falls a common concern of seniors we offer a complimentary fall-risk and/or home safety assessments...
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Falls A Common Concern of Seniors
We offer a complimentary fall-risk and/or home safety assessments to our managed care seniors. Please call our Wellness Center at 760-969-6550.
Falls: A Common Concern of Seniors
More than 1/3rd of adults 65+ fall each year in US
50% of seniors that fall have fallen before
As the Senior population increases,
so will the absolute number of falls
Population Growth
Who Falls?
By Age Per Year
65- 69 22.4%
70- 74 27.9%
75- 79 31.4%
80- 84 39.6%
Who Falls?
Women 65+ 30% Men 65+ 13% Gender Differences
decrease after 75; at 85 Men = Women
By Sex
Who Falls?
Community: 0.2 - 0.8 per person per year
Hospital: 0.6 - 2.9 per person per year
Long-term Care: 0.6 - 3.6
By Living Environment (rates)
Falls cause
Fear of falling
Falls cause:
Fear of falling - limits activities- leads to decreased
mobility/fitness
- increases social isolation
- increases actual risk of falling
Falls cause
Fear of falling Increased risk of Nursing Home
Placement
Falls cause
Increased risk of Nursing Home Placement
- those 75+ who fall are 4-5x more likely to be admitted to long-term care for 1 + years
Falls cause
Fear of falling Increased risk of Nursing Home
Placement Moderate to severe injuries
Falls cause
Moderate to severe injuries
- bruises,
- traumatic brain injuries- accounts for 46% of fatal falls
- fractures: 6% of falls, including, spine, hip, leg, pelvis, ankle upper arm and hand
Falls cause
Fear of falling Increased risk of Nursing Home
Placement Moderate to severe injuries Increased risk of death
Falls cause
Increased risk of death- 15,800 annual deaths in seniors d/t fall (2005); 1.8 Million treated in ER- 85% percent of deaths from falls from seniors 75 and older- after 75 years, white men have highest fatality rates
> white women > black men > black women - Men are more likely to die than women (49% higher
mortality rates)
Hip Fractures in Seniors
- 1% of falls result in hip fractures
($10 billion cost)- 350,000 senior hip fractures/year- 60% have restricted mobility- 25% remain functionally more
dependent- 25% die within 1 year
FALLS
Reasons Why Falls Occur
Intrinsic Factors Extrinsic Factors
Normal Aging Changes
Intrinsic Factors
Normal Aging Changes Neurologic
- proprioception- reaction time - righting reflexes
Intrinsic Factors
Normal Aging Changes Neurologic Gait
- Slower
- Stride length and arm swing
- Body flexion & head/torso; knees shoulders forward
- Lateral sway
Intrinsic Factors
Normal Aging Changes Neurologic Gait Vision
- Accommodation - Dark adaptation
Intrinsic Factors
Normal Aging Changes Neurologic Gait Vision Muscle mass
FALLS
Reasons Why Falls Occur
Intrinsic Factors Extrinsic Factors
Normal Aging Changes
Chronic & Acute Disease
Intrinsic Factors
Chronic Disease
Cataracts, macular degeneration
Arthritis Parkinsons, Strokes The “Dizzy’s”
Intrinsic Factors
Chronic Disease
The “Dizzy’s”- 27% of seniors 65+ report during last month - 37% last > 1 minute- 50% of those 80 or greater that are dizzy due to
Benign Positional Vertigo - Usually due to many causes:
- Meniere's disease, circulation, blood pressure drops,
- anemia, heart rhythms, anxiety/depression
Intrinsic Factors
Acute Illness/Confusion UTI, pneumonia, diarrhea, dehydration, vomiting
FALLS
Reasons Why Falls Occur
Intrinsic Factors Extrinsic Factors
Normal Aging Changes
Chronic & Acute Disease
Trouble walking
Intrinsic Factors
Trouble Walking (Dysmobility)
- Trouble walking increases with age
- > 65 y/o: 15%
- 85 y/o: 25% men; 33% women
- 2/3 of seniors in hospital/Nursing Homes
can’t walk w/o assistance
FALLS
Reasons Why Falls Occur
Intrinsic Factors Extrinsic Factors
Normal Aging Changes
Chronic & Acute Disease
Medications
Extrinsic Factors
4+ prescriptions!
Extrinsic Factors
Medications– The big offenders
- Sedative/hypnotics- Depression/anxiety/mood-stabilizing
medications
- Heart, blood pressure, seizure, incontinence, other medications
FALLS
Reasons Why Falls Occur
Intrinsic Factors Extrinsic Factors
Normal Aging Changes
Chronic & Acute Disease
Medications
Environment
Improper Use of Cane/Walker
Extrinsic Factors
Environment- Home hazards: bathrooms, stairs, clutter,
throw rugs, lighting, sidewalks
- "risky" behavior
Improper use of cane/walker
Falls: A Common Concern of Seniors
So What to Do?
So What to Do?
Screen for Risk Factors
– Do your own Home Safety Evaluation– Evaluate your activity; Exercise– Talk to your doctor
So What to Do?
Nintendo Wii Golf
What your doctor will be thinking
Ask all >= 75+
Dx & Treat
Join exercise program
None
>= 2 Falls or Balance/
Gait
1 Fall or
Balance/ Gait
Specific Risk Factors, Assessment, Management
Assessment & Risk Factor
Management
Previous Falls? Change environment and activity to reduce recurrent falls
4+ Medications Reduce
High-risk medications
Review & Reduce
Vision Ample lighting without glare. Avoid multifocal glasses while walking. See eye doctor
Specific Risk Factors, Assessment, Management
Assessment & Risk Factor
Management
Check BP when standing?
Diagnose & treat cause
Check Balance & Gait Diagnose & treat cause
Check Neuro exam Diagnose & treat cause
Check muscles/joints & range
Diagnose & treat cause
Check heart See Cardiologist
Home safety evaluation See your handout
Specific Risk Factors, Assessment, Management
Evidence shows these interventions work!
Strategy
Estimated Risk of
Reduction Trials
Health care-based strategy: % #
Balance, gait & strength exercise 14-27 2 of 3
Reduction in home hazards 19 1 of 1
Discontinuation of psychotropic medication
39 1 of 1
Multifactorial risk assessment with targeted management
25-39 3 of 3
Evidence shows these interventions work!
Strategy
Estimated Risk of
Reduction Trials
Community-based strategy: % #
Specific balance or strength exercise programs
29-49 2 of 2
Falls A Common Concern of Seniors
We offer a complimentary fall-risk and/or home safety assessments to our managed care seniors. Please call our Wellness Center at 760-969-6550.
References
Center for Disease Control and Prevention, National Center for Health Statistics,
Health, United States, 2007.
“Clinical Practice”. New England Journal of Medicine 2 January 2003:41-44.
“What Causes Falls in the Elderly.” American Family Physician. 1 Apr. 2000. http://www.aafp.org/online/en/home.html