1. Jennifer Jost Hana Kudera Melissa Kumm Concordia University
Falls and the Elderly
Jennifer Jost
Hana Kudera
Melissa Kumm
Concordia University

2. Falls One out of three older adults fall each year
Less than half of them inform their health care provider about their falls
Leading cause of fatal and nonfatal injuries
2010, over $30 billion were toward medical costs related to falls

3. Outcomes linked to falls
Injuries
Lacerations, hip fractures, head traumas
Most common cause of traumatic brain injuries
46% of fatal falls in 2000 were due to traumatic brain injuries
Most common fractures
Spine, hip, forearm, leg, ankle, pelvis, upper arm and hand
Once a fall occurs, the older adult develops a fear of falling.
The fear can cause the older adult to limit their activities which will then increase their risk of falling

4. Who is at risk? Fall Related Deaths
21,700 older adults died from falls in 2010
Men
40% more likely than women in 2010
Older white adults are 2.4 times more likely
Older non-Hispanics have a higher fatality rate than Hispanics

5. Who is at risk? Fall Injuries 75 years and older who fall
4-5 times more likely than aged years old to be admitted to a nursing home for a year or longer
Fractures occur almost two times more often in women than men
2010, there were 258,000 hip fractures
95% of hip fractures are caused by falls

6. Prevention Exercise regularly Improve leg strength and balance
Tai Chi is good because promotes flexibility, balance, improved body awareness
Have the doctor or pharmacist review all their medications
Look for interactions that may cause dizziness or drowsiness
Change medications is able
Have their eyes checked at least yearly

7. Prevention In the home Good fitting shoes
Add grab bars next to toilet and in shower/bath areas
Railings on all stairways
Improve lighting
Reduce tripping hazards
Clear walk areas and remove area rugs
Good fitting shoes

8. Prevention To reduce risk of hip fractures
Increase calcium and vitamin D intake
Weight bearing exercises
Screened for osteoporosis
If needed, get treatment

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10. Legal and ethical considerations related to falls
If a fall is the result of neglect, the nurse could lose her job, license, be sued for compensation, and could face jail time depending on the outcome of the fall.
Ethically
Accountability of the caregiver and/or nurse to be loyal and responsible for the older adult
Doing what is right when no one is watching
Older adult wanting to do for self when it isn’t safe

11. CUTLURAL, PROFESSIONAL AND SPIRITUAL CONSIDERATIONS RELATED TO FALLS
Cultural competence
sex orientation, age, and race, faith or conviction
Language access
Pastoral access
Patient advocacy
Patient safety
Patient provider communication
Health care policy
Research and risk management.

12. RESEARCH FINDINGS ON NURSING INTERVENTIONS RELEVANT TO FALLS
Inherent factors (poor indicators for change in risk status d/t slow changing over time)
Visual deficiencies
Muscle weakness
Impaired balance
Transient factors (good indicators for change in risk status)
Rise in temperature
Dehydration
Changing medication
Room change

13. RESEARCH FINDINGS ON NURSING INTERVENTIONS RELEVANT TO FALLS CONT. .
Little evidence reveals the cost benefit of fall prevention and injury protections programs
No regulations for postulating the right combination of intervention techniques to ensure protection of at-risk population
There is no one study that delivers an absolute multifactorial model to guide practice in nursing homes

14. RESEARCH FINDINGS ON NURSING INTERVENTIONS RELEVANT TO FALLS CONT.
Once a nursing home resident falls, they are more likely to fall again and have an increase of injuries due to these falls.
Continuous evaluation after the fall is required to determine the extent of injury, especially in residents with impaired mental condition.
Extra care and evaluation of these residents after a fall are necessary to avoid missing post fall injuries that might not be self-reported or observed on initial assessment.

15. Case Study
Mr. Jones is a 90 year old white male who lives at home. He has come into the office for a routine care visit. His daughter accompanies him. She reports that Mr. Jones has had multiple falls in the past 6 months. Mr. Jones agrees that he has had multiple falls recently be attributes it to old age.
Mr. Jones’ health history is significant for hypertension, diabetes mellitus type 2, and congestive heart failure.
Upon review of his medications the nurse notices he is on Lasix, lisinopril, metformin, and lantus

16. Case Study Cont. Risk Factors for Falls
hypotension r/t lisinopril, and Lasix
hypo/hyperglycemia as r/t diabetes mellitus, metformin, lantus
Urinary frequency/urgency as r/t Lasix
age

17. Case Study Cont. Fall Prevention - Teachings
Educate on need to monitor blood pressures to prevent hypotension, before and after taking medications
Teach how to monitor blood glucose levels to prevent hypoglycemia
Teach on s/s of hypoglycemia,
Educate on keeping walk areas clutter free, proper lighting, non slip surfaces, non-slip shoes, grab bars, remove throw rugs etc.

18. References
Centers for Disease Control and Prevention. (2013). Falls Among Older Adults: An Overview. Retrieved from:
Ensign, M. R. (2004). Ethical Issues and the elderly: guidance for eldercare provider. Retrieved from:
Falls Among Older Adults. (2014). Retrieved from:
Ginsburg & Associates. (2013). Elderly Falls Injury. Retrieved from:
Gray-Micelli, D., Quigley, P. (2012). Fall prevention: assessment, diagnosis, and intervention strategies. Retrieved from
Fuller GF. (2000). Falls in the Elderly. American Family Physician. 61(7):
Falls in the Elderly. American Family Physician. 61(7):
Media Cache Picture (2014). Retrieved from:

19. References
Neyens JCL, Dijcks BPJ, Haastregt JCM van, et al. (2009) A multifactorial intervention for the prevention of falls in psychogeriatric nursing home patients, a randomized controlled trial. Age Ageing. 38 (2):
NIHSeniorHealth. (2013). Falls and Older Adults: Causes and Risk Factors. Retrieved from:
NIHSeniorHealth. (2014). Retrieved from:
Quigley, P., et al. Fall Prevention and Injury Protection for Nursing Home Residents. Journal of the American Medical Directors Association, Volume 11, Issue 4,
Tabloski, P. (2010). Gerontological Nursing (2nd ed.). Upper Saddle River, New Jersey: Pearson.
Tai Chi. (2014). Retrieved from:
Weil, A. (2014). Can Tai Chi Slow Aging? Retrieved from: