Fall Risk Presentation

Jeremy D. Nelson MPTPhysical Therapistwww.structuredmotion.com

Identifying and Mitigating Fall Risk in the Home Environment for Seniors

Objectives for DiscussionIdentify the common causes of falls and interventions to reduce risk in each part of a typical homeDiscuss decreasing fall risk to promote Aging in PlaceReview common field tests to decrease fall riskDiscuss interventions to improve patient stability and mobility

What causes falls External Demands and Internal CapacityInteraction between person and environment COG within BOSMultiple systems interact to maintain this relationship over varying external demandsSensationMobilityStabilityVestibular inputVisionAs we move, BOS changes shapeSeatedDouble Limb SupportSymmetricalAsymmetricalSingle Limb SupportedCan the neuromuscular system coordinate muscle timing to keep the COG in BOSPhysical capacity must meet or exceed the demands of the environment in terms of attenuating forces, timing, control.

Universal Design & Aging in PlaceUniversal Design - AKA Barrier Free DesignSupported by ADAMatching the environment to minimize imposed demandsIn Senior population meant to provide a safe environment for the progressive decline in function associated with aging.Seeks to provide surfaces at heights most efficient for human function.Aging In Place Trend for modifying currently owned residence to compensate for changes in physical capacity.

Age Related Changes - Internal

Mithal A, Bonjour J-P, Boonen S, Burckhardt P, Degens H, El Hajj Fuleihan G, Josse R, Lips P, Morales Torres J, Rizzoli R, Yoshimura N, Wahl D.A., Cooper C, Dawson-Hughes B(2011) Impact of nutrition on muscle strength and performance in older adults. Osteoporosis International

The At Risk SeniorPersonGait UnsteadyShuffling gaitPoor weight shifting during double limb supportTrendelenburg sign in single limb supportDizzinessc/o room spinning when head turns, turning in bedOrientationIntermittent disorientation more likely to increase fallsWeaknessNeurologic, sarcopenia related, hypoglycemiaPoor Posture Posterior COGL/S lordosisT/S KyphosisC/S Forward head posture

Diagnosis Associated with Increased Fall Risk Home ModificationsNeurologicalCVA, Dementia Creating Safe PassagesOrthopedicOA, DDD, RA, THA, TKA (Impaired mobility/stability)Changing heights of furniture/ Bathroom to promote Sit to StandMetabolicDM, (Insulin OD, hypoglycemia, Peripherial Neuropathy)Changing from Plush Carpet to hardwoor, low ply carpet, linelum surfacesCardiacHTN,CHF, CAD, MI ( Medications, OH)Changing Environment to promote energy conservationPulmonaryCOPD, PE (Medications, OH)Changing Envinronment to promote energy conservation

Increased Environmental DemandsWhat are the demands imposed by the patients environment?Unlit areasObstaclesUneven SurfacesSlippery SurfacesDistracting AreasChanges in environment can decrease the disability threshold.Senior Assessment of their Environment - CDC

Match or Mismatch?Functional Reserve (FR) vs. Environmental DemandsMrs. J Uses walker, Unable to Sit to Stand without UE FR Adequate on even surfaces - MATCHTile surfaces in kitchenBathroom linoleum surfaceFR inadequate on Uneven surfaces - MISMATCHPlush carpeting in hallwayBedroom

Into Out of Home

Kitchen

Bathroom

Bed Room

Stairs

Equipment2+ Hand Touch

2 Hand Touch

1 Hand Touch1 Hand Touch

ResearchA Multifactorial Intervention To Reduce The Risk Of Falling Among Elderly People Living In The Community. (Tinetti, Mary E.; Baker, Dorothy I.; McAvay, Gail; Claus, Elizabeth B.; Garrett, Patricia; Gottschalk,Margaret; Koch, Marie L.; Trainor, Kathryn; Horwitz, Ralph I.) NewEngland Jounal of Medecine Volume 331(13) 29 Sep 1994 pp 821-827A Randomized, Controlled Trial of Fall Prevention Programs and Quality of Life in Older FallersA Review of Balance Instruments for Older Adults; Susan L. Whitney, Janet L. Poole, Stephen P. Cass September 1998, Volume 52, Number 8Aging, muscle activity, and balance control: physiologic changes associated with balance impairmentPredicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers

Resourceshttp://agingresearch.buffalo.edu/hssat/ AARPCDCAPTAhttp://sandiego.networkofcare.org/content/client/4/Home-Modification-Program-Home-Safety2013.pdf