Fall Prevention Awareness

Every 18 seconds, an older adult is in the emergency room because of a fall, according to the Center for Disease Control and Prevention (CDC). That translates into a person 65 or older dying, due to a fall, every 35 minutes, according to the CDC. Falling in adults 65 and older is a complex problem confronting public health, the health care system and families. Statistics alone do not begin to measure the pain, suffering and loss of independence that are experienced by older adults who fall, but according to the CDC, a number of trends highlight the magnitude of the problem: Falling accounts for 80-95% of hip fractures in older adults, The rate of fatal falls increase dramatically with age,

Falls are the leading cause of injury deaths for older adults, and Among adults 75 and older, those who fall are four to five times more likely to be admitted to a long-term care facility for a year or longer. Based on the CDC 2012 data, each year one in three older American’s 65 and older fall and about 30% of those falls require medical treatment. Falls are not only the leading cause of fatal and nonfatal injuries but also the most common cause of hospital admission for trauma. More than $19 billion annually is spent on treating the elderly for the adverse effects of falls: $12 billion for hospitalization, $4 billion for emergency department visits, and $3 billion of outpatient care. Most of these expenses are paid for by the Center for Medicare and Medicaid Services through Medicare. According to the CDC, It is projected that direct treatment costs for elder falls will escalate to $43.8 billion annually by 2020.

There are several reasons why people fall. Fall risk is multifactorial in nature, with risk factors being intrinsic (i.e., age-related physiologic changes, diseases and medications) or extrinsic (i.e, environmental hazards) (Graafmans et al., 1996). It is important to remember that a single fall may have multiple causes, and repeated falls may each have a different etiology (Graafmans et al., 1996).It’s not just in their own homes that elderly persons are at risk for dangerous falls. Seniors fall in public places and in nursing facilities, too. Many elderly people don’t see as well as younger adults, and may not move as quickly as they once did or with the same agility. Complications of old age are often compounded by stroke, disease, or some other physical ailment (Fuller, 2000). Sometimes persons advanced in age get confused as to where they are; as a result of anxiety, many seniors are not as careful moving about the surrounding area – even familiar places.

According to NIH Senior heath, there are a number of personal risk factors to falling. Muscle weakness, especially in the legs, is one of the most important risk factors. Your balance and your gait — how you walk — are other key factors. Blood pressure that drops too much when you get up from lying down or sitting can increase your chance of falling. Some people with postural hypotension feel dizzy when their blood pressure drops. Your reflexes may also be slower than when you were younger. Foot problems that cause painful feet, and wearing unsafe footwear can increase your chance of falling. Sensory problems can cause falls, too. If your senses don’t work well, you might be less aware of your environment. Not seeing well can also result in falls.

Other vision problems contributing to falls include poor depth perception, cataracts, and glaucoma. Wearing multi-focal glasses while walking or having poor lighting around your home can also lead to falls. Confusion, even for a short while, can sometimes lead to falls. Some medications can increase a person’s risk of falling because they cause side effects like dizziness or confusion. The more medications you take the more likely you are to fall.

Educating seniors to the causes of falling before a falling incident occurs is the best prevention against falling accidents. Single risk-factor modification and multifactorial interventions can both help prevent falls in the elderly. Single intervention include the following (Rao, 2005): Exercise and Physical therapy (includes a progressive muscle strengthening program, balance training, and a walking plan) Home Safety Assessment and Modifications

Medication Withdrawal
Cardiac Pacemaker
Hip Protectors

Multifactorial health and environmental screening and intervention programs in community-dwelling older adults prove a significant reduction in falls (Rao, 2005). “The components of a successful multifactorial intervention include: exercise programs incorporating gait and balance training, advice on appropriate use of assistive devices by an occupational therapist, review and modification of medications; evaluation and treatment of postural hypotension; removal or modification of environmental hazards; and targeted medical and cardiovascular assessment and treatments” (Rao, 2005).

