Transcript Falls A Common Concern of Seniors

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 760-9696550.
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
Population Growth
Who Falls?
By Age
65- 69
70- 74
75- 79
80- 84
Per Year
22.4%
27.9%
31.4%
39.6%
Who Falls?
By Sex



Women 65+ 30%
Men 65+ 13%
Gender Differences
decrease after 75; at 85
Men = Women
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
Falls cause

Fear of falling
Falls cause:
Fear of falling
- limits activities
- leads to decreased
mobility/fitness
- increases social
isolation
- increases actual risk of
falling

Falls cause


Fear of falling
Increased risk of Nursing Home
Placement
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

Falls cause



Fear of falling
Increased risk of Nursing Home
Placement
Moderate to severe injuries
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
Falls cause




Fear of falling
Increased risk of Nursing Home
Placement
Moderate to severe injuries
Increased risk of death
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
> white women > black men > black women
- Men are more likely to die than women (49% higher
mortality rates)
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
Reasons Why Falls Occur
Intrinsic Factors
Extrinsic Factors
Normal Aging
Changes
FALLS
Intrinsic Factors
Normal Aging Changes
Neurologic
- proprioception
- reaction time
- righting reflexes

Intrinsic Factors
Normal Aging Changes


Neurologic
Gait
- Slower
- Stride length and arm swing
- Body flexion & head/torso; knees shoulders forward
- Lateral sway
Intrinsic Factors
Normal Aging Changes



Neurologic
Gait
Vision
-
Accommodation
Dark adaptation
Intrinsic Factors
Normal Aging Changes




Neurologic
Gait
Vision
Muscle mass
Reasons Why Falls Occur
Intrinsic Factors
Extrinsic Factors
Normal Aging
Changes
FALLS
Chronic & Acute
Disease
Intrinsic Factors
Chronic Disease




Cataracts, macular
degeneration
Arthritis
Parkinsons, Strokes
The “Dizzy’s”
Intrinsic Factors
Chronic Disease

The “Dizzy’s”
-
-
-
27% of seniors 65+ report during last month
37% last > 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
Intrinsic Factors
Acute Illness/Confusion

UTI, pneumonia, diarrhea, dehydration, vomiting
Reasons Why Falls Occur
Intrinsic Factors
Extrinsic Factors
Normal Aging
Changes
FALLS
Chronic & Acute
Disease
Trouble walking
Intrinsic Factors
Trouble Walking (Dysmobility)
- Trouble walking increases with age
- > 65 y/o: 15%
- 85 y/o: 25% men; 33% women
- 2/3 of seniors in hospital/Nursing Homes
can’t walk w/o assistance
Reasons Why Falls Occur
Intrinsic Factors
Extrinsic Factors
Normal Aging
Changes
Medications
FALLS
Chronic & Acute
Disease
Extrinsic Factors
 4+
prescriptions!
Extrinsic Factors
Medications
–
The big offenders
- Sedative/hypnotics
- Depression/anxiety/mood-stabilizing
medications
- Heart, blood pressure, seizure, incontinence,
other medications
Reasons Why Falls Occur
Intrinsic Factors
Extrinsic Factors
Normal Aging
Changes
Medications
FALLS
Environment
Chronic & Acute
Disease
Improper Use
of Cane/Walker
Extrinsic Factors
Environment
- Home hazards: bathrooms, stairs, clutter,
throw rugs, lighting, sidewalks
- "risky" behavior
Improper use of cane/walker
Falls: A Common Concern of Seniors
So What to Do?
So What to Do?

Screen for Risk Factors
Do your own Home Safety Evaluation
– Evaluate your activity; Exercise
– Talk to your doctor
–
So What to Do?

Nintendo Wii Golf
What your doctor will be thinking
None
Ask all >= 75+
>= 2 Falls
or
Balance/
Gait
Dx & Treat
1 Fall
or
Balance/
Gait
Join exercise
program
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
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
Specific Risk Factors,
Assessment, Management
Evidence shows these interventions work!
Estimated
Risk of
Reduction
Trials
%
#
14-27
2 of 3
Reduction in home hazards
19
1 of 1
Discontinuation of psychotropic
medication
39
1 of 1
25-39
3 of 3
Strategy
Health care-based strategy:
Balance, gait & strength exercise
Multifactorial risk assessment
with targeted management
Evidence shows these interventions work!
Strategy
Community-based strategy:
Specific balance or strength
exercise programs
Estimated
Risk of
Reduction
Trials
%
#
29-49
2 of 2
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 760-9696550.
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 2003:41-44
“What Causes Falls in the Elderly.” American Family Physician. 1 Apr. 2000.
http://www.aafp.org/online/en/home.html