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    Prevention of Falls in Older Adults: Evidence Based Practices

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    sandeshkunnath
    This document discusses falls in older adults and prevention strategies. It covers physiological changes with aging that increase falls risk, common medical conditions that contribute to falls, falls risk factors, and statistics on falls. Prevention strategies discussed include exercise programs, home modifications, medication management, nutrition, fall risk assessments, education, and community resources. The goal is to identify older adults at high risk and implement personalized plans to address modifiable risk factors and prevent injuries from falls.

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    Prevention of Falls in Older Adults: Evidence Based Practices

    Uploaded by

    sandeshkunnath
    110 views34 pages
    This document discusses falls in older adults and prevention strategies. It covers physiological changes with aging that increase falls risk, common medical conditions that contribute to falls, falls risk factors, and statistics on falls. Prevention strategies discussed include exercise programs, home modifications, medication management, nutrition, fall risk assessments, education, and community resources. The goal is to identify older adults at high risk and implement personalized plans to address modifiable risk factors and prevent injuries from falls.

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    Falls Prevention

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    This document discusses falls in older adults and prevention strategies. It covers physiological changes with aging that increase falls risk, common medical conditions that contribute to falls, falls risk factors, and statistics on falls. Prevention strategies discussed include exercise programs, home modifications, medication management, nutrition, fall risk assessments, education, and community resources. The goal is to identify older adults at high risk and implement personalized plans to address modifiable risk factors and prevent injuries from falls.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    110 views34 pages

    Prevention of Falls in Older Adults: Evidence Based Practices

    Uploaded by

    sandeshkunnath
    This document discusses falls in older adults and prevention strategies. It covers physiological changes with aging that increase falls risk, common medical conditions that contribute to falls, falls risk factors, and statistics on falls. Prevention strategies discussed include exercise programs, home modifications, medication management, nutrition, fall risk assessments, education, and community resources. The goal is to identify older adults at high risk and implement personalized plans to address modifiable risk factors and prevent injuries from falls.

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    © All Rights Reserved
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    of 34

    Prevention of Falls in Older

    Adults:
    Evidence Based Practices
    Hadeel Hakeem
    Physiology of Normal Aging
    and Falls Risk
    Heart and arteries
    Lungs
    Brain
    Postural Instability
    Bladder
    Body wt and body fat
    Muscular-skeletal
    Sight and hearing
    Acute and Chronic
    Conditions and Falls Risk

    Arthritis
    Stroke
    Parkinsons
    Dementia
    Neuropathy
    Cardiac
    Osteoporosis
    Population by Age: US Census
    "Year 2000"
    35 to 44
    17%
    4%
    1%
    7%
    6%
    55 to 64
    9%
    45 to 54
    14%
    7%
    7%
    7%
    7%
    7%
    7%
    under 5
    5 to 9
    10 to 14
    15 to 19
    20 to 24
    25 to 29
    30 to 34
    35 to 44
    45 to 54
    55 to 64
    65 to 74
    75 to 84
    85 and over
    Leading Causes of Death: 65+

    1. Heart Disease
    2. Cancer
    3. Stroke
    4. COPD/Pulmonary disease
    5. UNINTENTIONAL INJURIES

    Top Causes of Injury Among Older
    Adults, CA

    Falls
    Suicide
    Motor Vehicle Accidents

    Hospitalizations Due to
    Unintentional Injuries by Age in
    Alameda County
    2000 Data, CA Dept of H & HS
    0-20
    21-44
    45-64
    65+
    0
    500
    1000
    1500
    2000
    2500
    3000
    3500



    Unintentional Injuries: 60+
    Alameda County
    77% from falls
    falls all others
    What is a fall?
    A fall is defined as an unintentional
    loss of balance that leads to failure
    of postural stability (Nelson and Amin 1009)

    Recurrent fallers are those that have
    fallen 2 or more times in either 6 or
    12 months (Studentski et all 1994, Gregg et all 2000)
    Health Care:
    What is a fall?
    A fall is a sudden and unexpected
    change in position, usually resulting
    in landing on the floor.

    Finding a patient on the floor or
    lowering or assisting a person to the
    floor is considered a fall and needs
    to be documented as such.

    Myths about falling

    Due to carelessness.
    A normal process of aging.
    They just happen.
    Cannot be predicted or anticipated.
    Facts About Falling
    1/3 of community dwelling older adults fall
    annually: 50-100% in nursing homes.

    95% of hip fractures result from a fall.

    Of those who fall, 25% suffer injuries that
    reduce mobility and independence.

    50% of those who sustain injury from a fall
    can no longer live independently.
    Facts About Hip Fractures
    1 in 7 women will break hip.

    25% will regain full functional ability.

    50% will end up in nursing home.

    25% will die within one year.