TEACHING PLAN

Objectives
A person completing this will be able to:
Describe the risk factors for falls
Implement effective intervention for preventing falls
Respond appropriately to fall hazards

The Lesson
1. Deliver a mini-lecture covering the material on the facts about falls, why do people fall, environmental reasons for falls, fall prevention, medications, environment, senses, and strength. Encourage participant discussion and ask for additional ideas that could help will fall prevention. 2. Discuss any participants that are prone to falls. Apply the information from the lecture to discuss interventions that might help and put a plan in place for these participants. 3. Play “Fall Trivia” with participants. Cut the trivia questions on the activity page apart so there are 18 individual question cards. Simply ask the questions and award a small prize to the first participant to answer each question correctly. The answers are on the answer key.

Conclusion
Participants who take the test and score a least 7 correct answers may receive a certificate of Completion. Participants are asked to take a minute or two to complete a questionnaire by ticking their responses to certain statements. Everyone will leave with a home safety checklist.

LECTURE MATERIAL

Facts about Falls
Falls are the leading cause of death from injuries for people ages 65 and older. In 1995, there were 7,700 Americans over age 65 that died as a result of falls. The risk of falling increases with age. An estimated one-third of Americans over age 65 will suffer falls each year. Older adults who have fallen previously or who stumble frequently are two to three times more likely to fall within the next year. Fall-related death rates and hip fracture hospitalization rates are on the rise. Falls are the cause of a large proportion of fatal traumatic brain injuries among seniors. From 1989 to 1998, the fall-induced traumatic brain injury death rate among people ages 80 and older increased 60%. Falls are responsible for at least 95% of hip fractures among older adults. Hip fractures often cause an elderly person to lose functional abilities and develop other health problems. Sometimes hip fractures lead to death. Why do people fall?

People fall for a variety of reasons. Some people are more prone to falls than others. These people generally have one or more “risk factor” for falls. This means they have a condition or a characteristic that makes them ore likely to fall. The following characteristics significantly increase a person’s risk of falling: Being female

Being white or Asian
Being over age 65
Being thin
Smoking
Having a family history of falls
Having had a previous fall
Having lower body weakness
Having gait or balance problems
Having osteoporosis
Having foot problems
Having low blood pressure or blood pressure that drops when the person stands
up Having had a stroke
Having physical limitations
Wearing glasses or having other visual problems
Having more than one chronic disease
Having Parkinson’s, multiple sclerosis, seizure disorder, or other neuromuscular disease Having urinary incontinence
Having Alzheimer’s or being confused or cognitively impaired Lack of exercise
Excessive alcohol intake
Having early menopause
Taking more than four medications
Taking psychotropic medications
Wearing shoes with thick, soft soles

Environmental Reasons for Falls
In addition to the factors already discussed, problems in the environment often cause falls. People trip on many things; clutter, throw rugs, wrinkled carpets, electrical cords and wires, and telephone cords. They slip on wet floors or in showers and tubs. They fall because they can’t see where they are going in a darkened room. We must make the environment safe. Fall Prevention

We can prevent many falls, even for those that are prone to falling because they have many risk factors. We will look at four areas of fall prevention: Medications
Environment
Senses
Strength
Addressing only one area of fall prevention is not enough. Interventions that work require multiple approaches.

Medications
If someone is on four or more medications they have a higher risk of falling. Anyone who takes medicine to treat anxiety, depression, behavior problems, or insomnia has a higher risk of falling. Many other medications have side effects that increase the risk of falling. A nurse or pharmacist should
review your medications regularly to see is you are taking anything that might cause you to fall. If you are having trouble with falls, try these interventions: 1. Ask a nurse or pharmacist to review your medication regimen, look for prescription or over-the-counter medicines that may cause:

a. Dizziness
b. Disorientation or confusion
c. Impaired memory or judgment
d. Unsteady gait, imbalance, or weakness
e. Drowsiness
f. Lack of coordination
2. When such medications are in use, your doctor may be able to prescribe alternatives.

3. You, your family, the nurse, or the pharmacist should ask the doctor to evaluate you and review the medications in light of the risk of falls.

Environment
To reduce environmental hazards that cause people to fall, perform these interventions: Reduce clutter everywhere
Ensure that eyeglasses, dentures, hearing aid, telephone, and other essential items are within easy reach of the bed and/or chair. Place everyday objects at an easy height to avoid reaching and bending. Arrange furniture in all rooms to maintain clear pathways. Remove protruding furniture or objects in traffic areas. Remove throw rugs and fix wrinkled carpeting.

