1. Falls in the Elderly
Dr/Rehab F Gwada

2. Out lines: Definition of falls Incidence of falls
Risk factors of falls
Consequences of falls
Assessment
Prevention & intervention

3. Definition of Falls
Falls is an event which result in a person coming to rest on the ground or another lower level with or without loss of consciousness or injury.

4. Incidence of Falls One of every three adults
the seventh leading cause of death, Among people aged over 65 years
One of every three adults
over 65 years fall in every year

5. Where are people likely to fall?
For people 65 years old or older…..
Nursing Home 10%
Home 60%
Public Places 30%

6. Cont. unfamiliar environment
injury rates are more higher with 10 ~ 25% of nursing home, or long-term care facilities resulting in fracture, or sever tissue injuries (Rubenstein, 1999)
Falling will tend to occur within the first few days or first weeks upon entering a nursing home, Why?
That may be due to:
unfamiliar environment
person who admitting in has more chronic illness, medications, and immobility due to long time sitting or in bed.
24% of nursing home falls are due to the weakness and gait problems of the residents.
16% of nursing home fall caused by environmental hazards.
Higher use of psychotropic drugs (e.g. antidepressants) have been associated with risk of falling.

7. Fall Injuries in Older Adults
Up to 20-30% of falls in older adults result in an injury requiring medical care
Most fractures in Medicare population are due to falls
Falls in older adults are the second leading cause of SCI and traumatic brain injury(TBI)
Men have a higher rate of fatal falls (due to TBI)
Women are more likely to have non-fatal falls
CDC Falls Among Older Adults: An Overview (2009)

8. Cont.
Falls is a major cause of severe nonfatal injuries and common cause of hospital admissions (40%) for traumatic injuries among older adults.
Approximately 30~ 50 % of falls result in minor soft tissue injuries. Overall, 20~30% of those who fall suffer from moderate to severe injuries that limit mobility and independence, even the risk of death

9. Unintentional Fall Death Rates by Gender, Age 65 +, U.S. 1996
Falls are one of leading cause of deaths among people 65 years and older. Fall related deaths for men and women increase with advancing age. More than 60% of fall related death are occurred to the persons aged 75 years or older. Men aged over 85 years (128.3 per 100,000) were almost ten times higher for men in (11.5 per 100,000). Men showed consistently higher death rates than women.
Source: National Center for Health Statistics, Vital Statistics

10. Unintentional Fall Age-Adjusted Death Rates, Age 65 +, gender and race U.S.
White, Men
Black, Men
White, Women
For both men and women, death rates were higher for whites than for blacks. White men have the highest death rate (30 deaths per 100,000), followed by white women (19 deaths per 100,000) , black men (17 deaths per 100,000) and black women (10 deaths per 100,000) in 1998.
Black, Women
Source: National Center for Health Statistics, Vital Statistics

11. Consequences of Falls Mortality Morbidity Fractures
Soft tissue injuries
Head trauma
Joint distortions and dislocations
Loss of confidence - fear of falling
Restricted activity
In 2000, estimated fall-related injury cost was $20 billion. By 2020, the costs are projected to reach $44 billion.

12. Fractures 3% of all falls cause fractures.
Approx. 95% of hip fractures in older people aged over 65 years are the result of a fall
People who have a hip facture are 5 ~20% more likely to die in the first year following the injury than any other reason in the same age groups

13. Common Types of Fractures
Hip Fracture (pelvis, hip, femur)
Forearm (Wrist) Fracture
Spine Fracture
Ankle Fracture
Upper arm, hand

14. a psychological result of a fall (Fear of (Falling
Loss of self confidence
Fear of not being able to get up after a fall
Decrease of physical activity level and quality of life
result in recurrent fall occurrence
Physical injury is not the only impact of a fall.

