Transcript Fall Prevention

Haley Gladfelter
University of Findlay
DPT May 2012
[email protected]
Cindy Nagel MA, BSN, RNBC
Trauma Program Manager
St. Rita’s Medical Center
[email protected]
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What is considered a fall
Staggering statics about falling in older
adults
Dangers of falling
What to do if you fall
How to prevent and protect yourself from
falling
Balance exercises
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A fall, as defined by The Technical Assistance
Program (TAP) of the Ohio Department of Health
includes:
◦ An intercepted fall is still a fall.
 An episode where and individual lose his or her
balance but catches themselves before they fall.
◦ A fall without an injury is still a fall.
 If you fall but do not acquire an injury it is still
considered to be a fall.
◦ A fall to the ground where the individual is found
on the ground and or acquired an injury.
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The Ohio Department of Health (ODH) and
The Ohio Prevention Partnership reports:
◦ Falls in older adults 65 and older have reached
epidemic proportions
◦ Falls and fall-related injury seriously affect older
adults’ quality of life and present a substantial
burden to the Ohio health-care system.
◦ They surpass all other mechanisms of injury as a
cause of ER visits, hospitalization and death and are
higher than rates for all other injuries combined.
ST. RITA'S MEDICAL CENTER
Trauma Registry Patients- Cause Codes
2011
Pedestrian
ATV Bike
2% 2%
1%
Other
13%
Sport Assaults
3%
Burn
2%
5%
MVC
18%
Fall
50%
Motorcycle
3% GSW
1%
Farm
0%
Patients > 65 years of age
Mechanism of Injury
2011
Other Unknown
Assault
2%
MC
1%
1%
1%
Bike Burn
1% 1%
MVC
11%
Fall
82%
Other includes such mechanisms
as cut by saw, struck by falling
object, etc.
Mortality in patients > 65 years of age
Mechanism of injury
2011
PED
BURN
5%
6%
MVC
21%
MC
5%
FALL
63%
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Fall-related ER visit and hospitalization rates
increased 61% and 51% respectively from 2002 to
2009.
In 2009, there were 4 fall-related ER visits for
every 100 Ohio older adults and 10 fall-related
hospitalizations for every 1,000 Ohio older adults
From 2000 to 2009, Ohioans aged 65 and older
experienced a 125% increase in the number of
fatal falls and 112% increase in the fall death
rate.
On average, 2.3 older Ohioans suffered fatal falls
each day in 2009.
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Ohioans 65 and older accounted for
approximately 82% of fatal falls in 2009;
while they represent only 14% of the
population.
Risk for suffering serious injury after a fall
increases dramatically with advancing age.
Females 85 years and older account for half
of fatal falls, while they account for only 3% of
the female population
Fatal Falls per Year between 2000-2006
http://www.odh.ohio.gov/sitecore/content/HealthyOhio/default/vipp/~/link.as
px?_id=6A91950F498E4D048648B21DA985BEE7&_z=z
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Falls among older adults cost Ohio and its
residents $4.2 billion in 2003, more than
two-thirds (68 percent), of the total annual
costs of nonfatal, hospital-admitted falls.
Direct medical costs represent only a fraction
(8%) of the total cost.
Costs Associated with Falls Among Older Adults, Ages 65+, Ohio, 2003
Medical
$ 327,366,900
Work-Loss
$ 116,513,800
Quality-of-Life
$ 3,728,623,600
Total Costs
$ 4.2 billion
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In older adults
◦ Falls are the leading cause of injury- related deaths
◦ The most common cause of nonfatal injuries and
hospital admissions for trauma
◦ The most common fractures are
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Spine
Hip, pelvis, and leg
Forearm, upper arm, hand
Ankle
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The psychological consequences of any
fall, whether injury-causing or not, can be
severe, resulting in
◦ Fear
◦ Decreased quality of life from self‐imposed
restriction of activities,
◦ Social isolation and depressive symptoms.
◦ These “near-miss” falls can put someone at risk for
future falls as well if they are not adequately
assessed and managed by a health care
professional.
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Biological changes secondary to age
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Decreased balance and coordination
Slowed reaction time
Overall decline in strength and conditioning
Sensation issues
 Peripheral Neuropathy
 Decreased skin sensation
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FALLS ARE NOT A NORMAL PART OF AGING!
◦ Simple steps discussed later can significantly
decrease your risk of falling
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If an upper extremity injury
◦ Use elbow to push up to side sitting position
◦ Then use good arm to push to kneeling position
◦ Last use legs to help move to standing position
 Stationary object can be used to help stand
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If a lower extremity injury
◦ If lateral fall on side of hip
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Try to roll onto your back
Sit up to your bottom
Then scoot backwards across the floor using good leg
Keep affected leg still if possible
◦ If you fall on your bottom
 Try to scoot along the floor on the opposite side of the
hip
