Falls A major concern for the elderly

Falls - a major concern for the elderly

• 75% of falls do not result in serious injury, but the risk of injury increases with age.• 1/3 of individuals 65 years & ½ of people 80+ older experience a fall each year • 20% hospital & 40% nursing home admissions are related to falls• Falls in elderly can produce dependence and invalidism.• 95% of hip fractures are caused by falls• In NZ, falls cost ACC approx. $100m/year.

• Center for Disease Control – National center for injury prevention and control (2006). Falls among older adults: Summary of research findings. Retrieved February 20, 2007 from

• http://www.cdc.gov/ncipc/pub-res/toolkit/SummaryOfFalls.htm

• Joanna Briggs Institute (1998). Best Practice: Falls in hospitals. http://www.joannabriggs.edu.au/pubs/best_practice.php?pageNum_rsBestPractice=2&totalRows_rsBestPractice=44

• Johnston, M. (2006). Exercise schemes save elderly from falls. New Zealand Herald, August 14, 2006.http://www.nzherals.co.nz/category/story.cfm?c_id=204&ObjectID=10396078

• Women who fall sustain a greater degree of injury than do men

• In institutionalised older people, restraints in the form of physical modalities (lap belts; geri-chairs) and chemical modalities have precipitated the events they sought to prevent.

• Documented injuries and deaths resulting from these restraints include: strangulation, vascular and neurological damage, pressure ulcers, skin tears, fractures, increased confusion and significant emotional trauma.

Psychological effects

• Fear of falling again or not being able to get up independantly

Even if no physical injury occurs, fall victims may develop a fear of falling again and reduce their activities as a result; this can lead to unnecessary dependency, loss of function, decreased socialization and a poor quality of life.

• Loss of confidence• Increased dependency• Social isolation

Economic impact

• 20% of hospital admissions (US) of elderly directly related to falling

• Average length of stay twice that for a ‘faller’ than for a ‘non-faller’

• Nearly 50% of those hospitalised for hip fracture become institutionalised in long-term care

Intrinsic Risk Factors

• Reduced visual capacity; cataracts

• Poor vision at night and in dimly lit areas

• Less foot and toe lift during stepping; shuffling

• Altered centre of gravity leading to balance being lost more easily

• Urinary frequency & urgency• Cardiovascular/respiratory

changes• Disease or chronic illness effects

– i.e. hemiparesis• Foot/feet problems

• Poor fitting shoes and socks• Long robes or pant legs• Improper use of canes, walkers,

wheelchairs or using them without being prescribed, properly fitted or instructed in safe use

• Not using brakes during transfers!!

Disease-related symptoms

• Orthostatic hypotension• Incontinence• Reduced cerebral blood

flow• Oedema• Dizziness• Weakness• Fatigue

• Osteoporosis• Paralysis• Ataxia• Mood disturbances• Confusion

Medications – particularly those that cause:

• Drowsiness (benzodiazepines & sleeping tablets)• Dizziness (nitrates → Nitroglycerin, Imdur, Isordil)• Orthostatic Hypotension (for example: α or β

blockers, diuretics, narcotics/sedatives, Viagra, tricyclic antidepressants)

• Incontinence (for example: diuretics → Frusemide, sedatives, alcohol, anticholinergics, calcium channel blockers)

Extrinsic Risk Factors

Environmental Hazards• Wet surfaces• Waxed floors• Objects on floor• Poor lighting• Uneven surfaces• Tears in carpets or dog-

eared carpets• Steps in poor condition

Care-giver related factors• Improper use of

restraints• Delays in responding to

requests• Unsafe practices• Poor supervision of

problem behaviours

Assessment Fall prevention programmes

• A history of falls can predict an individual’s risk of future falls; therefore, persons who have experienced a fall or even a minor stumble should be carefully assessed to identify factors that may increase their risk of this problem.

• Some falls will occur, despite the best prevention measures.

• The fall victim should be assessed and kept immobile until a full examination for injury is done.

Assessment data following a fall may include, but not limited to:

• Skin breaks • Discolouration• Swelling• Bleeding / ecchymosis• Asymmetry of extremities, • Shortening of a limb/leg• External or internal rotation

– leg • Pain• NVS (GCS) & V/S

• Medical examination & x-ray are warranted if

fracture suspected

Interventions

• Assess risk for falling • Plan interventions to

reduce specific risk• Implement a falls-

prevention program i.e. Tai Chi programme that is supported by ACC.

• Include patient and family in planning care and preventative management regimes

• Assess home for potential hazards

• Create a safe environment

• Utilize safety devices such as hip protectors.

• Use night-lights• Monitor persons intake of

food, fluid and medications (monitor for polypharmacy)

InterventionsPhysical Modifications

   •    Cushion the landing surface.   •    Use specialized tile that absorbs the

impact of falls.   •    Pad the floor.   •    Cushion bony prominences.   •    Use padding around high-risk bony

prominences.   •    Gain weight (if appropriate).   •    Lower the distance to the floor surface.   •    Use low-rise beds.   •    Use futon beds or a mattress on the

floor.   •    Sit during dressing and shaving

whenever possible.   •    Sit in a shower chair instead of

standing in a tub.   •    Avoid high heels; use wedge heels or

flat shoes.

Behavioural Modification

   •  Slow the pace of activities.   •    Avoid risk-taking behaviours such

as climbing on ladders if unsteady.

   •    Rise slowly and dangle the legs before changing position.

   •    Pay attention to the environment, terrain, and uneven or

slippery surfaces.

Interventions

Environmental Safety    •    Paint curbs and edges.

   •    Remove intravenous tubing in the hospital setting.

   •    Remove urinary catheter and drainage bag.

   •    Install grab bars or rails.   •    Use the “Lifeline” for fall

detection.   •    Set a predetermined schedule for “checking in” with neighbours or friends.