FALLS IN THE ELDERLY LEARNING OBJECTIVES IDENTIFY THE

FALLS IN THE ELDERLY

LEARNING OBJECTIVES üIDENTIFY THE SCOPE OF THE PROBLEM üDESCRIBE THE CONTRIBUTING FACTORS FOR FALLS üADDRESS FALL PREVENTION üDISCUSS INTERVENTION PROGRAMS

FALLS • “UNINTENTIONAL” INJURIES • CAUSE CAN BE MULTIFACTORIAL • FALL RELATED INJURIES CAN BE DEBILITATING OR

HOW SERIOUS IS THIS PROBLEM?

INCIDENCE OF FALLS IN U. S. One out of three adults over 65 years fall every year

• MILLIONS OF PEOPLE FALL EVERY YEAR • LESS THAN HALF TELL THEIR DOCTOR • EACH FALL DOUBLES YOUR RISK OF FALLING

WHERE ARE PEOPLE LIKELY TO FALL? FOR PEOPLE 65 YEARS OLD OR OLDER…. . Nursing Home 10% Public Places 30% Home 60%

CONSEQUENCES OF FALLS § MORTALITY § MORBIDITY § FRACTURES § SOFT TISSUE OR HEAD TRAUMA § JOINT DISLOCATIONS § LOSS OF CONFIDENCE - FEAR OF FALLING § RESTRICTED ACTIVITY § ESTIMATED FALL-RELATED INJURY COST IS $34 BILLION. (CDC)

UNINTENTIONAL FALL DEATH RATES Source: National Center for Health Statistics, Vital Statistics

FRACTURES • MOST FALLS DO NOT CAUSE FRACTURES • FALLS ARE THE CAUSE OF 80 -90% OF ALL FRACTURES (FOR THOSE >65 YEARS OLD) • ~95% OF HIP FRACTURES IN THOSE >65 ARE CAUSED BY FALLS • PEOPLE WHO HAVE A HIP FRACTURE

COMMON TYPES OF FRACTURES ü FOREARM (WRIST) FRACTURE ü SPINE FRACTURE ü HIP FRACTURE (PELVIS, HIP, FEMUR) ü ANKLE FRACTURE ü UPPER ARM, FOREARMS, HAND

FEAR OF FALLING • LOSS OF SELF CONFIDENCE • DECREASE IN PHYSICAL ACTIVITY LEVEL AND QUALITY OF LIFE • FEAR OF NOT BEING ABLE TO GET UP AFTER A FALL

Risk Factors • AGED (OVER 65 YEARS) • FEMALE • LOW MOBILITY OR FRAGILITY – • LOWER EXTREMITY WEAKNESS, AND POOR GRIP STRENGTH • FUNCTIONAL IMPAIRMENTS

• COGNITIVE IMPAIRMENT OR DEMENTIA • CHRONIC ILLNESS - PARKINSONS, VISUAL DIFFICULTIES, STROKE, HYPERTENSION, OR URINARY INCONTINENCE • PSYCHOACTIVE MEDS • PREVIOUS FALLS

Relative Risk Factors

ENVIRONMENTAL FACTORS • POLYPHARMACY – ≥ 4 MEDS • HOME HAZARDS • CLUTTER OR LOOSE FURNITURE • POOR LIGHTING • LACK OF “GRAB BARS” • FOOTWEAR • BUSY STREET OR ELEVATED

Intrinsic : Aging, poor balance Contributing factors Extrinsic : Home hazards Occurrence of falls Fall Outcomes Fractures Soft tissues injures, trauma Loss of Confidence No injuries Disability, reduced quality of life

DIMENSION OF FRACTURES Force Bone Fragility Fall itself Source: National Osteoporosis Foundation

CAUSE OF THE FALL ITSELF § LOSS OF FOOTING § CHANGES IN REFLEXES WITH AGE § CHANGES IN MUSCLE MASS AND BODY FAT § LOSS OF MUSCLE STRENGTH § CHANGES IN VISION AND HEARING § CHRONIC CONDITIONS WITH MEDICATIONS

FORCE AND DIRECTION OF A FALL §BEING TALL INCREASED RISK OF HIP FRACTURES §HOW YOU LAND §WHAT SURFACE YOU FALL ON

FALL DIRECTIONS AND HIP FRACTURE Circumstances Hit hip/thigh when fall Hit hand when fall Hit knee when fall Fell sideways Fell forward Fell backward Odds Ratio 48. 6 0. 42 0. 26 3. 17 0. 22 1. 03

FRAGILE BONE Normal Bone Osteoporotic Bone

Prevention/Intervention ASSESSMENT OF RISK • “GET-UP AND GO” TEST • CHECK FOR BALANCE, GAIT, AND MOBILITY • REVIEW üCHRONIC MEDICAL CONDITIONS üMEDICATIONS üVISIONS AND HEARING ABILITY üFOOT DISABILITIES • EVALUATE ENVIRONMENTAL HAZARDS üHOME HAZARDS

ASSISTANT DEVICES • HIP PADS • MOBILITY AIDS • CANE • WALKERS • WHEELCHAIRS • BATHROOM AIDS - RAISED TOILET SEATS - GRAB BARS

INTERVENTION • EXERCISE TO IMPROVE MUSCLE STRENGTH, BALANCE, AND GAIT • ASSESSMENT OF HOME FALL HAZARDS • EVALUATION OF MEDICAL CONDITION, MEDICATIONS, AND NUTRITION

COMMUNITY INTERVENTION EXAMPLE üSTRENGTH, TRAINING, OR BALANCE TRAINING üOVERALL SIGNIFICANT REDUCTION OF FALL E. G. “TAI CHI” REDUCED THE RATE OF FALLS DURING THE 4 MONTHS FOLLOW UP IN

CONCLUSIONS • FALLS, AND RELATED INJURIES ARE SIGNIFICANT HEALTH HAZARDS TO THE ELDERLY • IDENTIFY FALL RISK FACTORS TO EVALUATE