15. Mechanisms of Fall Contributing factors Intrinsic :
Aging, poor balance
Extrinsic :
Home hazards
Occurrence of falls
No injuries
Fall Outcomes
A fall is not usually caused by a single factor. Most falls by older persons result from the numerous, or complex interaction of intrinsic ( personal or host) factors, and extrinsic (environmental) factors.
Soft tissues
injures,
trauma
Disability,
reduced
quality of life
Fractures
Loss of
Confidence

16. Risk factors of falls A-Intrinsic risk factors: Age Related changes
Visual function
Neurological function
Musculoskeletal function
Diseases (medical problems).
Female sex .

17. A: Most Common Intrinsic Fall Risk Factors
Muscle weakness
History of falls
Gait deficit
Balance deficit
Visual deficit
Chronic illness (Arthritis, Parkinson’s Disease, hypertension)
Impaired Activities of Daily Living
Depression
Cognitive Impairment
Age >65 years
American Geriatrics Society (2001), Guideline for the Prevention of Falls in Older Persons, JAGS, 49:

18. Relative risk ratio (RR) or Odd Ratio (OR) of Fall
From selected 16 studies, the most common risk factors for falls were listed. Muscle weakness was significantly related to fall events from 10 out of 11 studies. Also, history of fall was consistently associated with risk of recurrent falls. <a href=“ Click the image to enlarged image</a>
‘American Geriatrics Society (AGS) Panel on Falls in Older Persons’ Guidelines for the Prevention falls in older persons. (JAGS, 2001;49: )
J Am Geriatr Soc. 2001

19. B:Extrinsic or Environmental Factors
Medications :such as laxative ,antihypertensive, Narcotic , antidepressants
Home hazards
Clutter, loose rugs, slippery or uneven floor
Poor lighting on stairs and hallways
Lack of bathroom safety, e.g. grab bars in bathtub
Improper Footwear
Improper assistive devices
Busy street or elevated walkways

20. Assessment 1-History of falls
Environmental assessment: location, floor surface, lighting……..
Symptoms ' dizziness or vertigo, palpitation, chest pain ''
Previous fall '' during past year ''
Activity at time of falls .
Review current & past medications .
Chronic medical conditions

21. 2-Physical examination
Visions and hearing ability
Vestibular function.
Cardiovascular examinations 'arrhythmias , heart failure .
Neurological examination 'mental status, mood and behavior.
Musculoskeletal; examinations muscle weakness severe arthritis, limited
range of motion , foot problems.
Cognitive function evaluation
Mobility evaluation .
Balance &Gait
transfer (wheel chair patient )
3- Laboratory /diagnostics testing
complete blood count , X-ray , ECG

22. Intervention & Prevention—
Assessment & management of chronic conditions, vision, & hearing
Encourage health with exercise & nutrition
Osteoporosis screening
Medication review (reduce if possible)
Mental activity & focus training
Education to improve home environment
Confidence training for fear
Home Safety – Reducing hazards
Wear appropriate footwear(Firm back and cover with adjustable fastening, ankle support and non-slip sole)
Use assistive devices

23. Assistant Devices Hip pads Mobility aids Cane Walkers Wheelchairs
Bathroom aids
Elevated toilet seats
Grab bars

24. Environmental modification:
Provide adequate lighting in rooms and hallways with switches located at room entrance
Use nights keep flashlights,
Arrange furniture so that pathway are not obstructed
Provide stable furniture along pathway for balance and support
Provide nonskid rugs and carpets runners on slippery floors ,

25. Use elevated toilet seat or install toilet safety frame
Apply nonskid mat on tub floors
Provide handrails on both sides of bathroom

26. Intervention Programs
Exercise or physical therapy to increase/gain muscle strength, balance, and gait
Exercise programs composed of endurance, balance, gait training, strength training, and Tai Chi

27. Tai Chi Tai chi is a Chinese exercise system
that uses slow, smooth body movements to achieve a state of relaxation of both body and mind.
Its benefits
 Improve and maintain health. 
Help in achieving a state of physical and mental relaxation. 
 Strengthen the cardiovascular and
 immune systems

28. Thank you