F ALLS IN THE E LDERLY : W HO ? W HY ? W HAT H APPENS N EXT ? Rhonda Bugbee, RN, CEN Trauma Consultant

H ELP ! I’ VE F ALLEN AND I C AN ’ T G ET U P !

E MERGENCY V ISITS Falls are the leading cause of external injuries Most common in children less than 5 years old and adults 65 and older Trauma is the 5 th cause of death in those >65 years Falls are responsible for 70% of accidental deaths in people over 75 years old 1/4 of the elderly people who fracture their hips die within 6 months of the injury

L EADING C AUSES OF D EATH Age GroupFirst Leading Cause of Trauma Death Second Leading Cause of Trauma Death 35 – 64Motor Vehicle 36.8% Falls 29.6% 65+Falls 43.3% Motor Vehicle 10.2%

D EATH BY I NJURY S EVERITY S CORES Age Group1 – > %1.4%4.5%28% %4.3%11.8%43%

H IP F RACTURES In 1996 more than 250,000 older Americans had fractured hips 90% are associated with falls Excess of $10 billion Leading fall-related injury that results in hospitalization – which are often prolonged and costly.

T RAUMATIC B RAIN I NJURY Also a common injury following a fall Many elderly on “blood thinners” Symptoms may be subtle and not apparent at the time of injury.

R ISK F ACTORS FOR F ALLS Increased age Living alone Previous falls Use of a cane or walker Acute illness Reduced vision Glare intolerance Altered depth perception Decreased night vision Decline in peripheral vision

R ISK F ACTORS FOR F ALLS CVA that results in hemiparesis, sensory and/or motor function deficits Decreased range of motion and flexibility in lower legs and spine Weakness Decreased step length (short shuffling steps) Alzheimer’s or dementia Arthritis Parkinson’s disease Foot problems Toenail length, callouses, bunions, deformities

R ISK F ACTORS FOR F ALLS Difficulty rising from a chair Neurologic changes Slowed reaction times Diminished sensory awareness for light touch, vibration, and temperature Decline in proprioception Decreased hearing Impaired speech discrimination Excessive cerumen accumulation Loss of high frequency tones Risky behaviors

R ISK F ACTORS FOR F ALLS Medications Some antidepressants Sedatives Some antihypertensive and cardiac medications Hypoglycemic drugs Alcohol

P REVENTING F ALLS Exercise Physical Therapy assessment Review all medications by the health care provider Vision exam Podiatrist exam

P REVENTING F ALLS IN THE H OME Remove throw rugs Secure carpet edges Reduce clutter Remove cords and wires on the floor Avoid floor wax Push in the drawers

P REVENTING F ALLS IN THE H OME Check lighting for adequate illumination at night and on the stairs Install handrails on both sides of the stairwell Eliminate chairs that are too low to sit in and get out of easily Keep often used items in cabinets that can be reached easily without using a step stool. Wear well-fitting shoes and slippers with non- skid bottoms.

P REVENTING F ALLS IN THE B ATHROOM Install grab bars in the shower and by the toilet Use rubber mats in the bathtub and shower Install a raised toilet seat Keep drawers closed

P REVENTING F ALLS O UTSIDE THE H OME Repair cracked sidewalks Install handrails on stairs and steps Trim shrubbery along the pathway to the home Install adequate lighting by doorways and along walkways leading to doors.

P REVENTING F ALLS F ROM THE M EDICAL S TANDPOINT Test for balance – “Get Up and Go Test” Refer to PT for gait assessment Postural hypotension Taking 3 or 4 prescription medications Treat osteoporosis

W HAT H APPENS A FTER THE H IP F RACTURE ? One in four people that have a hip fracture that lived independently before the fracture had to live in a nursing home for a year afterward, according to the CDC Some never recover their balance and strength This can lead to depression and dementia and a downhill spiral. Unfortunately 1/4 of the elderly people who fracture their hips die within 6 months of the injury

S O W HAT TO D O ? Do safety checks of the home – inside and out Test for gait and balance Encourage exercise and movement Check the medications Dress right Get your feet checked and cared for If you drink, do so moderately