Falls Prevention Voice

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Falls Prevention : 

Falls Prevention Gerontology

Objectives : 

Objectives Discuss the magnitude of the problem of falls in the elderly. Identify risk factors for falls. Distinguish between intrinsic and extrinsic risk factors. Identify common screening tests for fall risk. Discuss the roles of education and exercise in fall prevention.

How big is the problem? : 

How big is the problem? More than one third of adults 65 and older fall each year in the United States (Hornbrook et al. 1994; Hausdorff et al. 2001). Among older adults, falls are the leading cause of injury deaths. They are also the most common cause of nonfatal injuries and hospital admissions for trauma (DC 2006).

How big is the problem? : 

How big is the problem? In 2005, 15,800 people 65 and older died from injuries related to unintentional falls; about 1.8 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized (CDC 2008). The rates of fall-related deaths among older adults rose significantly over the past decade (Stevens 2006).

What outcomes are linked to falls? : 

What outcomes are linked to falls? 20-30% of people who fall suffer moderate to severe injuries such as bruises, hip fractures, or head traumas. These injuries can make it hard to get around and limit independent living. They also can increase the risk of early death (Alexander et al. 1992; Sterling et al. 2001). Falls are the most common cause of traumatic brain injuries, or TBI (Jager et al. 2000). In 2000, TBI accounted for 46% of fatal falls among older adults (Stevens et al. 2006).

What outcomes are linked to falls? : 

What outcomes are linked to falls? Most fractures among older adults are caused by falls (Bell et al. 2000). The most common fractures are of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand (Scott 1990).

What outcomes are linked to falls? : 

What outcomes are linked to falls? Many people who fall, even those who are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and physical fitness, and increasing their actual risk of falling (Vellas et al. 1997). In 2000, direct medical costs totaled $0.2 billion ($179 million) for fatal falls and $19 billion for nonfatal fall injuries (Stevens et al. 2006).

Who is at risk? : 

Who is at risk? Men are more likely to die from a fall. After adjusting for age, the fall fatality rate in 2004 was 49% higher for men than for women (CDC 2005). Women are 67% more likely than men to have a nonfatal fall injury (CDC 2006).

Who is at risk? : 

Who is at risk? Rates of fall-related fractures among older adults are more than twice as high for women as for men (Stevens et al. 2005). In 2003, about 72% of older adults admitted to the hospital for hip fractures were women (CDC 2005).

Who is at risk? : 

Who is at risk? The risk of being seriously injured in a fall increases with age. In 2001, the rates of fall injuries for adults 85 and older were four to five times that of adults 65 to 74 (Stevens et al. 2005) Nearly 85% of deaths from falls in 2004 were among people 75 and older (CDC 2006).

Who is at risk? : 

Who is at risk? People 75 and older who fall are four to five times more likely to be admitted to a long-term care facility for a year or longer (Donald et al. 1999). There is little difference in fatal fall rates between whites and blacks from ages 65 to 74 (CDC 2006).

Who is at risk? : 

Who is at risk? After age 75, white men have the highest fatality rates, followed by white women, black men, and black women (CDC 2006). White women have significantly higher rates of fall–related hip fractures than black women (Stevens 2005). Among older adults, non–Hispanics have higher fatal fall rates than Hispanics (Stevens et al. 2002).

The Cost of Falls : 

The Cost of Falls Direct costs are what patients and insurance companies pay for treating fall-related injuries: fees for hospital and nursing home care, doctors and other professional services, rehabilitation, community-based services, use of medical equipment, prescription drugs, changes made to the home, and insurance processing.

The Cost of Falls : 

The Cost of Falls Direct costs do not account for the long-term effects of these injuries such as disability, dependence on others, lost time from work and household duties, and reduced quality of life. In 2000, the total direct cost of all fall injuries for people 65 and older exceeded $19 billion: $0.2 billion for fatal falls, and $19 billion for nonfatal falls.

