factors contributing to the increased risk of falls among the elderly presented by: mary ann...
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Factors Contributing to the Increased Risk of Falls Among
the ElderlyPresented by:
Mary Ann Zelinsky, M.A., COMS, CVRT, BROS
2009 Regional AER Conference
November 13-15, 2009
Why Talk about Falls?
• Aging and Risk
• 341 people ages 65+ died from falls, public officials reviewed death certificates
• Rates of falls among MA 85+ nearly doubled
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Zelinsky, M.A.
Why Talk about Falls?
• Cost
• Nursing Homes
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Zelinsky, M.A.
Why Falls Occur?
• Intrinsic
• Extrinsic
• Complex Events
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Zelinsky, M.A.
Intrinsic FactorsAge-Related Changes
1. Vision
2. Balance
3. Gait
4. Musculoskeletal system
5. Cardiovascular system
6. Diseases
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Intrinsic FactorsNon-age Related
• Medications
• Fear
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Vision
• Adapt to darkness• Glare• Depth perception• Visual acuity• Visual field• Contrast sensitivity
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BalancePostural Sway
Age 6-9 yrs old
80 yrs old
Zelinsky, M.A. James H. Quillen, VAMC 8 Mt. Home, TN
Balance
• Righting Reflex
• Body displaced– Ankle strategy– Hip strategy
Zelinsky, M.A. James H. Quillen, VAMC 9 Mt. Home, TN
Gait
• Two phases
-Stance
-Swing
• Step length, speed,
and height
• Gender Differences
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Musculoskeletal System
Zelinsky, M.A. James H. Quillen, VAMC 11 Mt. Home, TN
• Lower extremities
• Calcification
• Limited extension
Cardiovascular System
• Baroreflex
• Syncope
• Postural hypotension
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Zelinsky, M.A.
• Prodomal Falls
• Acute Diseases
-Stroke
-Parkinson’s
-Osteoporosis
Diseases
Zelinsky, M.A. James H. Quillen, VAMC 13 Mt. Home, TN
Visual Impairments
Cataracts Glaucoma
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Zelinsky, M.A.
Medications
• Polypharmacy
• Meds mostly associated
with falls include
Diuretics Psychotropics
Hypnotics Anti-hypertensive
Sedatives NSAIDs
Laxatives Anti-DepressantsZelinsky, M.A. James H. Quillen, VAMC 15
Mt. Home, TN
Fear
• Number 1 worry among older adults in U.S.
• Avoidance
• Inactive cycle/Depression
Zelinsky, M.A. James H. Quillen, VAMC 16 Mt. Home, TN
Extrinsic Factors• Indoors -
1. Floors, 2. Stairways, 3.Bathroom
(Yale School of Medicine)• Outdoors-
1.Uneven sidewalks, 2. Crowds, 3. Bus
steps• Other –
1. Shoes (type/sole), 2. Glasses
Zelinsky, M.A. James H. Quillen, VAMC 17 Mt. Home, TN
Minimize Risk FactorsAssessments
• One leg balance test• Get-Up and Go Test
<10 sec =Freely mobile
<20 sec = Mostly Independent
• Frequency of Falls• Checklist for Home
-www.cdc.gov
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Minimizing Risk Factors
• Frequency of Falls
-Include area and suggest way to resolve
• Checklist for Home
-www.cdc.gov
Zelinsky, M.A. James H. Quillen VAMC Mt. Home, TN
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Minimizing Risk Factors
• Programs – A Matter of Balance• Exercise• -Tai Chi• -Strengthening• -Range of Motion
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Mt. Home, TN
• Guardian Alert 911
• www.logicmark.com
• One time cost - $199
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Zelinsky, M.A.
Minimizing Risk Factors at Home
Minimizing Risk Factors
• Bed mats• www.pelicanmanufac-
turing.com
• Gait belts• www.dmesupplygroup
.com
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Zelinsky, M.A.
Minimizing Risk Factors with Medicine Management
• www.envisionamerica.com
• Microchip embedded in label
• Any size bottle, box, vial, or tube
• Provides drug name, dosage instructions,
doctor name, prescription #Scrip
Talk 23James H. Quillen VAMC
Mt. Home, TN Zelinsky, M.A.
• Motion Sensing LED Stair Light
• 15’ motion range, over 270º, $30
• www.improvements-catalog.com
• www.mrbeams.com• Uses 3 C batteries• Outdoors/indoors
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Minimizing Risk Factors with Lighting
Zelinsky, M.A. James H. Quillen VAMC 24 Mt. Home, TN
Reviewing FallsO&M instructors prefer these types
References
• Arabadjis, Peter, “The Fundamentals of Geriatric Rehabilitation,” handout from presentation as part of the UMO Center on Aging-Geriatric Series. Hutchinson Center, Belfast, ME , April 30, 2003.
• Gandel, Catherine, “Going Steady”, AARP July –August 2003, (http://www.aarpmagazine.org/health/Articles/a2003-08-20).
• Fuller, George F., Falls in the Elderly. American Academy of Family Physician, 2000. (http://www.aafp.org/afp/20000401/2159.html).
• Hogan, David B., MacDonald, F.A., Betts, J., Brikcer, S., and et al. A randomized controlled trial of a community-based consultation service to prevent falls. Canadian Medical Association Journal. 2001: 165(5), 537-543.
• Hyman, Marybeth, Trzop-Haiden, S., “Pharmacotherapy in the Elderly,” handout from presentation as part of the UMO Center on Aging-Geriatric Series, EMMC, Bangor, ME. March 18, 2003.
References Cont’d
• Kleinfield, N.R. The elderly and fear of falling. The New York Times, March 6, 2003 as found in The International Herald Tribune (www.iht.com).
• Lord, Stephen, R. Sherrington, C, and Menz, H. B. Falls in older people Risk factors and strategies for prevention. Cambridge University Press: Cambridge, United Kingdom, 2001 (http://www.cambridge.org).
• Northridge, Mary E., Nevitt, M.C., Kelsey, J.L., and Link, B. Home Hazards and Falls in the Elderly: The Role of Health and Functional Status. American Journal of Public Health. 1995:85 (4), 509-515.
• Tideiksaar , Rein. Falls in Older People Prevention and Management. Health Professions. Press: Baltimore, 2002 (www.healthpropress.com).
Websites
• Administration on Aging (AOA), www.aoa..gov• American Associaiton of Retired Persons (AARP), www.aarp.org• American Geriatrics Society (AGS), www.americangeriatrics.org• American Society on Aging (ASA), www.asaging.org• The Boston University (BU)Roybal Center for the Enhancement of
Late-Life Function,• www.bu.edu/roybal (A Matter of Balance –falls prevention program)• The Centers for Disease Control and Prevention (CDC),
www.cdc.gov