falls prevention: putting evidence - selwyn foundation · powerpoint presentation author: office...

Falls Prevention:

Putting evidence

into practise

• Matthew Hodgson,

The Selwyn

Foundation

What is a fall?

WHO definition

‘…an event which results in a person coming

to rest inadvertently on the ground, or

floor, or other lower level.’

Gerontology Nursing Conference 2017

Who falls?


• World wide 37.3 million falls that require

medical attention occur each year, with

424000 fatal falls

• 28-35% of people aged 65+ fall each year

increasing to 32-42% for those 70 years+

• People aged 60+ have the highest risk of

death or serious injury from falls

Falls risk assessment

• History of falls

• Mobility problems and use of assistive devices

• Medications

• Poly pharmacy >4

• Sedation, confusion, BP Change

• Mental Status – Confusion, delirium

• Continence

• Equipment – IV pole, O2 tubes etc.

• Vision

• Orthostatic hypotension


Fall precaution measures

• Familiarise the patient with the

environment.

• Have the patient demonstrate call light

use.

• Maintain call light / bell within reach.

• Keep the patients personal possessions

within patient safe reach.

• Have sturdy handrails in patient

bathrooms, rooms, and hallway.

• Place hospital bed in low position when

pt in bed, raise to comfortable height for

transfers.


Fall precaution measures continued

• Keep hospital bed brakes locked.

• Keep wheelchair wheels locked when

stationary.

• Keep non slip, comfortable well-fitting

footwear on patient.

• Use night lights or supplemental lighting.

• Keep floor surfaces clean and dry. Clean

spills promptly.

• Keep patient care areas uncluttered.

• Follow safe handling practices.

AHRQ Toolkit


Balance

Maintaining center of

mass over base of

support.

Needs to be

responsive to the

interaction between

person, task &

environment.

Shumway-Cook 2001


Base of support


Centre of gravity / mass


Just in front of S2

Types of balance

• Static – Maintaining stability

• Reactive – Recovering from perturbation

• Proactive – Anticipatory


Balance inputs

• Proprioception

• Vestibular

• Somatosensory

• Visual


Balance is

multisensory

and therefore

involves

complex

central

processing with

communication

between many

different areas

of the brain.


Central processing of balance inputs

Balance outputs


Balance assessment

• Berg Balance

• Timed up and go

• Cognitive / manual timed up and go

• Sit to stand x5 / 30 secs

• 360 deg turn

• Alternate step test

• 4 stage balance test


Why do people fall?

Interaction between physiology, behaviour,

and environment.

• People with less function fall in less

challenging environments during less

challenging activities.

• People with better physical function fall

in more challenging environments or

during more challenging activities.


https://www.pinterest.com/pin/309763280599887321/

https://www.pinterest.com/pin/309763280599887321/

Exercise to prevent falls in older people

1. Exercise should include a high challenge

to balance

– Reduce base of support

– Move centre of gravity

– Standing without using arms for

support

2. 3hrs+ per week

– Exercise reduces fall rates by 21%

but if exercise for > 3hrs week the

fall rate reduction is 39%

3. Ongoing participation necessary


Exercise to prevent falls in older people continued

4. Interventions should be targeted at everyone

5. Either group or home based intervention

6. Include walking training, but not brisk walking for high risk individuals

7. Strength training may be included

8. Referral for other risk factors

9. Exercise may prevent falls in people with Parkinson's disease or cognitive impairment. There is no evidence that exercise alone reduces falls in residential care, or post stroke, or in those recently discharged from hospital

Updated recommendations (Sherrington et al 2016)


Also consider

Target exercise to an individuals specific

needs –

• Are they falling / losing balance in a

specific direction? Is their ankle strategy

reduced or is it saving response work

they need?

• What about vision? Are they falling at

night when light is low? Or trip over

things consistently within an impaired

visual field. Do we need to work on

balance with eyes closed / reduced

visual input?


Also consider continued

• Include a secondary cognitive or motor

challenge.

• If taking a class or designing a more

generalised programme we need to cover

all balance strategies including ankle

strategy, hip strategy and stepping +

static and dynamic responses.


Balance exercise prescription

Falls prevention exercises should be

specific to the individuals needs. This is

due to -

• Specific Adaption to Imposed

Demand(SAID principle)

• “Nerves that fire together wire

together”

• “You don’t get better at playing a

piano by practicing on a banjo”


Tailoring a programme

• Sustainable / Enjoyable

• Functional

• Lifestyle Integrated Programme



Aging well / Quality of Life

vs

Reducing falls rate

Further Discussion

Reference list

• http://www.who.int/ageing/publications/Falls_prevention7March.pdf?ua=1

• Exercise to prevent falls in older Adults: an updated systematic review and meta-analysis. Sherrington C et al. Br J Sports Med 2016;0:1-10. doi;10.1136/bjsports-2016-096547

• http://www.cochrane.org/CD007146/MUSKINJ_interventions-for-preventing-falls-in-older-people-living-in-the-community

• Step training improves reaction time, gait and balance and reduces falls in older people: a systematic review and meta-analysis. Yoshiro Okubo, Daniel Schoene, Stephen R Lord; http://bjsm.bmj.com/content/51/7/586


http://www.who.int/ageing/publications/Falls_prevention7March.pdf?ua=1

http://www.cochrane.org/CD007146/MUSKINJ_interventions-for-preventing-falls-in-older-people-living-in-the-community

http://bjsm.bmj.com/content/51/7/586

Reference list continued

• https://www.hqsc.govt.nz/assets/Falls/PR/ri

sk-assessment-tool-Oct-2014.pdf

• https://www.hqsc.govt.nz/assets/Falls/10-

Topics/topic3-risk-assessment-tools-care-

plans-Sep-2013.pdf

• https://www.hqsc.govt.nz/assets/Falls/10-

Topics/topic3-risk-assessment-tools-care-

plans-Sep-2013.pdf

• http://aic-learn.sg/uploadedFiles/Training_

Grants/HDMP-ILTC/A.Assessment%20Protocols

%20for%20Standardized%20Balance%20Tests%

20Modified.pdf

• https://www.ahrq.gov/professionals/systems

/hospital/fallpxtoolkit/fallpxtk3.html


https://www.hqsc.govt.nz/assets/Falls/PR/risk-assessment-tool-Oct-2014.pdf

https://www.hqsc.govt.nz/assets/Falls/10-Topics/topic3-risk-assessment-tools-care-plans-Sep-2013.pdf


http://aic-learn.sg/uploadedFiles/Training_Grants/HDMP-ILTC/A.Assessment Protocols for Standardized Balance Tests Modified.pdf


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