Clean up spills immediately
Maintain wheelchairs, walkers, and canes in proper working order. Check wheelchair brakes regularly. Check the tips of walkers and canes regularly. Be sure the wheelchair, walker, or cane is the correct size and height for you. Use nightlights in bathrooms, bedrooms, and hallways. Be sure they work. Place brightly colored collars on pet so you can see them easily. Wear properly fitting, sturdy slippers or shoes with laces, high sides, and nonskid thin soles at all times. Keep them laced and tied. Avoid shoes with thick, soft soles, like jogging shoes. You should never wear socks without shoes. Use nonskid bath mats. Nonskid waterproof shoes are available for showering. When walking outside, remember that water, ice and snow can make surfaces slippery. Maintain a warm temperature. When you are cold you muscles don’t work as well as when they are warm, putting you at a higher risk for falling. Consider such aids as lift chairs, emergency call pendants, beside commodes, and hip pads for people prone to falls

Senses
These interventions address sensory problems that increase the risk of falls: Keep eyeglasses clean and in good condition with current prescriptions. Make sure to have regular eye exams. Bifocals more than double the risk of a fall. It’s usually best to have two separate pairs if needed, one for reading and one for distance. Teach people to rise from the bed or chair slowly to prevent dizziness. Ask for help if you feel weak, dizzy, or lightheaded when getting up. Over 80% of older people have one or more foot problems. Foot pain and other foot problems contribute to an increased risk of falls. Make sure to keep your feet healthy. See your podiatrist regularly. Enjoy the sun. Vitamin D helps keep bones strong, and is formed by the action of sunlight on the skin. Calcium intake in your diet will help build bones. Calcium is in dairy products, grains, beans, nuts and dark green vegetables.

Strength
People with good body strength and flexibility are much less likely to fall than those who are weaker and less flexible. Regular exercise is the key to maintaining and improving muscle strength, flexibility, and good balance. In addition, activity keeps muscles warm. Cold muscles don’t work as well and may lead to accidents.

Although vigorous exercise reduces the risk of fall-related fractures among healthy seniors, it increases risk among those with functional limitations. Those older adults may require an individualized exercise program. Physical and occupational therapists can help with individualized plans if needed and the doctor approves.

Exercises that improve lower body strength and balance reduce the risk of falls and fall-related injuries. Studies have shown that practicing Tai Chi can improve balance and reduce falls. Progressive resistance training, such as using free weights or stretch bands, can increase strength and improve mobility. Whatever type of exercise you choose, the key is to GET MOVING!

References:

Centers for Disease Control and Prevention (2013). Costs of Falls Among Older Adults. Retrieved 11/15/13 from www.cdc.gov/homeandrecreationalsafety/falls/fallcost.html

Centers for Disease Control and Prevention (2013). Falls Among Older Adults: An Overview. Retrieved from www.cdc.gov/HomeandRecreationalsafety/falls/adultfalls.html

Centers for Disease Control and Prevention (2013). Hip fractures Among Older Adults. Retrieved 11/15/13 from www.cdc.gov/homeandrecreationalsafety/falls/adulthipfx.html

Fuller, G.F. (2000). Falls in the Elderly. American Family Physician 61(7), 2159-2168. Retrieved 11/15/2103 from www.aafp.org/2000/0401/p2159.html

Graafmans, W.C., OOms, M.E., Hofstee, H.M., Bezemer, P.D., Bouter, L.M., & Lips, P. (1996). Falls in the elderly: a prospective study of risk factors and risk profiles. American Journal of Epidemiology, 143(11), 1129-1136.

NIH Senior Health (2013). Falls & Older Adults: Causes and Risk Factors. Retrieved 11/15/2013 from http://nihseniorhealth.gov/falls/causesandriskfactors/01.html

Rao, S.S. (2005). Prevention of Falls in Older Patients. American Family Physician, 72(01), 81-88. Retrieved 11/24/13 from www.aafp.org/afp/2005/0701/p81.html