Falls A Common Concern of Seniors

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Falls A Common Concern of Seniors

• We offer a complimentary fall-risk and/or home
  safety assessments to our managed care seniors. 
  Please call our Wellness Center at 760-969-6550.

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Falls A Common Concern of Seniors

• More than 1/3rd of adults 65 fall each year in
  US
• 50 of seniors that fall have fallen before
• As the Senior population increases,
• so will the absolute number of falls

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Population Growth
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Who Falls?

• By Age Per Year
• 65- 69 22.4
• 70- 74 27.9
• 75- 79 31.4
• 80- 84 39.6

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Who Falls?
By Sex

• Women 65 30
• Men 65 13
• Gender Differences decrease after 75 at 85 Men
  Women

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Who Falls?
By Living Environment (rates)

• Community 0.2 - 0.8 per person per year
• Hospital 0.6 - 2.9 per person per year
• Long-term Care 0.6 - 3.6

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Falls cause

• Fear of falling

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Falls cause

• Fear of falling
• limits activities
• leads to decreased mobility/fitness
• - increases social isolation
• - increases actual risk of falling

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Falls cause

• Fear of falling
• Increased risk of Nursing Home Placement

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Falls cause

• Increased risk of Nursing Home Placement
• - those 75 who fall are 4-5x more likely to be
  admitted to long-term care for 1 years

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Falls cause

• Fear of falling
• Increased risk of Nursing Home Placement
• Moderate to severe injuries

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Falls cause

• Moderate to severe injuries
• - bruises,
• - traumatic brain injuries
• - accounts for 46 of fatal falls
• - fractures 6 of falls, including, spine, hip,
  leg, pelvis, ankle upper arm and hand

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Falls cause

• Fear of falling
• Increased risk of Nursing Home Placement
• Moderate to severe injuries
• Increased risk of death

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Falls cause

• Increased risk of death
• - 15,800 annual deaths in seniors d/t fall
  (2005)
• 1.8 Million treated in ER
• 85 percent of deaths from falls from seniors 75
• and older
• after 75 years, white men have highest fatality
  rates gt white women gt black men gt black women
• - Men are more likely to die than women (49
  higher mortality rates)

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Hip Fractures in Seniors

• 1 of falls result in hip fractures
• (10 billion cost)
• 350,000 senior hip fractures/year
• 60 have restricted mobility
• 25 remain functionally more dependent
• 25 die within 1 year

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Reasons Why Falls Occur
Intrinsic Factors Extrinsic Factors
Normal Aging Changes
FALLS
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Intrinsic Factors

• Normal Aging Changes
• Neurologic
• - proprioception
• reaction time
• righting reflexes

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Intrinsic Factors

• Normal Aging Changes
• Neurologic
• Gait
• - Slower
• - Stride length and arm swing
• - Body flexion head/torso knees shoulders
  forward
• - Lateral sway

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Intrinsic Factors

• Normal Aging Changes
• Neurologic
• Gait
• Vision
• Accommodation
• Dark adaptation

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Intrinsic Factors

• Normal Aging Changes
• Neurologic
• Gait
• Vision
• Muscle mass

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Reasons Why Falls Occur
Intrinsic Factors Extrinsic Factors
Normal Aging Changes Chronic Acute Disease
FALLS
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Intrinsic Factors

• Chronic Disease
• Cataracts, macular degeneration
• Arthritis
• Parkinsons, Strokes
• The Dizzys

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Intrinsic Factors

• Chronic Disease
• The Dizzys
• 27 of seniors 65 report during last month
• 37 last gt 1 minute
• 50 of those 80 or greater that are dizzy due to
  Benign Positional Vertigo
• Usually due to many causes
• - Meniere's disease, circulation, blood
  pressure drops,
• - anemia, heart rhythms, anxiety/depression

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Intrinsic Factors

• Acute Illness/Confusion
• UTI, pneumonia, diarrhea, dehydration, vomiting

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Reasons Why Falls Occur
Intrinsic Factors Extrinsic Factors
Normal Aging Changes Chronic Acute
Disease Trouble walking
FALLS
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Intrinsic Factors

• Trouble Walking (Dysmobility)
• - Trouble walking increases with age
• - gt 65 y/o 15
• - 85 y/o 25 men 33 women
• - 2/3 of seniors in hospital/Nursing Homes
• cant walk w/o assistance

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Reasons Why Falls Occur
Intrinsic Factors Extrinsic Factors
Normal Aging Changes Chronic Acute Disease
Medications
FALLS
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Extrinsic Factors

• 4 prescriptions!

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Extrinsic Factors

• Medications
• The big offenders
• - Sedative/hypnotics
• Depression/anxiety/mood-stabilizing medications
• - Heart, blood pressure, seizure, incontinence,
  other medications

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Reasons Why Falls Occur
Intrinsic Factors Extrinsic Factors
Normal Aging Changes Chronic Acute Disease
Medications Environment Improper Use of
Cane/Walker
FALLS
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Extrinsic Factors

• Environment
• - Home hazards bathrooms, stairs, clutter,
• throw rugs, lighting, sidewalks
• - "risky" behavior
• Improper use of cane/walker

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Falls A Common Concern of Seniors

• So What to Do?

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So What to Do?

• Screen for Risk Factors
• Do your own Home Safety Evaluation
• Evaluate your activity Exercise
• Talk to your doctor

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So What to Do?

• Nintendo Wii Golf

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What your doctor will be thinking
Join exercise program
None
Ask all gt 75
1 Fall or Balance/ Gait
gt 2 Falls or Balance/ Gait
Dx Treat
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Specific Risk Factors, Assessment, Management
Assessment Risk Factor Management
Previous Falls? Change environment and activity to reduce recurrent falls
4 Medications Reduce
High-risk medications Review Reduce
Vision Ample lighting without glare. Avoid multifocal glasses while walking. See eye doctor
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Specific Risk Factors, Assessment, Management
Assessment Risk Factor Management
Check BP ? when standing? Diagnose treat cause
Check Balance Gait Diagnose treat cause
Check Neuro exam Diagnose treat cause
Check muscles/joints range Diagnose treat cause
Check heart See Cardiologist
Home safety evaluation See your handout
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Specific Risk Factors, Assessment, Management
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Evidence shows these interventions work!
Strategy Estimated Risk of Reduction Trials
Health care-based strategy
Balance, gait strength exercise 14-27 2 of 3
Reduction in home hazards 19 1 of 1
Discontinuation of psychotropic medication 39 1 of 1
Multifactorial risk assessment with targeted management 25-39 3 of 3
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Evidence shows these interventions work!
Strategy Estimated Risk of Reduction Trials
Community-based strategy
Specific balance or strength exercise programs 29-49 2 of 2
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Falls A Common Concern of Seniors
We offer a complimentary fall-risk and/or home
safety assessments to our managed care seniors. 
Please call our Wellness Center at 760-969-6550.

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References
Center for Disease Control and Prevention,
National Center for Health Statistics, Health,
United States, 2007. Clinical Practice. New
England Journal of Medicine 2 January
200341-44. What Causes Falls in the Elderly.
American Family Physician. 1 Apr. 2000.
http//www.aafp.org/online/en/home.html