling while stepping into a tub shower  The seat allows for you to shower without the risk of slipping and falling ◦ Elevated toilet seat  Decreases the risk of falling while getting up and down from the toilet

1. Increase Physical Activity ◦ 15 minutes of daily activities can increase muscle strength, and balance.  Walking  Biking  Swimming  Tia Chi 2. Yearly Eye Examinations ◦ Age related disease can increase risk of falling  Cataracts  Macular degeneration  Diabetic retinopathy ◦ Early detection is the key!!

3. Review Your Medications ◦ Ask your doctor if the medicine your are taking can cause dizziness or drowsiness. ◦ Discuss if your are taking your medicine safely  Decrease risk of mixing medicine or taking too much medication. 4. Remove Environmental Hazards ◦ Increase lighting ◦ Remove all throw rugs ◦ Watch for slippery floor  Linoleum  Wood floors  Tile ◦ Eliminate unsteady furniture

5. Think, Plan, Slow Down ◦ Many falls are caused by rushing  Slow down and think though task you are performing before completing the task  Be mindful of all safety concerns/fall risks and plan your tasks accordingly 6. Always Have Emergency Phone ◦ It is very important that you always have a cell phone or life alert device for emergency situations ◦ Always have a phone that can be reached from the floor level (end table) ◦ BE PREPARED!

 4 way hip  Calf raises (going up on toes)  Single leg standing ◦ All the above should be done by standing at a stationary table or counter top for support.  Side-walking  Mini squats against a wall  Toe taps at household objects

 Fall risks are a serious danger for older adults. The following precaution may significantly decrease you risk of falling. ◦ Remove environmental hazards and add additional safety features to your home. ◦ Have annual eye examinations and asking your doctors about your medications. ◦ Think, plan, and slow down before implementing and completing a task. ◦ Always be prepared by having an emergency phone ready. ◦ Stay active with at least 15 minutes of exercise daily

 nth/Documents/2012_Falls_Preventionpublic. pdf nth/Documents/2012_Falls_Preventionpublic. pdf  ealthyOhio/default/vipp/~/link.aspx?_id=6A9 1950F498E4D048648B21DA985BEE7&_z=z ealthyOhio/default/vipp/~/link.aspx?_id=6A9 1950F498E4D048648B21DA985BEE7&_z=z

 St. Rita’s Medical Center ◦ Trauma Services and Injury Prevention Program  Cindy Nagel MA, BSN, RNBC    University of Findlay ◦ DPT Class of 2013  Haley Gladfelter  

 Ohio Injury Prevention Partnership. Falls Among Older Adults. Revised April 19, Available at: althyOhio/default/vipp/~/link.aspx?_id=6A9195 0F498E4D048648B21DA985BEE7&_z=z.Accessed May 16, althyOhio/default/vipp/~/link.aspx?_id=6A9195 0F498E4D048648B21DA985BEE7&_z=z  National Safety Council. Preventing Slips, Trips and Falls. Revised Available at: th/Documents/2012_Falls_Preventionpublic.pdf. Accessed May 16, 2012.