Transcript Document 7323608

STOPping FALLS
one step at a time
Fall Prevention Center of Excellence
GOALS
 Make fall prevention a key public health priority
 Create, test and evaluate effective and sustainable
fall prevention programs
 Build a comprehensive fall prevention system in
California
Table of Contents
 Prevalence
 Awareness
 Falls outside the Home
 Falls in Home
 Prevention
 Medical Management / Risk Assessment
 Balance and Mobility
 Home Modification
 Tips to Take Home
Are you at risk of Falling?
 Do you take 4 or more medications daily?
 Have you fallen 2 or more times in the past 6 months?
 Do you wear floppy slippers or a long bathrobe?
 Do you have trouble getting in and out of the bathtub?
 Do you have trouble walking without holding on to
something?
 Do you have trouble getting in and out of a chair?
 Do you have throw rugs?
 Do you have stairs without rails?
 Do you have clutter in your walking space?
 Do you have trouble seeing pathways or pets?
Provided by the San Diego County Office of Public Health,
A Division of the Health & Human Services Agency
How many did you answer
yes to?
Falls are a serious health risk.
In the United States, ONE OF EVERY THREE
persons age 65 and older falls each year.
Among older adults, falls are the leading cause
of injury deaths and the most common cause of
injuries and hospital admissions for trauma.
In 2002, nearly 13,000 people ages 65 and
older died of fall-related injuries.
http://www.cdc.gov/ncipc/pub-res/toolkit/toolkit.htm
Falls Heard Around the World:
Pope falls down, cuts head.
Sandomierz, Poland June 6, 1999
Queen Mother recovering after
two falls in a week.
November 6, 2000
Famous “Fallers”
…fell in a bathtub
… hospitalized
…never recovered
Dr. Robert Atkins
April 17, 2003
Diet guru of low-carb, highprotein fame, died Thursday
at Cornell University Medical
Center from injuries received
earlier this month when he
fell.
Atkins, 72, was on his daily
walk to work when he fell
on an icy sidewalk
outside his New York
City office and suffered
injuries to his head.
Billy Graham
Falls, Breaks Hip January 7, 2004
Billy Graham was
recovering.. after falling
and breaking his hip.
Graham, 85…. He
received a partial hip
replacement…"He's in
good spirits,“…will need
extensive physical
therapy…ailments in
recent years, including
Parkinson's Disease.
Fidel Castro
October 21, 2004
Castro broke his
left knee and
right arm in a
fall after giving a
graduation speech
in the central
Cuban city of
Santa Clara.
Risk Factors for Falling
 Being female.
 Being white.
 Having had a previous fall.
 Having lower body weakness or gait or balance
problems.
 Having physical limitations, wearing glasses, or having
other visual problems.
 Having more than one chronic disease, history of stroke,
Parkinson’s Disease, neuromuscular disease, urinary
incontinence, or postural hypotension.
 Being cognitively impaired
 Taking more than four medications or using psychoactive
medications
 Wearing shoes with thick, soft soles (e.g., jogging shoes)
http://www.cdc.gov/ncipc/pub-res/toolkit/SummaryOfFalls.htm
Facts about Senior Falls
For people ages 65 and older, falls are the
leading cause of injury death (CDC 2001).
Among seniors, falls are the underlying
cause of a large proportion of fatal
traumatic brain injuries (TBI). From 1989
to 1998, the fall-induced TBI death rate
among people ages 80 and older
increased 60% (Stevens 2001).
The risk of falling increases exponentially
with age (Samelson 2002).
Courtesy of CDC website
More Facts
Older adults who have fallen previously or who
stumble frequently are two to three times more
likely to fall within the next year (Tinetti 1988;
Teno 1990).
For people ages 65 and older, two-thirds to onehalf of falls occur in or around the home (Nevitt
1989; Wilkins 1999).
At least 95% of hip fractures among older adults
are caused by falls (Nyberg 1996).
Fall-related death rates and hip fracture
hospitalization rates have been increasing
(Stevens 1999).
Courtesy of CDC Website
Where People Fall
22%
Inside the house
55%
23%
Outside, but near, the
house
Away from the home
Source: National Health Interview Survey, 1997-1998 (Kochera, 2002)
Awareness
Falls outside the Home
Falls in the Home
For people ages 65 and older, two-thirds to
one-half of falls occur in or around the
home (Nevitt 1989; Wilkins 1999).
Outdoor Community Hazards
1) Uneven pavement or
surfaces and/or pavement
cracks
2) Tree roots
3) Obstacles in walkways
4) Obstacles in walkways
5) Uneven steps
6) Unsafe stair design
7) Poor lighting
Problems in the Community
Lack of features
related to the built
environment:
Poor enforcement of
safety codes or
regulations, and/or
inadequate building
codes, are related to
problems in the
community
Possible Community
Modifications
- Identifying and eliminating
hazardous conditions that
interfere with mobility and
increase fall risk
- Adding supportive features
Preventing Outdoor Falls
 Be cautious about the surface
and setting in which you walk
 Walk on a prescribed track
 Walk for exercise in newer, well
maintained areas, even malls
and civic spaces
Preventing Outdoor Falls
 Be aware of your surroundings
 Cracks in sidewalks, tree roots, holes, and
changes in elevation
 Look for tree roots as hazards as well as
fallen leaves, blossoms, seed pods, and other
debris
 Note curbs and changes in elevation
 Walk in good lighting
 Wear footwear with firm soles and low
heels
Fall Prevention
Medical Management
Physical Activity
Home Modification
Medical Management
Understanding the Problem
People age 65 and over buy more than 25
percent of all prescription medicines and 30
percent of all nonprescription (over-the-counter)
medicines sold in this country.
Older people more likely than younger people to
have long-term illnesses such as arthritis,
diabetes, high blood pressure, and heart
disease that require taking medicines on a
regular basis
Common for older people to take several
different medicines
http://www.healthinaging.org/public_education/eldercare/23.xml
Medication Management Is
Confusing
Older Individuals tend to be
more sensitive to drug effects
 THIS SLIDE POSSIBLY NOT NEEDED?
For example, a drug such as
Valium(TM)(diazepam) may stay in an 80-yearold body four times as long as it does in a 40year-old body.
The liver and the kidneys break down and
remove most drugs from the body. As people
age, these organs may not work as rapidly as
they once did and some drugs may leave the
body more slowly, sometimes causing side
effects
http://www.healthinaging.org/public_education/eldercare/23.xml
Different doctors = possibility of
one or more medicines
At least one doctor should keep track of all
the medicines a person is taking to
minimize drug-drug interaction and other
risks associated with taking many
medicines
 If the (primary care) doctor is unaware of
the medicine already prescribed by other
doctors and health care providers, this can
cause problems.
http://www.healthinaging.org/public_education/eldercare/23.xml
Inform your
doctor or pharmacist
 All prescription drugs from any doctor, including eye
drops, creams, and ointments.
 Nonprescription medicines, including vitamins, minerals,
antihistamines, sleeping pills, laxatives, cold medicines,
and antacids.
 Folk remedies, nontraditional products, or "alternative
medicines," such as plant compounds, herbs, special
teas, or nutritional supplements.
 "Social" drugs such as alcohol, tobacco, or caffeine.
http://www.healthinaging.org/public_education/eldercare/23.xml
Physical Activity
Physical Activity
Engage in Regular Physical Activity
Ask your physician what types of activities
would be best for you.
Determine a plan for regular physical
activity that fits with your interests and
abilities.
Consider targeted balance and mobility
exercises that are most effective at
reducing fall risk.
http://nihseniorhealth.gov/exercise/benefitsofexercise/06.html
Benefits of Exercise
People of all ages and physical conditions
benefit from exercise and physical activity
because it helps prevent or delay many
diseases and disabilities
Moderate exercise and physical activity can
even improve the health of people who are frail
or who have diseases that accompany aging
Exercise and physical activity can help older
people maintain or partly restore:
strength, balance, flexibility, and endurance
http://nihseniorhealth.gov/exercise/benefitsofexercise/06.html
Benefits of Exercise
Increasing strength and endurance make
it easier to climb stairs and carry
groceries.
Improving balance helps prevent falls.
Being more flexible may speed recovery
from injuries.
http://nihseniorhealth.gov/exercise/benefitsofexercise/06.html
Exercises to Try
Four types of exercise are important for
staying healthy and independent:
strength exercises
balance exercises
stretching exercises
endurance exercises
http://nihseniorhealth.gov/exercise/benefitsofexercise/06.html
Strength Exercises
Strength exercises build muscle as well as
increase your metabolism, which helps
keep your weight and blood sugar in
check.
http://nihseniorhealth.gov/exercise/benefitsofexercise/06.html
Let’s try a Strength Exercise
Knee Flexion strengthens muscles in the
back of the thigh.
1. Stand straight, holding onto table or chair
for balance.
2. Slowly bend one knee as far as possible,
so foot lifts up behind you. Don't move
your upper leg at all; bend your knee
only.
3. Hold position.
http://nihseniorhealth.gov/exercise/benefitsofexercise/06.html
Knee Flexion
4. Slowly lower foot all the way
back down.
5. Repeat with other leg.
6. Alternate legs until you have 8
to 15 repetitions with each
leg.
7. Rest. Then do another set of 8
to 15 alternating repetitions.
http://nihseniorhealth.gov/exercise/benefitsofexercise/06.html
Balance Exercises
Balance exercises build leg muscles and help
prevent falls.
Each year, U.S. hospitals have 300,000
admissions for broken hips, and falling is often
the cause of those fractures.
