Transcript Prevention of Falls in the Geriatric Patient & the TUG test

Prevention of Falls in the
Geriatric Patient
&
the TUG test
Julie Smith
PA Class of 2009
Advisor: Professor Fahringer
The Facts

Falls can occur and any age, but drastically rise
after the age of 65

1/3 of adults over 65 years of age fall each year
in developed countries



Falls are the leading cause of fatal and nonfatal
injuries in people 65 and older in the United
States.
The most common serious injuries are head
injuries, wrist fractures, spine fractures, and hip
fractures.
60% of falls occur at home, 30% occur in the
community and 10% occur in nursing homes or
other institutions.
More Facts




Tripping in the home is a cause of many falls
Falls account for 80% of all injury related
admissions to the hospital of people over 65
years of age worldwide
Fractures accounted for only 35% of non-fatal
injuries but 61% of the total costs related to
falls
Lower extremity injuries > Upper extremity injuries
Hip Fracture Statistics




90% of 352,000 hip fractures in the United States each
year are the result of a fall. By the year 2050, there will be
an estimated 650,000 hip fractures annually. This is nearly
1,800 hip fractures a day.
The cost of hip fracture care averages $35,000 per
patient.
Women have two to three times as many hip fractures as
men.
White, post-menopausal women have a 1 in 7 chance of hip
fracture during a lifetime. The rate of hip fracture increases
at age 50, doubling every five to six years.
More Hip Fracture Statistics


The risk of hip fracture for women
5'8 " or taller is twice that of women
who are under 5'2. "
Nearly one half of women who reach
age 90 have suffered a hip fracture.
The Really Scary Statistics
* ONLY 25% of hip fracture patients will
make a full recovery
* 40% will require nursing home care
* 50% will need a cane or walker

And ….
* 24% of those over age 50 will die
within 12 months.
Who is Falling?



Women fall 2-3 times more than
men
Women’s healthcare costs
associated with falls were 2-3 times
higher than men’s costs overall
15% of people who have fallen, fall
again
Why do we Fall?







Home Hazards, throw rugs
#1 Reason in the home to fall….. is
Tripping or slipping due to loss of footing
or traction
Medication side effects, iatrogenic
Reduced muscle strength
Poor vision/Ear dysfunctions/Vertigo
Balance problems
Osteoporosis? Fracture then fall?
Geriatric robbery





Loss of quality of life
Loss of independence
Premature entrance to a nursing
home
Premature death
Extremely expensive>many can lose
house, savings, drivers license, etc…
Risk Factors








Age and Gender
Heredity> DEXA Scan to r/o osteopenia
and osteoporosis
Women > Men
Home hazards
Medication, regularly review necessary
and unnecessary meds
History of Falls
Peripheral Neuropathy
Ear/Eye dysfunctions
What can we do in the office?
• Ask about fall hx, screen in
patient hx forms
• Review Medication list
• Assess fall risk
• Refer to Physical Therapy
Assessing Fall Risk

Can we assess Fall risk?

Is it accurate? Is it functional?



Tinnetti Test
Berg Test -balance
Timed Up & Go
The Timed Up and Go Test
aka “ TUG“ Test

Quick & Easy for provider & patient
Need :
How to do it:
a chair with arms
a person, and
10 feet measured out
-consider hallway
Patient sits in a chair with arms, you ask them to rise from the chair, walk 10 feet,
turn around, walk back to the chair and sit back down.
Patient is allowed to use a walking aid and glasses if normally used.
Video:
www.youtube.com
http://www.homehealthquality.org/hh/hha/interventionpackages/falls_prevention.aspx

Goal: Less than 12 seconds = independent

>12 seconds to complete= Risk for Falls

TUG with an obstacle
Additional Test

Single Leg Stance
• 30 seconds is a general goal
• Try eyes open and closed
• Everyone should try this!!
Fall Prevention Tips
1. Take a Fall History

communication with patient and
family to eliminate hazards
2. Medication review:
•
•
•
•
•
benzodiazepines
sleeping aids
neuroleptics
antidepressants
seizure meds
3. TUG TEST – shoot for <12 sec
If >12 sec, walking aid, PT,
patient education
4. Visual acuity <20/60 puts at
risk for depth perception
deficits. Refer if needed
Ear checks- ear infections,
vertigo symptoms
5. Bone density: Family hx,
Dexa scans and Treat:
Calcium, Vit D, Fosamax
6. Home hazard safety -

7.Gait dysfunctions: Abnormal
gait, improper use of walking aids
lead to falls, Refer to PT

8.
Musculoskeletal
abnormalities/weakness,
Refer to PT for strengthening

9. Impaired neurological
exam, DM patients with
peripheral neuropathies,
- Refer for EMG, PT

10. Medic Alerts especially for
those living alone
Patient Education



Eliminate or secure all throw rugs
with non-slip pads
Assess lighting, and have
nightlights for evening bathroom
trips
Install hand rails in bathrooms
and stairways

Easy access to contact and
emergency numbers

Slow changes in positions from
lying to sitting to standing

Sit in chairs with arms

No high heels ladies!

