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					      REDUCING RISK
       FOR FALLING
Developed by:
Carol Rice, Ph.D., R.N.
Professor and Extension Health Specialist
Texas AgriLife Extension Service

          Adapted from “Epidemiology of Falls in Older Adults” by Martha L. Rammel, MHEd, PT, School
          of Allied Health Sciences, University of Texas Medical Branch at Galveston, with support from
             the Texas Consortium of Geriatric Education Centers, Baylor College of Medicine, 1994.
DEFINITION:




              A fall is an unintentional loss of
              balance causing one to make
              unexpected contact with the
              ground or floor.
INCIDENCE OF FALLS IN
COMMUNITY:



 25% fall at age 70 y/o
 35% fall after age 75 y/o
 50% of older adults who fall, do so
  repeatedly
FALLS IN THE COMMUNITY
 Many have severe
  psychological trauma
 5% result in serious soft-tissue
  injuries
 Only 5% of falls result in a
  fracture
 90% do not result in physical
  injury
 Most common site is stairs
INCIDENCE OF FALLS IN
NURSING HOME:
 45% of residents fall at least once
  each year
 Average of 2 falls per person per
  year
 Over 1/2 of all falls result in no
  injury
FALLS IN NURSING
HOMES:
 28% are associated with soft-tissue
  injury
 11% produce severe soft-tissue injury
 6% result in fractures
 40% of nursing home admissions
  mention falls and instability as a
  contributing factor to admission
CONSEQUENCES OF FALLS:

  Mortality


  Injury and Disability



  Health Care Costs
MORTALITY CONSEQUENCE
OF FALLS:

 accounts for 1/3 of deaths in
 people over age 65
INJURY CONSEQUENCES
OF FALLS:

 10 - 15% of falls result in serious
  injury
 cause nearly 90% of fractures in
  the elderly
 42% require hospitalization
 cause > 200,000 hip fractures
  each year
DISABILITY CONSEQUENCES
OF FALLS:

 decline in activity level
 decline in functional
  independence
 increased fear and
  depression
 increased social isolation
Functional Decline After
Hip Fracture
                                                  Marottoli, Berkman & Cooney, 1992
% Able to Perform Independently




                                  90
                                  80
                                  70                                   Dressing
                                  60                                   Transfers
                                  50
                                  40                                   Walking
                                  30                                   Stair Climbing
                                  20                                   Walking 1/2 Mile
                                  10
                                   0
                                       Baseline 6 Week     6
                                        Status Post-Fix Months
                                                        Post-Fix

                                       Time Relative to Hip Fracture
COSTS CONSEQUENCES
OF FALLS:

  3 million hospital days per year
   for hip fractures
  long-term care required for half
   of hip fracture survivors
Causes of Texas Trauma, 1995
         (Estimated)
                             Occurrences
                                    Percent
   Cause                   Number   of Total

   Motor vehicle           6,670    45%
   Falls                   3,448    23
   Fires                    155      1
   Environment - weather    233      2
   Assault - homicide      2,473    17
   All other causes        1,774    12

   Total                   14,753   100%
CAUSES OF FALLS
 A Summary of 8 Studies by Nelson & Amin, 1990


                            Syncope 1%
Other/Unknown Factors 26%                Gait/Balance Disorders 12%
• confusion                                         Orthostatic Hypotension 5%
• medicines




                                                        Environmental
 Dizziness 8%                                           Hazards 37%

                            Drop Attacks 11%
CAUSES OF FALLS

 Internal


 External
INTERNAL RISK FACTORS:

   Internal conditions that affect one’s ability to
    maintain his or her balance.
EXTERNAL RISK FACTORS:
   Safety hazards within the environment that
    predispose one to slipping and tripping.
EXTERNAL RISK FACTORS:

   Stairway               Room Location
   Bathroom               Decreased nursing
   Bedrails                staff
   Assistive Devices      First week in
   Improper Shoes          different
                            surroundings
   Poor lighting
COMMON ACTIVITIES
IMPLICATED IN FALLS

 Descending stairs (more often than
  ascending)
 Transferring on and off beds, chairs, &
  toilets
 Bending over and picking up things from
  floor
 Walking in a straight line
REDUCE RISK FOR FALLING:

 Identify high risk persons
 Modify internal risk factors
 Modify environmental risk
  factors
IDENTIFYING THE AT-RISK
PERSON:
   History and physical
    exam
   TIMED “Get Up and
    Go” test
   Cognitive testing
   Medication review
   Environmental
    assessment
OBTAIN A FALL HISTORY:

       S - ymptoms
       P - revious falls
       L - ocation
       A - ctivity
       T - ime
EVALUATE FOR AGE-
RELATED CHANGES:
   vision
   reaction time
   bone density
   physical activity level
   muscle atrophy
TIMED “GET UP & GO” TEST
 Begin timing
 Rise from standard arm chair
 Walk to line on floor
    3 yards & 10 inches away from chair
    (3 meters=118 inches)
 Turn and return to chair
 Sit in chair again
 End timing
TIMED “GET UP & GO” TEST
PRECAUTIONS/RULES
 May use cane or walker
 Only valid for person able to walk
  unassisted except for cane or walker
ASSESSING MENTAL
STATUS:
   mood
   memory
   attention
   orientation
   reaction time
ASSESSING MEDICATIONS:
   number of drugs
   types of drugs
    sedatives
    antidepressants
    hypotensives
    diuretics
    estrogen replacement
INFLUENCE OF DRUGS:

    confusion
    hypotension
    weakness
    fatigue
    blurred vision
    slowed reactions
ASSESSING THE
ENVIRONMENT:
 adequate lighting?
 loose objects on floor?
 type of rugs/carpet?
 steps or stairs?
 wet surfaces?
 accessible telephone?
 clear path from bed to
  bathroom?
INTERVENTION TO
REDUCE FALL RISK
 Ask provider to evaluate medications
 Monitor BP & blood glucose
 Teach to get up slower
 Teach safe transfers
 Provide strength training
 Secure & use assistive devices
 Flag chart and/or room
 Avoid fluids & caffeine after 6 pm
INTERVENTION TO REDUCE
FALL RISK (cont’d)

 Clear path to bathroom
 Night lights
 No throw rugs
 Ambularm or Bed-Check systems
 Answer call lights promptly
 Provide adequate staff coverage during
  shift change and at night
          SUMMARY:
1. Identify persons at risk.

2. Identify environmental risks.

3. Make all possible modifications to
   reduce probability of falling.
What would you do to
reduce falls at home?
What would you do reduce
falls in your facility?
What would you do to
reduce falls at home?
What would you do reduce
falls in your facility?
   How could you reduce
   Jane’s risk for a fall?
      92 years old
      Confusion--worse at night
      Thorazine 50 mg at bedtime
      History of falls at home
      Urinary urgency
      Has dizzy spells


Educational programs of the Texas AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin.
               The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating

				
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posted:9/23/2011
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