The Cost of Falls : 

The Cost of Falls By 2020, the annual direct and indirect cost of fall injuries is expected to reach $54.9 billion (in 2007 dollars). In a study of people age 72 and older, the average health care cost of a fall injury totaled $19,440, which included hospital, nursing home, emergency room, and home health care, but not physician services.

Costs by Injury and Setting : 

Costs by Injury and Setting In 2000, traumatic brain injuries (TBI) and injuries to the hips, legs, and feet were the most common and costly fatal fall injuries, and accounted for 78% of fatalities and 79% of costs. Injuries to internal organs caused 28% of deaths and accounted for 29% of costs from fatal falls.

Costs by Injury and Setting : 

Costs by Injury and Setting Hospitalizations accounted for nearly two thirds of the costs of nonfatal fall injuries, and emergency department treatment accounted for 20%. On average, the hospitalization cost for a fall injury was $17,500.

Costs by Injury and Setting : 

Costs by Injury and Setting Fractures were both the most common and most costly type of nonfatal injuries. Just over one third of nonfatal injuries were fractures, but they accounted for 61% of costs—or $12 billion. Hip fractures are the most frequent type of fall-related fractures. The cost of hospitalization for hip fracture averaged about $18,000 and accounted for 44% of direct medical costs for hip fractures.

Falls and Fractures : 

Falls and Fractures In 2004, there were more than 320,000 hospital admissions for hip fractures, a 3% increase from the previous year. However, from 1996 to 2004, after adjusting for the increasing age of the U.S. population, the hip fracture rate decreased 25% (from 1,060 per 100,000 population to 850 per 100,000 population). Over 90% of hip fractures are caused by falling, most often by falling sideways onto the hip.

Falls and Fractures : 

Falls and Fractures In 1990, researchers estimated that the number of hip fractures would exceed 500,000 by the year 2040. About one out of five hip fracture patients dies within a year of their injury. Most patients with hip fractures are hospitalized for about one week.

Falls and Fractures : 

Falls and Fractures Up to one in four adults who lived independently before their hip fracture has to stay in a nursing home for at least a year after their injury. In 1991, Medicare costs for hip fractures were estimated to be $2.9 billion. About 76% of all hip fractures occur in women.

Falls and Fractures : 

Falls and Fractures Hip fracture rates increase exponentially with age among men and women. People 85 and older are 10 to 15 times more likely to sustain hip fractures than are people ages 60 to 65. Osteoporosis increases a person’s likelihood of sustaining a hip fracture.

Hip Protectors : 

Hip Protectors The hip protector is a rigid shell made of durable plastic, designed to divert a direct impact away from the greater trochanter onto the surrounding soft tissue.

Falls in Nursing Homes : 

Falls in Nursing Homes About 5% of adults 65 and older live in nursing homes, but nursing home residents account for about 20% of deaths from falls in this age group. Each year, a typical nursing home with 100 beds reports 100 to 200 falls. Many falls go unreported. As many as 3 out of 4 nursing home residents fall each year. That’s twice the rate of falls for older adults living in the community.

Falls in Nursing Homes : 

Falls in Nursing Homes Patients often fall more than once. The average is 2.6 falls per person per year. About 35% of fall injuries occur among residents who cannot walk. About 1,800 people living in nursing homes die each year from falls.

Falls in Nursing Homes : 

Falls in Nursing Homes About 10% to 20% of nursing home falls cause serious injuries; 2% to 6% cause fractures. Muscle weakness and walking or gait problems are the most common causes of falls among nursing home residents. These problems account for about 24% of the falls in nursing homes.

