Prevention of Falls in Older Adults: Evidence Based Practices

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Prevention of Falls in Older Adults Evidence
Based Practices

• By Mary Louise Zernicke,MS MPH RD
• Consultant, Alameda County EMS/AAA

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Physiology of Normal Agingand Falls Risk

• Heart and arteries
• Lungs
• Brain
• Postural Instability
• Bladder
• Body wt and body fat
• Muscular-skeletal
• Sight and hearing

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Acute and Chronic Conditions and Falls Risk

• Arthritis
• Stroke
• Parkinsons
• Dementia
• Neuropathy
• Cardiac
• Osteoporosis

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Population by Age US Census
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Leading Causes of Death 65

• 1. Heart Disease
• 2. Cancer
• 3. Stroke
• 4. COPD/Pulmonary disease
• 5. UNINTENTIONAL INJURIES

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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

• 2000 Data, CA Dept of H HS

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Unintentional Injuries 60 Alameda County

• 77 from falls

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What is a fall?

• A fall is defined as an unintentional loss of
  balance that leads to failure of postural
  stability (Nelson and Amin 1009)
• 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)

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Health CareWhat is a fall?

• 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.

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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

• 1/3 of community dwelling older adults fall
  annually 50-100 in nursing homes.
• 95 of hip fractures result from a fall.
• Of those who fall, 25 suffer injuries that
  reduce mobility and independence.
• 50 of those who sustain injury from a fall can
  no longer live independently.

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Facts About Hip Fractures

• 1 in 7 women will break hip.
• 25 will regain full functional ability.
• 50 will end up in nursing home.
• 25 will die within one year.
• Risk of dying from osteoporosis
• Risk of dying from breast cancer

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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?

• 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.

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Cost of falls

• 8 of those over 70 visit ER annually for a fall.
• 1/3 of these are hospitalized.
• 5.3 of hospitalizations of those over 65 are
  directly due to falls.
• Ave. cost per fall for 65 19,440 (excluding
  MD). Rizzo 1998
• Cost to US-estimate 20B 1995 2020 32B.

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Cost of Falls in Nursing Homes

• 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

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Falls are PredictableRisk Factors for Falls

• Impairments in
• Cognition.
• Vision or hearing.
• Feet.
• Lower extremity strength.
• Balance or gait.
• Postural hypo-tension.
• Syncope and arrhythmia.

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Risk Factors for falls, cont.

• Medication use
• Total number over 4 AND/OR
• - 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

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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 HospitalClient Risk Factors

• 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.

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Falls in the HospitalInstitutional Risk Factors

• Recent admission.
• Furniture placement.
• Slick and/or hard floors.
• Unsupervised activities.

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Falls in the HospitalcontInstitutional Risk
Factors

• Reduced of nurses.
• Meal times.
• Absent handrails.
• Poor lighting.

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ED Assessment of falls(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

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Validated Falls Risk Assessment Tools

• In-patient
• STRATIFY
• Morse
• Develop your own!! Success is wildly mixed in
  research studies
• 75 of RNs from 150 institutions wanted more
  falls prevention support.

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STRATIFY as an examplePredicts 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?

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Special Considerations for high risk patients

• ID bracelets or sticker on chart
• Bed alarms
• Special flooring
• Hip protectors
• Toileting rounds at shift change
• Terry slippers
• Motion sensing lights
• Work with PTs
• Patient closer to nursing station

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Educate the patient and their family

• Videos in-house and at home
• Sit and be fit
• Written materials
• Community referrals
• BMD screening
• Pharmacists
• Call before you fall

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More than one causemore than one
solutionAvoiding falls in the community

• Physical Activity Support
• THE FOUNTAIN OF YOUTH
• Strength
• Balance
• Fear of falling
• Osteoporosis
• Arthritis
• CHD
• DM

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More solutions..

• Change behaviors.
• Manage medications.
• Proper nutrition.
• Home modification.

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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