facts about falls jo a. taylor, rn, mph. older adult population 34.9 million people 65 years and...
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Facts About FallsJo A. Taylor, RN, MPH
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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
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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
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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
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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
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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
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Older Adults in Nursing Homes
Over 50% fall each year
Of those, 30-40% will fall again
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Why Do Residents Fall?
Average 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
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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
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Intrinsic Fall Risk FactorsAcute 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
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Intrinsic Fall Risk Factors
Side effects of medications Drowsiness, over sedation Agitation, confusion, pacing Weakness, unsteadiness, Gait disturbances Dizziness, low blood pressure
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Extrinsic Fall Risk Factors Clutter Lighting Flooring Handrails Unstable furniture Hard to reach personal items Unsafe footwear New admissions
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Equipment
Missing wheelchair parts Incorrect wheelchair fit Inadequate wheelchair seating Broken wheelchair parts
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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.
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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
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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
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Staff Strategies to Reduce Fall Risk Toileting assistance Activities Muscle strengthening and balance training Behavioral strategies
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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
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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
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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
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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
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Use Low Blood Pressure PrecautionsFor 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
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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.