Download - Falls prevention for people living with dementia: Education session for home care workers
Curtin University is a trademark of Curtin University of TechnologyCRICOS Provider Code 00301J
Professor Keith Hill,
Head, School of Physiotherapy and Exercise Science,
Curtin University – [email protected]
Falls prevention for people living with dementia:
Education session for home care workers
Gippsland (Victoria): September 2014
Overview How common are falls among older people
What are the effects of falls on an older person
Why do older people fall
What effect does dementia have on falls
What should an older person do if they have a fall
How can a home care worker help clients to avoid falls
Case studies
Resources to help older people who fall
Falls in older people – Is it a problem???
One third of people over 65 years of age fall each year
10% cause a serious injury such as a fractured bone
Even falls that don’t cause an injury can cause loss of confidence in walking
Other factors
implicated in up to 40% of admissions to residential care
quality of life issues◦ independence◦ community living◦ active life-style◦ other
There are many possible causes of falls
Intrinsic factors
Extrinsic factors
Medications
Healthproblems
Ageing
Environment
Activityrelatedrisks
Health problems contributing to risk of falling
Poor eyesight
Arthritis in the legs
Dementia
Incontinence
Dizziness
Also includes:- other medical conditions such as stroke, Parkinson’s disease- pain (low back and legs)- low blood pressure
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Number of risk factors
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Modifiable and non-modifiable risk factors
There are many possible causes of falls
Intrinsic factors
Extrinsic factors
Medications
Healthproblems
Ageing
Environment
Activityrelatedrisks
Environmental problems contributing to risk of falling
Poor lighting
Loose mat or slippery / uneven surface
Poor footwear
….. having had a recent fall
The biggest risk for having a future fall is …….
Why is this important?◦ The Doctor can
assess the cause of the falls provide treatment to reduce
risk of a further fall◦ But if the Doctor is not
aware of the fall there will be no actions put
in place to reduce ongoing risk of falls
another fall is likely to occur
However many older people who fall do not tell a Doctor or other health professional
Reduced awareness of environment and safety
Agitation
Wandering
Increased unsteadiness
What effect does dementia have on a person’s risk of falling?
Even greater risk of falling
But the person with dementia may also have other falls risk factors…
Poor eyesight
Arthritis in the legs
Incontinence
Dizziness
• Poor eyesight• Dizziness• Incontinence• Arthritis • etc
OFTEN THESE CAN BE TREATED• Poor eyesight• Dizziness• Incontinence• Arthritis • etc
Case: Mary
85 yo lady Lives at home alone, has a home care worker visit twice weekly Has a personal alarm Has been falling for more than 10 years Multiple fractures from falls Medical past history includes osteoporosis, diabetes, depression,
osteoarthritis, cataracts Medications include sleeping tablets, antidepressants, and
several others Increasing unsteadiness in past few months Had a recent fall, has not seen Doctor about falls Environmental hazards
Early identification of risk: Mary
Case: Mary – what might the home care worker observe?
85 yo lady Lives at home alone, has a home care worker visit twice weekly Has a personal alarm Has been falling for more than 10 years Multiple fractures from falls Medical past history includes osteoporosis, diabetes, depression,
osteoarthritis, cataracts Medications include sleeping tablets, antidepressants, and
several others Increasing unsteadiness Had a recent fall, has not seen Doctor about falls Environmental hazards
Can the risk of falls among older people be
reduced?
YES!
What can help to reduce an older person’s risk of falls: 1. See the doctor or other health professional
If a person has a fall - even if they think it was just an accident
If a person is feeling more unsteady when walking / turning
Commences using a different walking aid
If a person is reducing their activities
What can help an older person to reduce their risk of falls: 2. Exercise
Evidence of what works in exercise in falls prevention
Group exercise programs
Home exercise programs (often prescribed by a physiotherapist)
Tai Chi- (note: different types of Tai Chi may have different effects)
Foot and ankle exercise as part of podiatric multi-faceted program (Spink et al, 2011)
Usually under intermittent supervision of physiotherapist or accredited exercise physiologist
Often need for encouragement to maintain participation
Many older people have an exercise program to do at home
What can an older person do to reduce their risk of falls: 3.
