Transcript Falls of Older Adults

Falls of
Older Adults
Objectives
1.
Describe demographics related to falls in
older adults.
2.
Identify organizational indicators to consider
when evaluating the impact of a Fall
Prevention Program.
3.
Identify risk factors related to falls in older
adults.
4.
Identify components in an evaluation of a fall.
5.
Discuss interventions for fall prevention and
minimizing injury in older persons.
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Demographics for 65+
• Falls remain the leading cause of
fatal/nonfatal injury
• Nonfatal injuries occur in 10% of all falls in
the US: hip fractures, dislocations, head
injuries, lacerations
• 70% of fall-related deaths
• For those over 75+ years old who suffer a
hip fracture from falling, 50% die within one
year.
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Demographics for 65+
• Annual acute care cost for fall-related fractures:
$10 billion
• 10% to 25% of institutional falls require hospital
care
• Hospitalized older adults = 84%
• Nursing home = 67%
• Community-dwellers = 35% to 40%
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Organizational Indicators
• Fall Index
Actual number of falls in a month
x 1,000
Number of patient days for the month
• Fall Injury Index
Number of fall-related injuries occurring in a month
x 100
Number of patient falls
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Organizational Indicators
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Falls Risk Assessment
Fall Risk Assessment
Try This Assessment
Series available at:
www.hartfordign.org
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Tinetti Balance and Gait Assessment
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Intrinsic Risk Factors
• Postural hypotension – declining baroreceptor
response
• Impaired mobility / gait / balance (Waddle and
Shuffle)
• Acute and chronic illness – syncope, seizures,
strokes, febrile conditions, COPD renal failure,
depression
• Polypharmacy
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Extrinsic Risk Factors
• Lighting – dim or glaring
• Floor Treatments – slick from wax or spills
• Furniture – cannot support leaning
• Footwear – fitted, nonslip
• Assistive devices and aids – no grab rails,
slippery tubs, chairs without armchairs
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Fall Evaluation Components
•
Activity at the time of the fall
•
Premonitory symptoms:
–
light-headedness, palpitations, dyspnea,
chest pain, vertigo, confusion,
incontinence, loss of consciousness,
tongue biting
•
Location of fall
•
Witnesses to fall
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Fall Evaluation Components
•
History of previous fall of the same or
different character
•
Past medical history
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Medications
•
History of falls may be difficult to elicit from
older adults
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Fall Evaluation Components
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Visual acuity
•
Cardiovascular system: blood pressure, pulse
(supine and standing), arrhythmia, murmur, bruits
•
Extremities: Arthritis, edema, podiatric problems,
poorly fitting shoes, ROM, strength
•
Neurologic system: Mental status testing, gait and
balance assessment (i.e., getting in and out of chair,
walking, bending, turning, reaching, ascending and
descending stairs, standing with eyes closed)
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Fall Evaluation Components
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Continency
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Romberg test, Sternal Push
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Injuries
•
Use of assistive devices
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Tools: Tinetti balance, Gait assessment, and
Fall Risk Assessment
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Assessment Interventions
•
Cognitive, sensory, mobility, mobility, mood state
•
Gait, balance, use of assistive devices (hand
rails, canes, walkers).
•
Alcohol use (may be difficult to get accurate
history).
•
Understanding of fall risk
•
Caregiver / surrogates’ understanding
•
Environment (lighting, loose rugs, slippery or
uneven flooring, exposed cords).
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Education Interventions
• Increase awareness; improve nurses’ attitudes
about falls; statistics
• Train the staff transfer skills from bed to chair
• Restraint-free attitudes
• Provide gait training, balance and strength;
appropriate use of assistive devices
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Environmental Interventions
• Decrease glare; provide dim light
• Elevated toilet seats; grab bars and handrail in
the shower, toilet and sink
• Stabilize furnishings; evaluate footwear
• Use signage (stickers, colored dots, wrist bands)
• Bed / chair exit alarm
• Remove clutter
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Treatment Interventions
• Decrease physical restraint use
• Evaluate medication regimen
• Reduce polypharmacy
• Evaluate continence needs; toileting schedule
• Exercise program; assistive devices
• Treat postural hypotension
• Gait training
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Summary
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Falls demographics
Success measures
Risk Factors
Components in a Fall evaluation
Fall prevention strategies
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