Facts About Falls

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Nov 2, 2013 (3 years and 11 months ago)

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Facts About Falls

Jo A. Taylor, RN, MPH

Older Adult Population


34.9 million people 65 years and older in the
US (13% of the population)


By 2030, 71 million or 20% of US population



Over 1/3 of all older adults fall each year


20
-
30% have moderate to severe injures


Fall risk increases with age


Falls in Older Adults


Most common cause of nonfatal injuries and
hospital admissions for trauma



72% of fall related deaths occur in 13% of
older adult population



Most common cause of nonfatal injuries and
hospital admissions for trauma

Falls Have Serious Consequences


Serious injury like hip fracture & brain injury


Increased risk of death


Loss of independence


Decreased ability to function


Increased need for care

Loss of self confidence and fear


Even without injury, falls lead to fear of falling
with self imposed restriction of activity and
reduced social interaction.




decreased quality of life

Healthcare Costs


Direct medical costs in 2000 were $19 billion
for nonfatal fall injuries



By 2020, the annual direct and indirect costs
of fall injuries is expected to reach $43.8
billion


Older Adults in Nursing Homes


Over 50% fall each year



Of those, 30
-
40% will fall again

Why Do Residents Fall?


A
verage age at admission is 82.6 years



Over 50% have 3 or more admitting diagnoses



48% receive full
-
time skilled nursing care
under a physician’s supervision, 98% require
help with bathing and 45% with eating

Intrinsic Fall Risk Factors

Effects of aging


Vision


decreased acuity, decreased contrast
sensitivity, increased sensitivity to glare, decreased
peripheral vision, decreased night vision


Hearing



decreased sensitivity


Changes in gait and balance



reduced arm
swing, decreased step length, slower reaction time,
slower movements, weakness


Urinary



feelings of urgency and frequency

Intrinsic Fall Risk Factors

Acute disease such as pneumonia and urinary
tract infection and chronic disease such as


stroke, diabetes & Alzheimer’s disease

Examples of symptoms:


Confusion, impaired judgment, agitation


Weakness, dizziness, fainting


Paralysis, tremors


Lower extremity weakness


Incontinence

Intrinsic Fall Risk Factors

Side effects of medications



Drowsiness, over sedation


Agitation, confusion, pacing


Weakness, unsteadiness,


Gait disturbances


Dizziness, low blood pressure

Extrinsic Fall Risk Factors


Clutter


Lighting


Flooring


Handrails


Unstable furniture


Hard to reach personal items


Unsafe footwear


New admissions

Equipment


Missing wheelchair parts


Incorrect wheelchair fit


Inadequate wheelchair seating


Broken wheelchair parts

Research Evidence


Fall reduction programs are effective when
they have
multiple

interventions that target
individual risk factors



Physical restraints do not reduce falls and are
associated with soft tissue damage, injuries,
fractures, delirium and death


It is impossible to prevent all falls in frail, older
nursing home residents but it is possible to
reduce risk.


Staff Strategies to Reduce Fall Risk


Falls assessment to determine high risk
medications, unsafe behavior, vision loss,
impaired gait and mobility and postural
hypotension



Medical evaluation



Medication review



Gait and balance training

Staff Strategies to Reduce Fall Risk


Protective equipment (e.g., hip protectors,
helmets, wrist protectors)


Individualized wheelchair seating


Low beds, mats


½ or ¼ side rails


Alarms, sensors


Specialized chairs

Staff Strategies to Reduce Fall Risk


Toileting assistance


Activities


Muscle strengthening and balance training


Behavioral strategies

How Families Can Help

1.
Remove clutter and keep pathways clear


2.
Provide safe footwear


3.
Promote safety during transfer and mobility


4.
Use low blood pressure precautions when
needed


Remove Clutter


Keep pathways around the bed and to the
bathroom clear



Provide only stable furniture from home



Remove items that are no longer needed


Help to keep personal items within easy reach

Provide Safe Footwear


Shoes and slippers with tread or non
-
skid
soles, with firm shape and low, even heels


Examples
:

tennis shoes with Velcro fasteners,
oxford style shoes, canvas or leather slip
-
ons,
and fitted slippers with some form of tread



Non
-
skid socks can be useful to wear at night

Promote Safety During Transfer


Call for help from staff when unsure about
safety


Provide easy to manage clothing with elastic
waist and Velcro fasteners


Lock wheelchair brakes before transfer


Keep all seating items in the wheelchair

Use Low Blood Pressure Precautions

For residents with low blood pressure:


Sit on edge of bed and dangle feet before
rising


Flex feet backwards several times before
rising


Do not tilt head backwards


Get up slowly with assistance


Report dizziness

Reducing the fall risk of our residents
is a challenge. With your help, we
can do a better job.


Thank you for your time and support.