Transcript Falls in the Elderly

Falls in the Elderly
Judith Harris, DNP, FNP-BC
Deborah Doerfler, Ph.D., PT
Objectives

Increase awareness of the problem;
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Identify who falls, what age, what gender;
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Become aware of the risk factors;
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Discuss methods of assessment and prevention measures;
and
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Recommend methods for improving strength and balance.
Who Falls?
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1 in 3 adults ages 65 and older fall each year.
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Unintentional falls are the leading cause of nonfatal and
fatal injuries for older adults. In New Mexico falls are the
leading cause of injury-related death and hospitalizations
among adults 65 years and older.
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Women age 65 years and older fall more frequently than
men. After age 85 years, men are more likely to die from
a fall than a woman.
Risk Factors
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Lower body weakness
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Difficulties with gait and balance
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Use of psychoactive medications
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Postural dizziness
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Poor vision
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Problems with feet and/or shoes
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Home hazards
Senior Health Clinic
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All patients are asked whether they’ve fallen in the past year and/or since
their last visit to the clinic.
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A brief fall risk assessment could be done: the Get up and Go, which has
proven reliable for assessing balance problems.
Assessment: Get up and Go
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1. Sit comfortably in a straight-backed chair.
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2. Rise from the chair.
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3. Stand still momentarily.
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4. Walk a short distance (approximately 3 meters).
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5. Turn around.
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6. Walk back to the chair.
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7. Turn around.
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8. Sit down in the chair.
Scoring for Get up and Go
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Observe the patient's movements for any deviation from a confident, normal
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performance. Use the following scale:
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1 = Normal
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2 = Very slightly abnormal
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3 = Mildly abnormal
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4 = Moderately abnormal
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5 = Severely abnormal
Scoring criteria-Get up and Go
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"Normal" indicates that the patient gave no evidence of being at risk of falling
during the test or at any other time.
"Severely abnormal" indicates that the patient appeared at risk of falling
during the test.
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Intermediate grades reflect the presence of any of the following as indicators
of the possibility of falling: undue slowness, hesitancy, abnormal movements
of the trunk or upper limbs, staggering, stumbling.
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A patient with a score of 3 or more on the Get-up and Go Test is at risk of
falling
Medication Review
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Refer to the American Geriatric Society Beers Criteria to ensure
medications prescribed for the elderly are not ‘potentially
inappropriate.’ Consider avoiding drugs on this list when prescribing
for adults 65 and older.
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Anticholinergic, i.e., Diphenhydramine
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Digoxin at doses higher than 0.125 mg per day
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Antiarrhythmic drugs, Amiodarone, Sotalol
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Barbiturates, Benzodiazepine, Nonbenzodiazepine hypnotics-Zolpidem
Postural Dizziness
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Check for orthostatic hypotension
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Check for Benign Postural Vertigo
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Check for Hydration
Check vision & Feet
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Acuity < 20/40 or no exam in >1 year
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Foot check, shoes
Home Safety Check
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Throw rugs
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Walk around furniture
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Objects on the floor
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Wires/Lamp cords
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Stairway lighted
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Handrails
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Shoes, books, papers on stairs
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Is the tub slippery
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Support when getting in and/or out of the tub
Quick Screen
Strength/POWER
Quick Screen - Balance
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Single leg stance (balance) = Uni-pedal
step test
 Timed
<
x 30 seconds
5 seconds
 Risk
 ***Eyes
of injurious falls
Closed
 More
sensitive
rehabmeasures.org
Reason for referral to PT
vs. Recommendations for Community Exercise
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Injurious fall
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Multiple unexplained falls (> 2)
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Determine primary deficit(s)
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multi-component exercise program
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Balance, strength/power, conditioning?
Patient Request
Additional Assessments by PT
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Dual tasking
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Sensory Interaction
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Response to perturbations
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Strength/power
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Timed stair climbing
Other Considerations
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Low vision/bifocals
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Shoe twist test
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Gait biomechanics – gait speed
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Fall recovery
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https://www.youtube.com/watc
h?v=QGU87lHjqh8
Falls Efficacy Scale
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Hip flexor & plantar flexor
stretching
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Confidence Scales
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Flexibility
Ø slippers
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Focuses on ADLs
The Activities-specific Balance
Confidence (ABC) Scale
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Higher level function
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Home environment
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Resources
Sensory Interaction Strategies
Eyes Open vs. Eyes Closed
Shoulder Width vs Narrowed Stance
Advanced: Narrow Base of Support
Ability to move lateral,
posterior
Perturbation Recovery
Determine Compensatory Strategies
ANKLE
HIP
STEPPING
Dynamic: Stairs - Obstacle Course
Navigation – Community Ambulation
Picking the right multi-dimensional
assessment tool
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Many Options
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Berg Balance Scale
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Dynamic Gait Index
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Tinetti
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Fast Gait Speed
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Barthel
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Etc…
Fall Prevention Methods
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Acknowledge the risk of falling and fear, if present
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Become involved with programs or activities that suit individual needs
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Silver sneakers
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Tai Chi
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Community Center for Exercise
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Chair exercises at home
References
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American Geriatric Society, www.americangeriatrics.org
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Center for Disease Control, www.cdc.gov
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New Mexico Department of Health, www.nmdoh.gov