    Risk of dying from osteoporosis =
    Risk of dying from breast cancer

    Why Do People Fall? summary of 12 studies
    Accident/environment- 31%
    Gait/balance problem 17%
    Dizziness/vertigo 10%
    Confusion 4%
    Postural hypo-tension 3%
    Vision 3%
    Other and unknown 20%

    Where do people fall?
    For those 65+
    - 60% happen at home
    - 30% occur in public places
    - 10% in health care institutions


    Facts About Falls and Hospitals
    .6 2.9 falls per bed annually in hospitals;
    (Rubenstein 2000)

    14% of d/c pts. fall the first month after
    discharge;

    falls are the BEST predictor of nursing
    home placement;

    40% of nursing home placements due in
    some way related to a fall.

    Cost of falls
    8% of those over 70 visit ER annually for a fall.

    1/3 of these are hospitalized.

    5.3% of hospitalizations of those over 65 are
    directly due to falls.

    Ave. cost per fall for 65+= $19,440 (excluding
    MD). Rizzo 1998

    Cost to US-estimate: $20B 1995 2020 $32B.

    Cost of Falls in Nursing Homes
    Falls in nursing homes once again
    make up the largest number of
    claims against nursing homes
    insured by St Paul Medical Service.
    The St Paul Annual Report to Shareholders
    Falls are Predictable:
    Risk Factors for Falls
    Impairments in
    Cognition.
    Vision or hearing.
    Feet.
    Lower extremity strength.
    Balance or gait.
    Postural hypo-tension.
    Syncope and arrhythmia.
    Risk Factors for falls, cont.
    Medication use
    Total number over 4 AND/OR

    - Sedatives: confusion, motor dysfunction
    - Anti-psychotics: hypotension
    - Anti-depressants: hypotension
    - Anti-hypertensives: postural hypo-tension
    - Anti-anxiety: Confusion
    - Diuretics: Urinary urgency resulting in a
    fall

    Risk Factors for Falls, cont.

    Alcohol intake.
    Dehydration.
    Poor Nutrition.
    - Vitamin D
    - Calcium

    Falls Risk,Extrinsic Factors
    Poor lighting.
    Uneven or slippery surfaces.
    Loose rugs.
    Steep stairs.
    Clutter/pets in pathway.
    Lack of handrails (inc bathroom).
    Furniture wrong height.
    Long bathrobe.

    Falls in the Hospital:
    Client Risk Factors
    Postural hypo-tension.
    Lowest weight percentile.
    Medications: 4+ or sedatives.
    Previous fall.
    Impaired arm strength or range of motion.
    Uneven gait.
    Unable to move from bed to bath without
    assistance.

    Falls in the Hospital:
    Institutional Risk Factors

    Recent admission.
    Furniture placement.
    Slick and/or hard floors.
    Unsupervised activities.



    Falls in the Hospital:cont
    Institutional Risk Factors

    Reduced # of nurses.
    Meal times.
    Absent handrails.
    Poor lighting.




    ED Assessment of falls(Aannals of internal meds 1997
    Things to consider in the History & Physical
    Elder abuse
    Alcohol abuse
    Medication review
    Falls in preceding months
    Hydration
    Malnutrition
    Eye exams in past year
    Gait, strength and balance
    Environmental hazards

    Validated Falls Risk
    Assessment Tools
    In-patient
    STRATIFY
    Morse
    Develop your own!! Success is wildly
    mixed in research studies

    75% of RNs from 150 institutions wanted
    more falls prevention support.

    STRATIFY as an example:
    Predicts up to 93% of falls
    Did patient present with a fall?
    Has s/he fallen since admission?
    Is patient agitated?
    Patient severely visually impaired?
    Patient needs frequent toileting?
    Transfer and mobility ability?


    Special Considerations for
    high risk patients
    1. ID bracelets or sticker on chart
    2. Bed alarms
    3. Special flooring
    4. Hip protectors
    5. Toileting rounds at shift change
    6. Terry slippers
    7. Motion sensing lights
    8. Work with PTs
    9. Patient closer to nursing station
    Educate the patient and
    their family
    Videos: in-house and at home
    Sit and be fit
    Written materials
    Community referrals
    BMD screening
    Pharmacists
    Call before you fall
    More than one cause
    more than one solution:
    Avoiding falls in the community
    Physical Activity Support
    THE FOUNTAIN OF YOUTH
    Strength
    Balance
    Fear of falling
    Osteoporosis
    Arthritis
    CHD
    DM

    More solutions..

    Change behaviors.
    Manage medications.
    Proper nutrition.
    Home modification.
    Community Resources.

    Area Agency on Aging
    Senior Centers
    Falls prevention focus groups
    Vital-Link
    FORE
    Local pharmacist
    GET A BUDDY!

    THANK YOU

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