1. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Professor Keith Hill, Head, School of Physiotherapy and Exercise Science, Curtin University – Keith.Hill@urtin.edu.au Gippsland (Victoria): September 2014

2.  How common are falls among older people  What are the effects of falls on an older person  Why do older people fall  What effect does dementia have on falls  What should an older person do if they have a fall  How can a home care worker help clients to avoid falls  Case studies  Resources to help older people who fall

3.  One third of people over 65 years of age fall each year  10% cause a serious injury such as a fractured bone  Even falls that don’t cause an injury can cause loss of confidence in walking

4.  implicated in up to 40% of admissions to residential care  quality of life issues ◦ independence ◦ community living ◦ active life-style ◦ other

5. Intrinsic factors Extrinsicfactors Medications Healthproblems Ageing Environment Activityrelatedrisks

6. Poor eyesight Arthritis in the legs Dementia Incontinence Dizziness Also includes: - other medical conditions such as stroke, Parkinson’s disease -pain (low back and legs) -low blood pressure

7. Modifiable and non-modifiable risk factors

8. Intrinsic factors Extrinsicfactors Medications Healthproblems Ageing Environment Activityrelatedrisks

9. Poor lighting Loose mat or slippery / uneven surface Poor footwear

10. ….. having had a recent fall

11.  Why is this important? ◦ The Doctor can  assess the cause of the falls  provide treatment to reduce risk of a further fall ◦ But if the Doctor is not aware of the fall  there will be no actions put in place to reduce ongoing risk of falls  another fall is likely to occur

12.  Reduced awareness of environment and safety  Agitation  Wandering  Increased unsteadiness Even greater risk of falling

13. Poor eyesight Arthritis in the legs Incontinence Dizziness Poor eyesight Dizziness Incontinence Arthritis etc OFTEN THESE CAN BE TREATED Poor eyesight Dizziness Incontinence Arthritis etc

14.  85 yo lady  Lives at home alone, has a home care worker visit twice weekly  Has a personal alarm  Has been falling for more than 10 years  Multiple fractures from falls  Medical past history includes osteoporosis, diabetes, depression, osteoarthritis, cataracts  Medications include sleeping tablets, antidepressants, and several others  Increasing unsteadiness in past few months  Had a recent fall, has not seen Doctor about falls  Environmental hazards

15.                

16.  85 yo lady  Lives at home alone, has a home care worker visit twice weekly  Has a personal alarm  Has been falling for more than 10 years  Multiple fractures from falls  Medical past history includes osteoporosis, diabetes, depression, osteoarthritis, cataracts  Medications include sleeping tablets, antidepressants, and several others  Increasing unsteadiness  Had a recent fall, has not seen Doctor about falls  Environmental hazards

17. Can the risk of falls among older people be reduced? YES!

18.  If a person has a fall - even if they think it was just an accident  If a person is feeling more unsteady when walking / turning  Commences using a different walking aid  If a person is reducing their activities

20.  Group exercise programs  Home exercise programs (often prescribed by a physiotherapist)  Tai Chi- (note: different types of Tai Chi may have different effects)  Foot and ankle exercise as part of podiatric multi- faceted program (Spink et al, 2011)

21.  Usually under intermittent supervision of physiotherapist or accredited exercise physiologist  Often need for encouragement to maintain participation

23.  Keep medications to the minimum needed  Take medications as prescribed  Have medications reviewed by the doctor regularly  Try to avoid / minimise use of sleeping tablets, anti anxiety tablets etc Largest effect of any falls prevention study involved weaning people off sleeping / anxiety medications

24.  Regular vision review  Cataract surgery ◦ First eye effective  Bifocals and multi-focal glasses– can be a problem

25.  Removing environmental hazards will reduce risk of falls  If having falls should have an occupational therapy home assessment

