Transcript Falls Prevention: Evidence Based Practices

Prevention of Falls in
Older Adults:
Evidence Based
Practices
By Mary Louise Zernicke,MS MPH RD
Consultant, Alameda County EMS/AAA
Physiology of Normal Aging
and Falls Risk
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Heart and arteries
Lungs
Brain
Postural Instability
Bladder
Body wt and body fat
Muscular-skeletal
Sight and hearing
Acute and Chronic
Conditions and Falls Risk
Arthritis
 Stroke
 Parkinson’s
 Dementia
 Neuropathy
 Cardiac
 Osteoporosis
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Population by Age: US Census
"Year 2000"
5 to 9
1%
6%
4%
10 to 14
7%
15 to 19
7%
55 to 64
9%
7%
20 to 24
25 to 29
45 to 54
14%
7%
30 to 34
35 to 44
7%
35 to 44
17%
under 5
7%
7%
45 to 54
55 to 64
65 to 74
75 to 84
85 and over
Leading Causes of Death: 65+
1.
2.
3.
4.
5.
Heart Disease
Cancer
Stroke
COPD/Pulmonary disease
UNINTENTIONAL INJURIES
Top Causes of Injury Among Older
Adults, CA
Falls
 Suicide
 Motor Vehicle Accidents
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Hospitalizations Due to
Unintentional Injuries by Age in
Alameda County
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2000 Data, CA Dept of H & HS
3500
3000
2500
2000
1500
1000
500
0
65+
45-64
21-44
0-20
Unintentional Injuries: 60+
Alameda County
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77% from falls
falls
all others
What is a fall?
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A fall is defined as an unintentional
loss of balance that leads to failure
of postural stability (Nelson and Amin 1009)
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Recurrent fallers are those that have
fallen 2 or more times in either 6 or
12 months (Studentski et all 1994, Gregg et all 2000)
Health Care:
What is a fall?
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A fall is a sudden and unexpected
change in position, usually resulting
in landing on the floor.
Finding a patient on the floor or
lowering or assisting a person to the
floor is considered a fall and needs
to be documented as such.
Myths about falling…
Due to carelessness.
 A normal process of aging.
 They “just happen”.
 Cannot be predicted or anticipated.
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Facts About Falling…
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1/3 of community dwelling older adults fall
annually: 50-100% in nursing homes.
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95% of hip fractures result from a fall.
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Of those who fall, 25% suffer injuries that
reduce mobility and independence.
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50% of those who sustain injury from a fall
can no longer live independently.
Facts About Hip Fractures
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1 in 7 women will break hip.
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25% will regain full functional ability.
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50% will end up in nursing home.
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25% will die within one year.
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Risk of dying from osteoporosis =
Risk of dying from breast cancer
Why Do People Fall?
summary of 12 studies
Accident/environment- 31%
 Gait/balance problem – 17%
 Dizziness/vertigo – 10%
 Confusion – 4%
 Postural hypo-tension –3%
 Vision –3%
 Other and unknown –20%
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Where do people fall?
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For those 65+
- 60% happen at home
 - 30% occur in public places
 - 10% in health care institutions
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Facts About Falls and Hospitals
.6 –2.9 falls per bed annually in hospitals;
(Rubenstein 2000)
14% of d/c pts. fall the first month after
discharge;
falls are the BEST predictor of nursing
home placement;
40%
of nursing home placements due in
some way related to a fall.
Cost of falls
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8% of those over 70 visit ER annually for a fall.
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1/3 of these are hospitalized.
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5.3% of hospitalizations of those over 65 are
directly due to falls.
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Ave. cost per fall for 65+= $19,440 (excluding
MD). Rizzo 1998
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Cost to US-estimate: $20B 1995 2020 $32B.
Cost of Falls in Nursing Homes
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“Falls in nursing homes once again
make up the largest number of
claims against nursing homes
insured by St Paul Medical Service.”
The St Paul Annual Report to Shareholders
Falls are Predictable:
Risk Factors for Falls
Impairments in…
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Cognition.
Vision or hearing.
Feet.
Lower extremity strength.
Balance or gait.
Postural hypo-tension.
Syncope and arrhythmia.
Risk Factors for falls, cont.
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Medication use
Total number over 4 AND/OR
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Sedatives: confusion, motor dysfunction
Anti-psychotics: hypotension
Anti-depressants: hypotension
Anti-hypertensives: postural hypo-tension
Anti-anxiety: Confusion
Diuretics: Urinary urgency resulting in a
fall
Risk Factors for Falls, cont.
Alcohol intake.
 Dehydration.
 Poor Nutrition.
- Vitamin D
- Calcium
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Falls Risk,Extrinsic Factors
Poor lighting.
 Uneven or slippery surfaces.
 Loose rugs.
 Steep stairs.
 Clutter/pets in pathway.
 Lack of handrails (inc bathroom).
 Furniture wrong height.
 Long bathrobe.
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Falls in the Hospital:
Client Risk Factors
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Postural hypo-tension.
Lowest weight percentile.
Medications: 4+ or sedatives.
Previous fall.
Impaired arm strength or range of motion.
Uneven gait.
Unable to move from bed to bath without
assistance.
Falls in the Hospital:
Institutional Risk Factors
 Recent
admission.
 Furniture placement.
 Slick and/or hard floors.
 Unsupervised activities.
Falls in the Hospital:cont…
Institutional Risk Factors
 Reduced
# of nurses.
 Meal times.
 Absent handrails.
 Poor lighting.
ED Assessment of falls
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(Aannals
of internal meds 1997
Things to consider in the History & Physical
Elder abuse
Alcohol abuse
Medication review
Falls in preceding months
Hydration
Malnutrition
Eye exams in past year
Gait, strength and balance
Environmental hazards
Validated Falls Risk
Assessment Tools
In-patient
 STRATIFY
 Morse
 Develop your own!! Success is wildly
mixed in research studies
75% of RN’s from 150 institutions wanted
more falls prevention support.
STRATIFY as an example:
Predicts up to 93% of falls
 Did patient present with a fall?
 Has s/he fallen since admission?
 Is patient agitated?
 Patient severely visually impaired?
 Patient needs frequent toileting?
 Transfer and mobility ability?
Special Considerations for
high risk patients
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3.
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6.
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8.
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ID bracelets or sticker on chart
Bed alarms
Special flooring
Hip protectors
“Toileting rounds” at shift change
Terry slippers
Motion sensing lights
Work with PT’s
Patient closer to nursing station
Educate the patient and
their family
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Videos: in-house and at home
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“Sit and be fit”
Written materials
 Community referrals
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BMD screening
 Pharmacists
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“Call before you fall”
More than one cause……
more than one solution:
Avoiding falls in the community
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Physical Activity Support
“THE FOUNTAIN OF YOUTH”
 Strength
 Balance
 Fear of falling
 Osteoporosis
 Arthritis
 CHD
 DM
More solutions…..
 Change
behaviors.
 Manage medications.
 Proper nutrition.
 Home modification.
Community Resources….
Area Agency on Aging
 Senior Centers
 Falls prevention focus groups
 Vital-Link
 FORE
 Local pharmacist
 GET A BUDDY!
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Packet and Resources