Balance exercises can help
you stay independent by helping
you avoid disabilities that may
result from falling.
Karate black belt Eleanor Hyndman, 90
http://nihseniorhealth.gov/exercise/benefitsofexercise/06.html
Anytime Anywhere
Balance Exercises
Walk heel-to-toe. Position your heel just in
front of the toes of the opposite foot each
time you take a step. Your heel and toes
should touch or almost touch.
Stand on one foot (for example, while
waiting in line at the grocery store or at the
bus stop). Alternate feet.
Stand up and sit down without using your
hands.
http://nihseniorhealth.gov/exercise/benefitsofexercise/06.html
Stretching Exercises
 Stretching exercises are thought to give
you more freedom of movement to do the
things you need and like to do.
 Stretching exercises alone will not
improve your endurance or strength.
http://nihseniorhealth.gov/exercise/benefitsofexercise/06.html
Endurance Exercises
Endurance exercises are any activity -walking, jogging, swimming, raking -- that
increases your heart rate and breathing for
an extended period of time.
Build up your endurance gradually, starting
with as little as 5 minutes of endurance
activities at a time, if you need to.
http://nihseniorhealth.gov/exercise/benefitsofexercise/06.html
Examples of
Moderate Endurance Activities
Older adults who have been inactive for a
long time will need to work up to these
activities gradually.
 walking briskly on a level surface
 swimming
 gardening, mowing, raking
 cycling on a stationary bicycle
 bicycling.
http://nihseniorhealth.gov/exercise/benefitsofexercise/06.html
How much, how often?
GOAL: work your way up to a moderate-tovigorous level that increases your
breathing and heart rate.
It should feel somewhat difficult to you.
 Once you reach your goal, you can divide
your exercise into sessions of no less than
10 minutes at a time, if you want to, as
long as they add up to a total of at least 30
minutes on most or all days of the week.
http://nihseniorhealth.gov/exercise/benefitsofexercise/06.html
Home Modification
The home environment is implicated
in 35% to 40% of falls (Josephson,
Febacher, & Rubeinstein, 1991)
The majority (55%) of fall injuries
occur inside the house (National
Health Interview Survey, 1997-1998)
Hazards and Safety Risks
in the Home
 Outside Steps To The Entrance
 Inside Stairs To A Second Floor
 Unsafe Bathrooms
Everyday Situations
Possible Solutions
1. Lack of support in the bathroom/shower.
Solution: Install grab bars and use non-slip
mats or non-skid strips.
2. Lack of support in the toilet.
Solution: Install grab bars or use raised toilet
seat.
3. Climbing stairs.
Solution: Installs handrails on both sides of the
stairs.
4. Dark passage or stairway.
Solution: Install brighter lights, and have
switches at both ends.
Everyday Situations
Possible Solutions
5. Objects in the way: books, clothes,
newspapers, and shoes.
Remove them from the pathway.
6. Slippery Rugs.
Remove or use double-sided tape to secure
them to the floor.
7. Items out of reach.
Keep ones most often used at levels that can
be reached easily.
Unmet Needs for Features
1.14 million elderly households
have an unmet need for home
modifications (HUD, 1999):
1) Handrails/grab bars
2) Ramps
3) Easy access bathrooms
A Home in Need of
Improvements
Front Entry
Back Entry
Back Entry
Back Entry Lacks Handrails
Back Entry Slope is Steep
Bathroom
Shower is Dark and Grab Bar Not Useful
High Step in Shower
Universal Design
Adaptable Housing and
Neighborhoods
Accessible to Persons of
All Ages and Abilities
The Design of All
Products and
Environments Should Be
Useable by All Persons to
the Greatest Extent
Possible
Home Safety Summary Checklist
Stairways
∙ Is there a light switch at the top and bottom of the stairs?
∙ With the light on, can you clearly see the outline of each step?
∙ Do stairways have sturdy handrails on both sides?
∙ Do handrails run the full length of the stairs?
∙ Are all the steps in good repair?
∙ Are stair coverings (rugs, treads) in good repair?
Exerpted from: California Dept. of Aging, Senior Housing Info & Support Center
Adapted From: Home Safety Summary Checklist developed by the Community and Home Injury
Prevention Project for Seniors (CHIPPS)
Do Does
Not
Not
Yes No Know Apply
Tips to take Home
 Educate yourself – know where falls occur and
be aware of risk factors
 Prepare yourself to prevent falls before they
happen with exercise, proper footwear, etc.
 Be an advocate to stop falls – Educate Service
Providers, Business Owners, Local Politicians
 Play an active role in preventing falls for
yourself and others in your community – Report
outdoor hazards such as broken sidewalks and
unmarked curbs to city officials.
Questions?
Fall Prevention Center of Excellence Program Office
University of Southern California
Andrus Gerontology Center
Los Angeles, California 90089-0191
Tel: 213.740.1364
Email: [email protected]