26.  Many older people have low levels of vitamin D  Main sources of vitamin D are: ◦ Sunlight (approx 20 min/day) ◦ Some foods (eg sardines) ◦ Supplements  Vitamin D and calcium together have been shown to reduce fractures and falls (in high risk samples)

27.  Useful if falling frequently, and / or if bones are weak  Will reduce risk of hip fracture substantially, if worn...  Several different types ◦ Hard shields ◦ Foam

28. Safe footwear Treat postural hypotension Education Treat incontinence Change walking aid

29.  85 yo lady  Lives at home alone, has a home care worker visit twice weekly  Has a personal alarm  Has been falling for more than 10 years  Multiple fractures from falls  Medical past history includes osteoporosis, diabetes, depression, osteoarthritis, cataracts  Medications include sleeping tablets, antidepressants, and several others  Increasing unsteadiness in past few months  Had a recent fall, has not seen Doctor about falls  Environmental hazards  Use her personal alarm if a fall occurs and cannot get up  Discuss hip protectors / vitamin D / possibly bone-strengthening medications  Review re cataracts-?surgery  Review medications, in particular sleeping tablets  Physiotherapy assessment of balance and mobility - ?exercise program  Have a medical review AND report the fall  Home safety assessment by occupational therapist

30.  85 yo lady  Lives at home alone, has a home care worker visit twice weekly  Has a personal alarm  Has been falling for more than 10 years  Multiple fractures from falls  Medical past history includes osteoporosis, diabetes, depression, osteoarthritis, cataracts  Medications include sleeping tablets, antidepressants, and several others  Increasing unsteadiness in past few months  Had a recent fall, has not seen Doctor about falls  Environmental hazards POSSIBLE OPTIONS TO REDUCE RISK OF FALLS  Use her personal alarm if a fall occurs and cannot get up  Discuss hip protectors / medications to strengthen bones  Review re cataracts-?surgery  Review medications, in particular sleeping tablets  Physiotherapy assessment of balance and mobility, and to provide an exercise program  Have a review by a Doctor AND report the fall  Home safety assessment by occupational therapist Dementia friendly environment Ensure consideration of causes and management of agitation Other …..

31. image  Home exercise programs for people with dementia, supported by a carer, have been shown to reduce falls  Need for assessment by physiotherapist and provision of exercise program  Followup home visits, support from others (eg home care workers) to encourage ongoing participation

32.  David: ◦ 70 year old ◦ Inoperable hydrocephalus ◦ Frequent falls ◦ Unable to get up after a fall – needed ambulance call out  Treatments ◦ Home based physiotherapy commenced (low compliance so physio home visits, as wife and carers were unable to persuade participation) OUTCOMES Maintained mobility No falls Able to remain at home for extended period before further decline and need for Nursing Home

33.  James: ◦ 70 years old ◦ Alzhiemer’s disease ◦ Lived on hobby farm ◦ Previously active and enjoyed daily walks ◦ As dementia progressed, activity reduced and needed prompting / supervision  Treatments ◦ Not suitable for community Rehab because of high level of prompting and supervision needed ◦ Home based physio exercise program introduced ◦ Wife and home care worker monitored and supported exercises OUTCOMES 1.5 years later, balance had been maintained, continuing with supervised walking but small decline in endurance

34.  Look for indicators of increased risk: ◦ Signs of a fall (eg bruises) ◦ Increased unsteadiness (furniture walking) ◦ Change in type of walking aid used ◦ Increased difficulty getting out of a chair ◦ Increased environmental hazards in the home increasing risk of trips Report to your manager

35.  If the client has a home exercise program: ◦ ask the client about the program ◦ encourage regular completion of the exercise program Report to your Manager or the physiotherapist

36.  Falls are common among older people, especially in people with dementia, and can cause serious injuries and loss of confidence  All falls should be reported to a doctor  There are a number of ways that falls risk can be reduced  Home care workers can play an important role in identifying potential risks for falling among their client, and supporting participation in recommended fall prevention activities