Remove clutter on floors and
stairways, cords especially

Proper use of walking aids include
actually using them

Always wear shoes or slippers
with rubber soles

Ear infections and eye problems
can lead to falls

Non-skid surface in bathtubs and
showers

Report any side effects from
medications involving dizzines

Evaluate thresholds for potential
tripping dangers

Stay active and practice a good
nutritional diet

Shower chairs and bedside
commodes are helpful

Take medicine as instructed
The Bottom Line



IT’S A BAD THING!!
BUT, YOU CAN MAKE
A DIFFERENCE
GIVE OUR ELDERS A
CHANCE TO TAKE
THE RIGHT STEPS
References


















1. Demura S, Uchiyama M. Proper assessment of the falling risk in the elderly by a physical mobility 2. Elley CR, Robertson MC,
Kerse NM, Garrett S, McKinlay E, Lawton B, et al. Falls assessment clinical trial (FACT):design, interventions, recruitment strategies,
and participant characteristics. BMC Public Health 2007, 7:185.
available
from:http://www.biomedcentral.com/1471-2458-7-185.
3. Fatalities and injuries from falls among older adults---United States, 1993-2003 and 2001-2005. MMWR Weekly Report Nov. 17,
206/55(45);1221-1224.
4. Healey F, Monro A, Cockram A, Adams V, Heseltine D. Using targeted risk factor reduction to prevent falls in older in-patients:a
randomized controlled trial. Age and Ageing 2004;33:390-395.
5. Kannus P, Khan KM, Lord SR. Preventing falls among elderly people in the hospital environment. MJA 2006;184 (8):371-373.
6. Laessoe U, Hoeck GC, Simonsen O, Sinkjaer T, Voigt M. Fall risk in an active elderly population-Can it be assessed? Journal of
Negative Results in BioMed 2007, 6:2.
7. Lord SR, Menz HB, Sherrington C. Home environment risk factors for falls in older people and the efficacy of home modifications.
Age and Ageing 2006; 35-S2 ii55-ii59.
8. Mansfield A, Peters A, LLiu B, Maki B. A perturbation-based balance training program for older adults:study protocol for a
randomized controlled trial. BMC Geriatrics 2007, 7:12. available from :http:/www.biomedcentral.com/1471-2318/7/12.
9. Melzer I, Benjuya N, Kaplanski J. Postural stability in the elderly:a comparison between fallers and non-fallers. Age and Ageing
2004;33;602-607.
10. Nordvall H, Gunhild Glanberg-Persson, Lysholm J. Are distal radius fractures due to fragility or falls? Acta Orthopaedica
2007;78:(2):271-277.
11. Ozcan A, Donat H, Gelecedk N, Ozdirenc M, Karadibak D. The relationship between risk factors for falling and the quality of life in
older adults. BMC Public Health 2005, 5:90. available from:http://www.biomedcentral.com/1471-2458//5/90
12. Peeters GE, deVries OJ, Elders PJ, Pluijm SM, Bouter LM, Lips P. Prevention of fall incidents in patients with a high risk of
falling:design of a randomized controlled trial with an economic evaluation of the effect of multidisciplinary transmural care. BMC
Ger. 2007, 7:15. available from :http://www.biomedcentral.com/1471-2318/7/15.
Shinichi Demura and Masanobu Uchiyama “Proper Assessment of the Falling Risk in the Elderly by a Physical Mobility Test with an
Obstacle”. Tohoku J. Exp. Med., Vol. 212, 13-20 (2007) .
13. Stenvall M, Olofsson B, Lundstrom M, Englund U, Borssen B, Svensson O, et al. A multidisciplinary, multifactorial intervention
program reduceds postoperative falls and injuries after femoral neck fracture. Osteoprorosis Int. 2007, 18:167-175.
14. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj. Prev.
2006;12;290-295.
15. van Schoor NM, Smit JH, Twisk JR, Bouter LM, Lips P. Prevention of Hip fractures by external hip protectors. JAMA, April 16,
2003-vol289, No. 15, p1957-1962.
16. Vassallo M, Sharma JC, Briggs RSJ, Allen SC. Characteristics of early fallers on elderly patient rehabilitation wards. Age and
Ageing 2003;32:338-342.
http://orthoinfo.aaos.org/topic.cfm?topic=A00121
VIDEO
http://www.youtube.com/watch?v=xx1XCpglOc