FALLS IN OLDER ADULTS Presented by: dr. menna shawkat Prepared by: Dr. shaimaa nabil rohaiem Lecturer of Geriatrics and Gerontology Ain Shams University

OBJECTIVES Know and understand: The importance of falls by older persons How to assess and treat falls by an older person

THE TIMED GET UP AND GO TEST Record the time it takes a person to: Rise from a hard-backed chair with arms Walk 10 feet (3 meters) Turn Return to the chair Sit down

Most adults can complete in 10 sec Most frail elderly adults can complete in 11 to 20 sec ≥14 sec =  falls risk >20 sec  comprehensive evaluation Results are strongly associated with functional independence in ADLs

FALLS Definition: coming to rest inadvertently on the ground or at a lower level One of the most common geriatric syndromes Most falls are not associated with syncope

EPIDEMIOLOGY OF FALLS Each year 30%–40% of community-dwelling persons aged ≥65, and about 50% of residents of long-term- care facilities, experience falls

SEQUELAE OF FALLS Associated with: Decline in functional status Nursing home placement Increased use of medical services Fear of falling

Risk factors of falls

RISK FACTORS OF FALLS BY OLDER ADULTS Rarely due to a single cause May be due to the accumulated effect of impairments in multiple domains (such as other geriatric syndromes) Complex interaction of: Intrinsic factors (eg, chronic disease) Challenges to postural control (eg, changing position) Mediating factors (eg, risk taking, underlying mobility level)

RISK FACTORS: INTRINSIC Age-related decline Changes in visual function Proprioceptive system, vestibular system Chronic disease Osteoarthritis Urinary incontinence “urge or stress” Postural hypotension Elderly female with post menopausal bleeding causing anemia Cognitive impairment Acute illness Post operative: spinal anesthesia (postural hypotension) General anesthesia (conscious level affection) Pain (delirium, conscious level affection)

RISK FACTORS: MEDICATION USE Specific classes, eg: Benzodiazepines Antidepressants Antipsychotic drugs Cardiac medications Hypoglycemic agents EXTRINSIC RISK FACTORS: Environmental Slippery floors Carpets or obstacles Poor lighting

FALLS ASSESSMENT Ask all older adults about falls in past year As about previous history of falls Screening tools: eg Timed up and go test Assess and treat osteoporosis Factors that play a role in bone loss related to estrogen deficiency: Increased resorption Osteoclast activity Fracture risk is inversely related to estrogen levels in post-menopausal women SERMs: RALOXIFINE is approved for osteoporosis prevention & treatment in postmenopausal women Referral to a geriatrician

TREATMENT Most favorable results with health screening followed by targeted interventions Aim to reduce intrinsic and environmental risk factors Interdisciplinary approach to falls prevention is most efficacious A Cochrane collaboration systematic review of interventions to reduce the incidence of falling in older adults was performed. Because of the large numbers of fall intervention trials and because interventions may be more effective in certain settings, systematic reviews of fall interventions were divided into two groups: fall prevention interventions among community dwellers and fall prevention interventions among institutionalized persons. The April 2009 update of the Cochrane systematic review of fall interventions among community dwellers included 111 individual trials. As of January 2008, a systematic review of falls interventions in acute and chronic hospital settings included 8 trials.

AGS FALLS PREVENTION GUIDELINES Recommendations include: Assessment of all older adults Assessment of anyone with history of falls Multifactorial interventions including: Minimize medications Initiate individually tailored exercise program Treat vision impairment Manage postural hypotension, heart rate and rhythm abnormalities Supplement vitamin D Manage foot and footwear problems Modify the house environment Cosponsored by the American Geriatrics Society and the British Geriatrics Society. Systematic reviews have concluded that there is no evidence that hip protectors are effective in reducing hip fractures in studies that randomized individual patients within an institution or among older adults living at home. However, adherence to the use of hip protectors was low in these studies, which many argue could explain the lack of efficacy. At least a dozen types of hip protectors are commercially available. Many of these hip protectors have not been tested in either the laboratory or in clinical trials. Despite the lack of evidence to date to support the use of hip protectors, it is not unreasonable to consider their use in patients at high risk of hip fractures who are willing to use them.

SUMMARY Gait disorders are associated with many diseases and syndromes, including falls Falls by older adults are common and usually multifactorial Falls predict functional decline Screening and targeted preventive interventions are most effective AGS falls prevention guidelines are available and recommend multifactorial interventions

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