What is known about falls risk and falls prevention

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What is known about falls risk and falls
prevention

• Prof. Stephen Lord
• Prince of Wales Medical Research Institute

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Why are falls a problem?

• Falls are very common
• Falls contribute to mortality and morbidity
• Falls are costly
• Falls affect lifestyle choices and the
  independence of older people

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Why are falls a problem?

• Approx. 30 of people 65 years and older living
  in the community fall at least once per year. The
  rate is higher for people in residential aged
  care (40-50)
• Falls are listed in the top three causes of
  disability world wide
• Leading cause of injury-related death and
  hospitalisation in people aged 65 years and over.
  Falls account for 4 of all hospital admissions
  in this age group
• By 2051 one quarter of the Australian population
  will be aged 65 years and over (ABS 1997)

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Consequences of falls

• 5-15 of falls result in major injuries - soft
  tissue damage, head trauma, dislocations and
  fractures
• Reduced quality of life and independence- due to
  disability, loss of confidence and restriction of
  activity
• Can result in the placement of older person in
  residential aged care
• Can result in death- 1000 people died in
  Australia in 2000-2001

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Location of falls

• 50 of falls occur in and around a persons own
  home, the rest occur in public places and other
  peoples homes
• Most falls occur on level surfaces in commonly
  used rooms- bedroom, living room, kitchen
• Many falls do not involve an obvious
  environmental hazard such as a loose rug or
  slippery floor

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Risk factors for falls
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NSW Health Projected Costs to 2050
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Causes of Falls
Trip 39.7
Slip 13.2
Unsure 14.3
Balance 20.8
Weak legs 5.5
Dizzy 5.2
Faint 1
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Contrast sensitivity - MET
Melbourne Edge Test
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Lower Limb Strength
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Reaction Time- Hand Foot
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Maximal Balance Range
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Fear of falling

• Effects
• 29 to 92 in those who have suffered previous
  falls
• 12 to 65 in those who have not
• Associated with
• Poor balance, reduced strength, poor health
  status, frailty, poor balance, immobility,
  reduced quality of life , pain, anxiety,
  depression and isolation

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Falls prevention - What works?
High level balance exercise in groups or at home (functional balance exercises, Tai Chi)
Occupational therapy interventions in high risk populations
Cataract surgery
Withdrawal of sleeping tablets / tranquilisers
Pacemakers for black-out type falls
Multidisciplinary assessment of high risk populations
Comprehensive geriatric assessment in nursing homes
Targeted interventions in hospitals
Community populations
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What does this mean for me?How can I reduce my
risk of falling?
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Strength and balance - exercise

• Before starting get a medical clearance from your
  GP
• Carry out at least 2-3 times per week
• Start at a comfortable level and gradually
  increase the intensity of the exercise as you
  improve
• Warm up - 5 minutes (walking, moving arms and
  legs)
• Conditioning period - strengthening, balance,
  flexibility, endurance and co-ordination
  activities
• Cool down - 5-10 minutes (stretches, slow
  movements)
• It takes time for improvements to become apparent
• JOIN A GROUP EXERCISE PROGRAM

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Strength training
Front Knee Strengthening
Back Knee Strengthening
Side Hip Strengthening
Try and use ankle weights whenever possible.
People aged 80 and over will start with 1-2 Kg.
Need to be able to do 8-10 reps before fatigue.
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Balance exercises
Backwards walking (with/without support)
Ensure person can recover balance using lower
limb strategies before prescribing exercise
without support
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Medical care

• Maintain regular visits to your GP for treatment
  of any conditions that can lead to falls
• Manage your medicines minimise use of sleeping
  tablets and tranquilisers. These medications
  double the risk of falls!

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Eye sight

• wear single lens glasses, not bifocals or
  multifocals when outside
• wear a hat and/or sunglasses when out in the sun
  to reduce glare
• have eyes checked by a specialist every 12 months
• make sure your home is well lit, especially when
  getting up at night
• have cataracts removed if recommended by eye
  specialist

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Bi- and Multifocal glasses
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Unsteady balance and numb legs

• wear safe shoes
• make sure you have been tested for diabetes
• take particular care on rough, uneven ground
• avoid dimly lit areas
• use a walking stick or umbrella as a sensor to
  give feedback about the contour of the ground

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Unsafe shoes
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Shoe features that facilitate balance
firm fit
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The environment

• ensure your home is well lit
• mop up spillages on floors to avoid slips
• install hand rails near stairs if necessary
• report fall hazards (eg. cracked footpaths) in
  public places to local council etc

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