◦ Do not try to stand
◦ Always have a phone at that can be reached at floor
level such as an end table.
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Hand rails
◦ Into and out of home
◦ Going up and down steps
between levels in the
home
◦ Hand rails on both sides
is best, yet one side will
still increase your safety
significantly
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Do not leave clutter on
the floor
◦ News papers and
magazines can increase
risk of falls
http://www.familyhandyman.com/DIYProjects/Home-Safety/
http://www.mitrecontracting.com/railings/
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Remove all throw rugs
◦ Throw rugs are a HUGE
cause of falls in older adults
◦ The rug can slip under your
feet or a toe can get caught
◦ One small ruffle in the rug
can cause you to lose your
balance and fall
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Furniture arrangement
◦ Critical during nighttime
hours
 When arising from bed you
could be slightly dizzy and
disoriented
 Arrange furniture to ensure
that there is always a clear
pathway to enter and exit a
room.
http://www.boomerlivingplus.com/article/an_ounce_of_prevention
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Increase lighting in the
home
◦ Dull lighting can affect how
your view your
surroundings leading to
falls
◦ Can be a simple as
increasing the bulb watt
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Be mindful of small dogs
and cats
◦ Small dogs and cats can
end up under your feet
causing you to lose your
balance
http://info.aia.org/aiarchitect/thisweek08/0801/0801
p_lighting.cfm
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Bathroom Features
◦ Grab bars
 Should be installed in the
shower and beside the toilet
◦ “Walk in showers” with a
seat
 Removes the risk of falling
while stepping into a tub
shower
 The seat allows for you to
shower without the risk of
slipping and falling
◦ Elevated toilet seat
 Decreases the risk of falling
while getting up and down
from the toilet
http://acmedical.com/blog/?Tag=Adaptive%20home%20r
emodeling
http://www.seabridgewalkinbathau.com/avalon-walkinshower.html
Increase Physical Activity
1.
15 minutes of daily activities can increase muscle
strength, and balance.
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Walking
Biking
Swimming
Tia Chi
Yearly Eye Examinations
2.
Age related disease can increase risk of falling
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Cataracts
Macular degeneration
Diabetic retinopathy
Early detection is the key!!
Review Your Medications
3.
Ask your doctor if the medicine your are taking can cause
dizziness or drowsiness.
Discuss if your are taking your medicine safely
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Decrease risk of mixing medicine or taking too much
medication.
Remove Environmental Hazards
4.
Increase lighting
Remove all throw rugs
Watch for slippery floor
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Linoleum
Wood floors
Tile
Eliminate unsteady furniture
Think, Plan, Slow Down
5.
Many falls are caused by rushing
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Slow down and think though task you are performing before
completing the task
Be mindful of all safety concerns/fall risks and plan your tasks
accordingly
Always Have Emergency Phone
6.
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It is very important that you always have a cell phone or
life alert device for emergency situations
Always have a phone that can be reached from the floor
level (end table)
BE PREPARED!
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4 way hip
Calf raises (going up on toes)
Single leg standing
◦ All the above should be done by standing at a
stationary table or counter top for support.
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Side-walking
Mini squats against a wall
Toe taps at household objects
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Fall risks are a serious danger for older
adults. The following precaution may
significantly decrease you risk of falling.
◦ Remove environmental hazards and add additional
safety features to your home.
◦ Have annual eye examinations and asking your
doctors about your medications.
◦ Think, plan, and slow down before implementing
and completing a task.
◦ Always be prepared by having an emergency phone
ready.
◦ Stay active with at least 15 minutes of exercise daily
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http://www.nsc.org/nsc_events/Nat_Safe_Mo
nth/Documents/2012_Falls_Preventionpublic.
pdf
http://www.odh.ohio.gov/sitecore/content/H
ealthyOhio/default/vipp/~/link.aspx?_id=6A9
1950F498E4D048648B21DA985BEE7&_z=z

St. Rita’s Medical Center
◦ Trauma Services and Injury Prevention Program
 Cindy Nagel MA, BSN, RNBC
 419-226-9150
 [email protected]

University of Findlay
◦ DPT Class of 2013
 Haley Gladfelter
 419-204-7342
 [email protected]
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
Ohio Injury Prevention Partnership. Falls Among
Older Adults. Revised April 19, 2012. Available
at:http://www.odh.ohio.gov/sitecore/content/He
althyOhio/default/vipp/~/link.aspx?_id=6A9195
0F498E4D048648B21DA985BEE7&_z=z.Accessed
May 16, 2012.
National Safety Council. Preventing Slips, Trips
and Falls. Revised 2012. Available
at:http://www.nsc.org/nsc_events/Nat_Safe_Mon
th/Documents/2012_Falls_Preventionpublic.pdf.
Accessed May 16, 2012.