1. Falls in the Elderly
Alisha Johnson

2. Lecture Objectives Identify and list the main causes of falls
Develop an understanding of how prominent falls in the elderly are
Describe the 3 systems affecting balance
List and memorize the areas of evaluation of falls
Understand fall prevention techniques
Utilize interventions and balance retraining exercises

3. Causes of falls Gait disturbance Illness Low blood pressure
Impaired posture
Confusion
Visual Impairment
Environmental Hazards
Muscle Weakness
Medication &/or alcohol
Vertigo
CNS disorders
Inappropriate shoes
Unstable bed or chair
Pain
Decreased fitness
Fear

4. Some Facts…
1 out of 3 adults >65 falls each year, but less than half report it.
Among older adults, falls are the leading cause of death and the most common cause of nonfatal injuries and hospital admissions for trauma.
In 2008, over 19,700 older adults died from unintentional fall injuries and death rates have risen over the past decade.
In 2009, 2.2 million nonfatal fall injuries among older adults were treated in emergency departments and more than 581,000 of these patients were hospitalized.
In 2000, direct medical costs of falls totaled a little over $19 billion—$179 million for fatal falls and $19 billion for nonfatal fall injuries, equaling $28.2 billion in 2010 dollars.

5. Facts Cont.
20-30% of people who fall suffer moderate to severe injuries.
Falls are the most common cause of TBI. In 2000, TBI accounted for 46% of fatal falls among older adults.
Most fractures among older adults are caused by falls. The most common fractures are: spine, hip, leg, ankle, pelvis, upper arm, forearm and hand.
Many people who fall, develop a fear of falling. Fear may cause them to limit their activities leading to decreased mobility and loss of physical fitness, which increases their actual risk of falling.

6. Fall injuries
The chances of falling and being seriously injured increase with age. In 2009, the rate of fall injuries for adults 85+ was almost 4 x that for adults
People age 75+ who fall are 4-5 x more likely than those age to be admitted to a long-term care facility.
Women are more likely to be injured in a fall than men; Osteoporosis being the main factor.
Rates of fall-related fractures among older women are more than twice those for men.
Over 90% of hip fractures are caused by falls. In 2007, there were 264,000 hip fractures and the rate for women was almost 3 x the rate for men.

7. Rate of Nonfatal, Medically Consulted Fall Injury Episodes, by Age Group
Yearly rates of injury when a health-care professional was contacted. A person experienced one or more injuries from an outside cause. Estimates are based on household interviews of a sample a non- institutionalized population. Per 1,000.

8. Fall Related Deaths
In 2008, 82% of fall deaths were among the elderly ages 65+.
Men are more likely to die from a fall. The fall death rate in 2007 was 46% higher for men than for women.
Ethnicity is also a factor: Older whites are 2.5 x more likely to die from falls than African-American and Hispanic decent.

9. Fear and Falling
21%-85% of the elderly population are afraid of falling, which per se is a fall risk.
Fear increases with age and is more common in women.
Fear of falling usually appears after a fall, but a previous fall is not necessary for fear to start.
Fear may lead to activity avoidance, like walking and reaching.
Fear of falling affects quality of life, physical function and may lead to depression.

10. Systems affecting balance
Maintaining balance requires coordination of input from multiple sensory systems including the somatosensory, vestibular, and visual systems.
Somatosensory: sensory system composed of the receptors and processing centers to produce the sensory modalities such as touch, temperature, proprioception (body position), and nociception (pain).
Vestibular: Contributes to balance by sense of spatial orientation, of where your body is in space, it is the sensory system that provides the leading contribution about movement and sense of balance.
Visual

11. Areas of Evaluation: ‘I Hate Falling’
I - Inflammation
H - Hypotension
A- Auditory/Visual abnormalities
T - Tremor
E – Equilibrium Problem
F – Foot problems
A - Arrhythmia
L – LLD
L – Lack of Conditioning
I - Illness
N –Nutrition, poor
G – Gait Disturbances

12. Tests and Measures Berg Balance Test: Predicts falls in the elderly.
Tinetti Balance Test: Task-orientated test. Measures gait and balance abilities.
Get Up and Go Test: For individuals prone to falls.
Three-Minute Walk Test: Establishes a baseline for gait.
Functional Reach Test: Used as an indicator of stability limits.

13. Fall Prevention
Make sure the elderly have proper shoe attire: non-skid is best
Make sure tripping hazards are moved out of the way
Remove throw rugs and high carpet
Use hand rails and grab bars
Make sure areas are well-lit and use a “night light” at night
Encourage regular Dr. visits
Encourage daily exercise like walking or Tai Chi
Discourage alcohol and tobacco products

14. Interventions to reduce a fall risk
Strengthen the core, LE’s, especially the ankle
Reduce joint pain with modalities and NSAID’S
Correct improper posture
Gait training with changes in terrain, elevation, time, distance, amount of support
Balance Interventions
COG control training
Standing balance
Somatosensory
Moving balance
Vestibular
Eye-head coordination
Postural strategies
Strength and Endurance

15. Balance Retraining Ideas
Standing with normal BOS to narrow BOS
Tandem standing to tandem walking
Standing on one foot
Change of arm positions: arms at side, over head, hands on waist, hands out front.
Perturbations
Aquatherapy
Reaching
Eyes open to eyes closed
Walking along strait line
Walking backwards, sideways, cross- stepping/karaoke
Altering lever arm from short to longer
March in place

16. Balance Retraining Ideas Cont
Change speeds of walking
Stop/start abruptly when walking
Turn abruptly when walking
Walk in a circle
Walk on heels & toes
Walk while turning head
Stepping over and around obstacles
Stair climbing: with/ without handrail, one step then step over step
Use of Swiss ball, foam pads, balance beam, Dynadisc, Bosu Ball, wedge, tilt board, TheraBand, Biodex Balance System, etc.

19. Works Cited
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Hausdorff JM, Rios DA, Edelber HK. Gait variability and fall risk in community–living older adults: a 1– year prospective study. Archives of Physical Medicine and Rehabilitation 2001;82(8):1050–6.
Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. Preventing falls among community–dwelling older persons: results from a randomized trial. The Gerontologist 1994:34(1):16– 23.
Stevens JA. Fatalities and injuries from falls among older adults – United States, 1993–2003 and 2001– MMWR 2006a;55(45).
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Scott JC. Osteoporosis and hip fractures. Rheumatic Diseases Clinics of North America 1990; 16(3): 717–40.
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Stevens JA, Dellinger AM. Motor vehicle and fall related deaths among older Americans 1990–98: sex, race, and ethnic disparities. Injury Prevention 2002;8:272–5.
Stevens JA, Sogolow ED. Gender differences for non-fatal unintentional fall related injuries among older adults. Injury Prevention 2005b;11:115–9.
National Hospital Discharge Survey (NHDS), National Center for Health Statistics. Available at: Assessed September 14, 2011.
Stevens JA. Falls among older adults–risk factors and prevention strategies. NCOA Falls Free: Promoting a National Falls Prevention Action Plan. Washington DC; The National Council on the Aging; 2005a.