1. Falls A Common Concern of Seniors We offer a complimentary fall-risk and/or home safety assessments to our managed care seniors. Please call our Wellness Center at 760-969- 6550.

2. Falls: A Common Concern of Seniors More than 1/3rd of adults 65+ fall each year in US 50% of seniors that fall have fallen before As the Senior population increases, so will the absolute number of falls

3. Population Growth

4. Who Falls? By Age Per Year 65- 69 22.4% 70- 74 27.9% 75- 79 31.4% 80- 84 39.6%

5. Who Falls? Women 65+ 30% Men 65+ 13% Gender Differences decrease after 75; at 85 Men = Women By Sex

6. Who Falls? Community: 0.2 - 0.8 per person per year Hospital: 0.6 - 2.9 per person per year Long-term Care: 0.6 - 3.6 By Living Environment (rates)

7. Falls cause Fear of falling

8. Falls cause: Fear of falling - limits activities - leads to decreased mobility/fitness - increases social isolation - increases actual risk of falling

9. Falls cause Fear of falling Increased risk of Nursing Home Placement

10. Falls cause Increased risk of Nursing Home Placement - those 75+ who fall are 4-5x more likely to be admitted to long-term care for 1 + years

11. Falls cause Fear of falling Increased risk of Nursing Home Placement Moderate to severe injuries

12. Falls cause Moderate to severe injuries - bruises, - traumatic brain injuries - accounts for 46% of fatal falls - fractures: 6% of falls, including, spine, hip, leg, pelvis, ankle upper arm and hand

13. Falls cause Fear of falling Increased risk of Nursing Home Placement Moderate to severe injuries Increased risk of death

14. Falls cause Increased risk of death - 15,800 annual deaths in seniors d/t fall (2005); 1.8 Million treated in ER - 85% percent of deaths from falls from seniors 75 and older - after 75 years, white men have highest fatality rates > white women > black men > black women - Men are more likely to die than women (49% higher mortality rates)

15. Hip Fractures in Seniors - 1% of falls result in hip fractures ($10 billion cost) - 350,000 senior hip fractures/year - 60% have restricted mobility - 25% remain functionally more dependent - 25% die within 1 year

16. FALLS Reasons Why Falls Occur Intrinsic Factors Extrinsic Factors Normal Aging Changes

17. Intrinsic Factors Normal Aging Changes Neurologic - proprioception - reaction time - righting reflexes

18. Intrinsic Factors Normal Aging Changes Neurologic Gait - Slower - Stride length and arm swing - Body flexion & head/torso; knees shoulders forward - Lateral sway

19. Intrinsic Factors Normal Aging Changes Neurologic Gait Vision - Accommodation - Dark adaptation

20. Intrinsic Factors Normal Aging Changes Neurologic Gait Vision Muscle mass

21. FALLS Reasons Why Falls Occur Intrinsic Factors Extrinsic Factors Normal Aging Changes Chronic & Acute Disease

22. Intrinsic Factors Chronic Disease Cataracts, macular degeneration Arthritis Parkinsons, Strokes The “Dizzy’s”

23. Intrinsic Factors Chronic Disease The “Dizzy’s” - 27% of seniors 65+ report during last month - 37% last > 1 minute - 50% of those 80 or greater that are dizzy due to Benign Positional Vertigo - Usually due to many causes: - Meniere's disease, circulation, blood pressure drops, - anemia, heart rhythms, anxiety/depression

24. Intrinsic Factors Acute Illness/Confusion UTI, pneumonia, diarrhea, dehydration, vomiting

25. FALLS Reasons Why Falls Occur Intrinsic Factors Extrinsic Factors Normal Aging Changes Chronic & Acute Disease Trouble walking

26. Intrinsic Factors Trouble Walking (Dysmobility) - Trouble walking increases with age - > 65 y/o: 15% - 85 y/o: 25% men; 33% women - 2/3 of seniors in hospital/Nursing Homes can’t walk w/o assistance

27. FALLS Reasons Why Falls Occur Intrinsic Factors Extrinsic Factors Normal Aging Changes Chronic & Acute Disease Medications

28. Extrinsic Factors 4+ prescriptions!

29. Extrinsic Factors Medications – The big offenders - Sedative/hypnotics - Depression/anxiety/mood-stabilizing medications - Heart, blood pressure, seizure, incontinence, other medications

30. FALLS Reasons Why Falls Occur Intrinsic Factors Extrinsic Factors Normal Aging Changes Chronic & Acute Disease Medications Environment Improper Use of Cane/Walker

31. Extrinsic Factors Environment - Home hazards: bathrooms, stairs, clutter, throw rugs, lighting, sidewalks - "risky" behavior Improper use of cane/walker

32. Falls: A Common Concern of Seniors So What to Do?

33. Screen for Risk Factors – Do your own Home Safety Evaluation – Evaluate your activity; Exercise – Talk to your doctor

34. So What to Do? Nintendo Wii Golf

35. What your doctor will be thinking Ask all >= 75+ Dx & Treat Join exercise program None >= 2 Falls or Balance/ Gait 1 Fall or Balance/ Gait

36. Specific Risk Factors, Assessment, Management Assessment & Risk Factor Management Previous Falls? Change environment and activity to reduce recurrent falls 4+ MedicationsReduce High-risk medicationsReview & Reduce VisionAmple lighting without glare. Avoid multifocal glasses while walking. See eye doctor

37. Specific Risk Factors, Assessment, Management Assessment & Risk Factor Management Check BP  when standing? Diagnose & treat cause Check Balance & GaitDiagnose & treat cause Check Neuro examDiagnose & treat cause Check muscles/joints & range Diagnose & treat cause Check heartSee Cardiologist Home safety evaluationSee your handout

38. Specific Risk Factors, Assessment, Management

39. Evidence shows these interventions work! Strategy Estimated Risk of Reduction Trials Health care-based strategy:%# Balance, gait & strength exercise14-272 of 3 Reduction in home hazards191 of 1 Discontinuation of psychotropic medication 391 of 1 Multifactorial risk assessment with targeted management 25-393 of 3

40. Evidence shows these interventions work! Strategy Estimated Risk of Reduction Trials Community-based strategy:%# Specific balance or strength exercise programs 29-492 of 2

41. Falls A Common Concern of Seniors We offer a complimentary fall-risk and/or home safety assessments to our managed care seniors. Please call our Wellness Center at 760-969- 6550.

42. References Center for Disease Control and Prevention, National Center for Health Statistics, Health, United States, 2007. “Clinical Practice”. New England Journal of Medicine 2 January 2003:41-44. “What Causes Falls in the Elderly.” American Family Physician. 1 Apr. 2000. http://www.aafp.org/online/en/home.html http://www.aafp.org/online/en/home.html