Medication review Keep medications to the
minimum needed
Take medications as prescribed
Have medications reviewed by the doctor regularly
Try to avoid / minimise use of sleeping tablets, anti anxiety tablets etc
Largest effect of any falls prevention study involved weaning people off
sleeping / anxiety medications
What can an older person do to reduce their risk of falls: 4. Vision
check
Regular vision review
Cataract surgery
◦ First eye effective
Bifocals and multi-focal glasses– can be a problem
What can an older person do to reduce their risk of falls: 5. Home
safety
Removing environmental hazards will reduce risk of falls
If having falls should have an occupational therapy home assessment
What can an older person do to reduce their risk of falls and fall injuries: Vitamin D and calcium
Many older people have low levels of vitamin D
Main sources of vitamin D are:◦ Sunlight (approx 20 min/day)◦ Some foods (eg sardines)◦ Supplements
Vitamin D and calcium together have been shown to reduce fractures and falls (in high risk samples)
What can an older person do to reduce their risk of falls injuries: Hip protectors
Useful if falling frequently, and / or if bones are weak
Will reduce risk of hip fracture substantially, if worn...
Several different types◦ Hard shields◦ Foam
Other interventions from best practice guidelines
Safe footwear
Treat posturalhypotension
Education
Treat incontinence
Change walking aid
Case: Mary – how can her falls risk be reduced?
85 yo lady Lives at home alone, has a home care
worker visit twice weekly Has a personal alarm
Has been falling for more than 10 years Multiple fractures from falls
Medical past history includes osteoporosis, diabetes, depression, osteoarthritis, cataracts
Medications include sleeping tablets, antidepressants, and several others
Increasing unsteadiness in past few months
Had a recent fall, has not seen Doctor about falls
Environmental hazards
Use her personal alarm if a fall occurs and cannot get up
Discuss hip protectors / vitamin D / possibly bone-strengthening medications
Review re cataracts-?surgery Review medications, in particular
sleeping tablets Physiotherapy assessment of balance
and mobility - ?exercise program Have a medical review AND report the
fall Home safety assessment by
occupational therapist
Case: if Mary also had dementia…
85 yo lady Lives at home alone, has a home care
worker visit twice weekly Has a personal alarm Has been falling for more than 10 years Multiple fractures from falls Medical past history includes osteoporosis,
diabetes, depression, osteoarthritis, cataracts Medications include sleeping tablets,
antidepressants, and several others Increasing unsteadiness in past few months Had a recent fall, has not seen Doctor about
falls Environmental hazards
POSSIBLE OPTIONS TO REDUCE RISK OF FALLS Use her personal alarm if a fall occurs and
cannot get up Discuss hip protectors / medications to
strengthen bones Review re cataracts-?surgery Review medications, in particular sleeping
tablets Physiotherapy assessment of balance and
mobility, and to provide an exercise program Have a review by a Doctor AND report the
fall Home safety assessment by occupational
therapist
• Dementia friendly environment• Ensure consideration of causes and management of agitation• Other …..
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Home exercise programs for people with dementia, supported by a carer, have been shown to reduce falls
Need for assessment by physiotherapist and provision of exercise program
Followup home visits, support from others (eg home care workers) to encourage ongoing participation
Exercise to reduce falls in people with dementia
David:◦ 70 year old◦ Inoperable
hydrocephalus◦ Frequent falls◦ Unable to get up after
a fall – needed ambulance call out
Successful case studies from Gippsland region (1)
Treatments◦ Home based
physiotherapy commenced (low compliance so physio home visits, as wife and carers were unable to persuade participation)
OUTCOMES• Maintained mobility • No falls• Able to remain at home for extended period
before further decline and need for Nursing Home
James:◦ 70 years old◦ Alzhiemer’s disease◦ Lived on hobby farm◦ Previously active and
enjoyed daily walks◦ As dementia progressed,
activity reduced and needed prompting / supervision
Successful case studies from Gippsland region (2)
Treatments◦ Not suitable for community
Rehab because of high level of prompting and supervision needed
◦ Home based physio exercise program introduced
◦ Wife and home care worker monitored and supported exercisesOUTCOMES
• 1.5 years later, balance had been maintained, continuing with supervised walking but small decline in endurance
Look for indicators of increased risk:◦ Signs of a fall (eg bruises)◦ Increased unsteadiness (furniture walking)◦ Change in type of walking aid used◦ Increased difficulty getting out of a chair◦ Increased environmental hazards in the home
increasing risk of trips
Ways a home care worker can assist in reducing client’s risk of falling
Report to your manager
If the client has a home exercise program:◦ ask the client about the program◦ encourage regular completion of the exercise
program
Ways a home care worker can assist in reducing client’s risk of falling
Report to your Manager or the physiotherapist
Falls are common among older people, especially in people with dementia, and can cause serious injuries and loss of confidence
All falls should be reported to a doctor
There are a number of ways that falls risk can be reduced
Home care workers can play an important role in identifying potential risks for falling among their client, and supporting participation in recommended fall prevention activities
Summary