Falls in Nursing Homes : 

Falls in Nursing Homes Environmental hazards in nursing homes cause 16% to 27% of falls among residents. Such hazards include wet floors, poor lighting, incorrect bed height, and improperly fitted or maintained wheelchairs. Medications can increase the risk of falls and fall-related injuries. Drugs that affect the central nervous system, such as sedatives and anti-anxiety drugs, are of particular concern. Other causes of falls include difficulty in moving from one place to another (for example, from the bed to a chair), poor foot care, poorly fitting shoes, and improper or incorrect use of walking aids.

What About Restraints? : 

What About Restraints? Routinely using restraints does not lower the risk of falls or fall injuries. They should not be used as a fall prevention strategy. Restraints can actually increase the risk of fall-related injuries and deaths. Limiting a patient’s freedom to move around leads to muscle weakness and reduces physical function. Since federal regulations took effect in 1990, nursing homes have reduced the use of physical restraints. Some nursing homes have reported an increase in falls since the regulations took effect, but most have seen a drop in fall-related injuries.

Multifactoral Causes of Falls : 

Multifactoral Causes of Falls Intrinsic Vision Hearing Strength Balance Medications Lack of sleep Mental status Chronic disease Extrinsic Stairs Clutter Wet surfaces Loose rugs Cords Poor lighting Hurrying/rushing

Fall Prevention : 

Fall Prevention

Screening for Fall Risk : 

Screening for Fall Risk History of falls Medications Single leg stand or Tandem stand Functional Reach Sit to Stand (aka Chair Rise) Timed Up and Go Tinetti Gait and Balance Berg Balance Scale Dynamic Gait Index Activities-specific Balance Confidence Scale

Medications : 

Medications Polypharmacy Anti-hypertensives Anti-depressives Anti-psychotics Levadopa Sedatives / muscle relaxants Long-term steroids

Fall Prevention : 

Fall Prevention Fall prevention involves a combination of medical treatment, rehabilitation, and environmental changes. The most effective interventions address multiple factors. The most effective way to prevent fall-related injuries is to combine exercise with other fall prevention strategies. RAND Report, 2003.

Fall Prevention Education : 

Fall Prevention Education Medications Obtain all from the same pharmacy Consult with physician or pharmacist about possible side effects Keep a current list of medications Watch for adverse reactions and report any Be extra careful when adding new meds or changing dosage Avoid alcohol use

Fall Prevention Education : 

Fall Prevention Education Mobility problems Use recommended assistive devices Keep assistive devices in good repair Perform regular foot care and inspection Wear well-fitting, supportive shoes Focus on the task: avoid carrying objects, talking, etc. while walking

Fall Prevention Education : 

Fall Prevention Education Vision Have vision tested regularly Clean glasses daily or more often as needed Remove reading glasses when walking Increase lighting especially in hallways and stairs Use night lights in bedroom, hall, and bathroom Allow eyes to accommodate to changes in light

Fall Prevention Education : 

Fall Prevention Education Dizziness Change positions slowly Pump ankles upon first sitting and before standing Stand momentarily before stepping Don’t attempt to walk when dizzy Drink plenty of fluids

Fall Prevention Education : 

Fall Prevention Education Depression Take anti-depression meds as prescribed Ask about counseling or other therapy if feeling depressed Exercise regularly Get socialization and support from family and/or friends

Fall Prevention Education : 

Fall Prevention Education Environmental Safety Avoid low seats, chairs w/o arms, and moveable chairs Install safety equipment in bathroom Keep pathways clear inside and out Remove or secure rugs Install and use handrails on stairs Improve lighting

Fall Prevention Exercise : 

Fall Prevention Exercise See a therapist for evaluation and exercise prescription Posture Strength ROM Balance Gait Endurance

ABC News Prevent Falls for the Elderly : 

ABC News Prevent Falls for the Elderly http://www.youtube.com/watch?v=JqQGjPOFio0

Slide 42: 

A test of a people is how it behaves toward the old. It is easy to love children. Even tyrants and dictators make a point of being fond of children. But the affection and care for the old, the incurable, the helpless are the true goldmines of a culture. Abraham J Heschel

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