Transcript 4-RiskFactorsforfalls-2012

Risk Factors for Falls
(and injuries)
- intrinsic
- extrinsic
- modifiable with exercise
Specialist PSI Exercise Module
A Risk continuum ?
• Over 200 risk factors
documented in the literature
D
A
80
70
60
Drugs and alcohol
Age related
physiological changes
M Medical conditions
E Environment
50
%
Falling
(12
months)
40
30
20
10
0
0
1
2
3 4+
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Intrinsic vs Extrinsic
- we are all ‘trippers’
• Over HALF the falls experienced in the home are due to
environmental hazards - trips, slips, unsafe or unlit stairways
• A decline in a person’s intrinsic risk factors (declining function
and balance) mean that the extrinsic risk factors (loose mats,
slippery floors) no longer just cause a correctable trip - they
cause an injurious fall
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D - Drugs and Alcohol
• Cumulative effect of medication / time of day
• Prescribed medications / multiple drug regimes
– Analgesics
– Sedatives
– Diuretics
- Antidepressants
- Antipscyhotics
- ANY 4 OR MORE MEDICATIONS
• Heavy drinkers (>7 units per week)
(Campbell et al., 1989,
O’Loughlin et al., 1993)
• Mixing medications with alcohol
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A - Age related
physiological changes
• Deterioration in physical functions and systems
(strength, power, endurance, coordination, reaction, balance,
proprioception and neural control, asymmetry)
• Decrease in functional capacity, mobility and activity
• Deterioration in feet (bunions, corns, circulation,
neuropathies)
• Increase in cognitive impairment and depression
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Psychological risk factors
• Fear of falling
• Avoidance of activity
• Reduced quality of life
• Increased anxiety
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M - Medical
• Acute Infections
• Cardiovascular control - postural hypotension, drop
attacks, heart disease, stroke, tia’s
• Dementia, Alzheimer’s Disease
• Parkinson’s Disease
• Thyroid dysfunction
 Peripheral Neuropathies or myopathies
 Malignancies
 Impaired hearing or vestibular function (Menieres Disease,
Tinnitus)
 Impaired vision (macular degeneration, glaucoma, cataracts, visual
acuity, contrast sensitivity, adaptation to dark)
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M - Medical 2
• Foot deformities – pain, bunions, corns, hard skin, arthritis, oedema
 Urinary incontinence or urgency
 Receiving community health or social services
 Recent discharge from hospital
 Use of assistive walking aids - cane, zimmer
• Malnutrition / Anaemia - Nutritional recommendations are 10-20g
rda Vitamin D and 1,000mg rda calcium, Vit B12 deficiency leads to
sensory abnormalities
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E - Environment
Personal
risk
factors:
• glasses
(bifocals and
varifocals)
• footwear and
clothing
Outdoors:
Indoors:
• Poorly lit pathways • Loose carpets
• Uneven pavements
• Wires and cables
• Slippery leaves
• Unstable
furniture
• Rubbish, building
materials, obstacles
• Bus drivers!
• Change of level
• Poor lighting
• Cold rooms
Sentimentality or “never been a problem before”
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Not modifiable with
tailored exercise
• vision problems
• gender
• multiple medications
• social class
• chronic medical conditions
• poor housing
• hypothermia
• poor heating
• malnutrition
• poor footwear
• age
exercise may not have a major effect
Specialist PSI Exercise Module
Modifiable with tailored
exercise
•
•
•
•
•
•
low strength
low power
poor gait
poor mobility
poor balance
arthritis
•
•
•
•
•
depression
postural hypotension
cognitive impairment
urinary urgency
fear of falling
exercise is likely to have
a major positive effect
Specialist PSI Exercise Module
How can we identify older
people at high risk of falling?
• AGS/BGS guidelines - “get up and go” test as a filter
for a full assessment by a specialist clinician for
people who have fallen at least once. J Am Geriatr Soc
2001; 49: 664 – 672.
• Falls Risk Assessment Tool (FRAT) –
5 questions to assess risk.
J Public Health 2004;
26:138-143.
?? Usefulness in residential/nursing settings
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FRAT - Assessment of falls
risk in older people
Is there a history of any fall in the previous year?
How assessed? Ask the person.
Is the patient / client on four or more medications per day?
How assessed? Identify number of prescribed medications.
Does the patient / client have a diagnosis of stroke or Parkinson's
Disease?
How assessed? Ask the person.
Does the patient / client report any problems with their balance?
How assessed? Ask the person.
Is the patient/client unable to rise from a chair of knee height?
How assessed? Ask the person to stand up from a chair of knee height
without using their arms.
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PROFET: targeting risk
factors
(Close et al. Lancet 1999)
• Medical assessment
•
•
•
•
•
•
General medical
Postural hypotension
Visual acuity
Balance
Cognition and affect
Corotid sinus syndrome
• Occupational Therapy
•
•
•
•
Function
Physical handicap
Psychological handicap
Environmental hazards
• Referral /
intervention
–
–
–
–
–
Day hospital
GP
O/P
Optician
Social services
– Supply minor equipment
The rate of falls was reduced by 60%
Specialist PSI Exercise Module
Tinetti (1994) - Multifactorial
Risk factor
Intervention
Postural hypotension (N)
- postural exercise (ankle pump)
- medication review and adjust
Use of sedative-hypnotic
medication (N)
- taper-off and discontinue
- non-pharm. treatment of sleep problems
Use of 4+ medications (N)
- medication review and adjustment
Unsafe bath or toilet transfers
(N)
- transfer training
- environmental adjustment
Gait / balance impairment (P)
- gait, balance and/or strength exercise
- use of aids
Less than full range of motion
against resistance (P)
- resistance exercises
The rate of falls was reduced by 30%
Specialist PSI Exercise Module