1. Falls in the Elderly Judith Harris, DNP, FNP-BC Deborah Doerfler, Ph.D., PT

2. Objectives  Increase awareness of the problem;  Identify who falls, what age, what gender;  Become aware of the risk factors;  Discuss methods of assessment and prevention measures; and  Recommend methods for improving strength and balance.

3. Who Falls?  1 in 3 adults ages 65 and older fall each year.  Unintentional falls are the leading cause of nonfatal and fatal injuries for older adults. In New Mexico falls are the leading cause of injury-related death and hospitalizations among adults 65 years and older.  Women age 65 years and older fall more frequently than men. After age 85 years, men are more likely to die from a fall than a woman.

4. Risk Factors  Lower body weakness  Difficulties with gait and balance  Use of psychoactive medications  Postural dizziness  Poor vision  Problems with feet and/or shoes  Home hazards

5. Senior Health Clinic  All patients are asked whether they’ve fallen in the past year and/or since their last visit to the clinic.  A brief fall risk assessment could be done: the Get up and Go, which has proven reliable for assessing balance problems.

6. Assessment: Get up and Go  1. Sit comfortably in a straight-backed chair.  2. Rise from the chair.  3. Stand still momentarily.  4. Walk a short distance (approximately 3 meters).  5. Turn around.  6. Walk back to the chair.  7. Turn around.  8. Sit down in the chair.

7. Scoring for Get up and Go  Observe the patient's movements for any deviation from a confident, normal  performance. Use the following scale:  1 = Normal  2 = Very slightly abnormal  3 = Mildly abnormal  4 = Moderately abnormal  5 = Severely abnormal

8. Scoring criteria-Get up and Go  "Normal" indicates that the patient gave no evidence of being at risk of falling during the test or at any other time. "Severely abnormal" indicates that the patient appeared at risk of falling during the test.  Intermediate grades reflect the presence of any of the following as indicators of the possibility of falling: undue slowness, hesitancy, abnormal movements of the trunk or upper limbs, staggering, stumbling.  A patient with a score of 3 or more on the Get-up and Go Test is at risk of falling

9. Medication Review  Refer to the American Geriatric Society Beers Criteria to ensure medications prescribed for the elderly are not ‘potentially inappropriate.’ Consider avoiding drugs on this list when prescribing for adults 65 and older.  Anticholinergic, i.e., Diphenhydramine  Digoxin at doses higher than 0.125 mg per day  Antiarrhythmic drugs, Amiodarone, Sotalol  Barbiturates, Benzodiazepine, Nonbenzodiazepine hypnotics-Zolpidem

10. Postural Dizziness  Check for orthostatic hypotension  Check for Benign Postural Vertigo  Check for Hydration

11. Check vision & Feet  Acuity 1 year  Foot check, shoes

12. Home Safety Check  Throw rugs  Walk around furniture  Objects on the floor  Wires/Lamp cords  Stairway lighted  Handrails  Shoes, books, papers on stairs  Is the tub slippery  Support when getting in and/or out of the tub

13. Quick Screen Strength/POWER

15.  Single leg stance (balance) = Uni-pedal step test  Timed x 30 seconds  < 5 seconds  Risk of injurious falls  ***Eyes Closed  More sensitive rehabmeasures.org Quick Screen - Balance

16. Reason for referral to PT vs. Recommendations for Community Exercise  Injurious fall  Multiple unexplained falls (> 2)  Determine primary deficit(s)  multi-component exercise program  Balance, strength/power, conditioning?  Patient Request

17. Additional Assessments by PT  Dual tasking  Sensory Interaction  Response to perturbations  Strength/power  Timed stair climbing  Flexibility  Hip flexor & plantar flexor stretching  Gait biomechanics – gait speed  Fall recovery  https://www.youtube.com/watc h?v=QGU87lHjqh8 https://www.youtube.com/watc h?v=QGU87lHjqh8 Other Considerations  Low vision/bifocals  Shoe twist test  Ø slippers  Confidence Scales  Falls Efficacy Scale  Focuses on ADLs  The Activities-specific Balance Confidence (ABC) Scale  Higher level function  Home environment  Resources

18. Sensory Interaction Strategies Eyes Open vs. Eyes Closed Shoulder Width vs Narrowed Stance

19. Advanced: Narrow Base of Support

20. Ability to move lateral, posterior

21. Perturbation Recovery Determine Compensatory Strategies ANKLE HIP STEPPING

22. Dynamic: Stairs - Obstacle Course Navigation – Community Ambulation

23. Picking the right multi-dimensional assessment tool  Many Options  Berg Balance Scale  Dynamic Gait Index  Tinetti  Fast Gait Speed  Barthel  Etc…

24. Fall Prevention Methods  Acknowledge the risk of falling and fear, if present  Become involved with programs or activities that suit individual needs  Silver sneakers  Tai Chi  Community Center for Exercise  Chair exercises at home

25. References  American Geriatric Society, www.americangeriatrics.orgwww.americangeriatrics.org  Center for Disease Control, www.cdc.govwww.cdc.gov  New Mexico Department of Health, www.nmdoh.govwww.nmdoh.gov