Falls

Increased risk associated with impaired cognition, polypharmacy, and atrial fibrillation.

Strength and balance training programs reduce falls in community dwelling people who are at least 75 years old.

Functional exercises to improve balance, and leg strength are recommended for fall prevention.

Movement and upright posture are important to protect the integrity of organ system and bodily functions such as the skin, coagulation homeostasis, and cardiovascular fitness.

Falls that occur during activities of daily living generally result from impairment of one or more of the above systems.

Risk factors for falling include: a history of previous falls, impaired strength, impaired gait, and impaired balance, and the use of specific medications.

Major contributor to decline in function and increase in health care utilization.

Falls without serious injury increases risk of requiring a skilled nursing facilityby 3 times, and with serous injury by 10 times, accounting for cognitive, social, psychological and medical factors (Tinetti ME).

Strongest risk factors include: previous falls, strength, gait and balance impairments and use of medications.

Risk of falls increases with number of risk factors.

15% individuals over the age of 65 years fall twice in a year.

Represent a leading cause of hospital admissions for trauma and deaths in older patients.

One in five inpatients falls at least once during hospitalization.

One in 4 individuals that fall seek medical care for the event (Stel VS).

Home visits by nurses ineffective in preventing falls (van Haastregt JC).

Approximately one-third of seniors over age 65 experience a fall, and this percentages rises with age to affect more than 50% of seniors over age 80.

Fall rates are higher for age-matched counterparts residing in assisted living or nursing homes.

Multifactorial fall prevention program does not reduce falls in high risk cognitive intact older persons (de Vries OJr).

A metanalysis suggested that a minimum dose of 50 hours is required to achieve effective fall prevention.

In a randomized controlled study, participants in exercise intervention, experienced an absolute reduction in fall risk of 7.2%.

Evidence is inconclusive for resistance training alone, yoga, dance training and walking programs alone compared with usual care.

The risk of falling increases from 8%-to 19% to 32% to 60% to 78% as the number of factors increase from 0 to 4 or more in a one year risk study

(Tinetti ME).

Hypertension, heart failure, and depression increase the risk of fall and so may the medication used to treat these processes.

Orthostatic hypotension with uncontrolled hypertension is a risk factor for falls.

Initiation of antihypertensive therapy in the elderly associated with increased risk of falls.

The risk of falling among the elderly increases with the number of medications consumed.

Agents that are associated with increased falls include psychoactive medications such as sedatives, antipsychotic agents, antidepressants, anticonvulsants and anti-hypertensive medications.

Fall are more likely to occur while wearing slippers, socks, or walking while barefoot.

In 2000 more than 2.6 million older adults had a fall related injury with an estimated cost of greater than $19 billion(Stevens).

Approximately 10% of falls result in a fracture, serious soft tissue injury or traumatic brain injury.

Falls without serious injury increases the risk of skilled nuring facility placement by three times and a serious injury increases the risk tenfold (Tinetti ME).

Functional loss after a fall is partially explained by diminished self confidence.

Women are more likely to experience fractures following a fall, and men and African Americans are more likely to experience brain trauma(Tinetti ME).

Falls and if they are related complications are the fifth leading cause of death in the developed world.

About 30% people 65 years will have at least one fall annually.

Approximately one in three persons aged65 years or older falls every year.

Are the primary reason for 85% of all injury related admissions to the hospital.

Account for more than 40% of nursing home admissions.

90% of falls associated with walkers or canes occur with walkers.

Increase in frequency with advanced age and account for 95% of hip fractures in the elderly.

Falls without serious injury increases the risk of a skilled nursing facility placement by three times and with a serious fall in increases the risk tenfold (Tinetti ME).

Falls that occur during activities of daily living generally result from impairment of one or more of the above systems.

Risk factors for falling include: a history of previous falls, impaired strength, impaired gait, and impaired balance, and the use of specific medications.

The risk of falling among the elderly increases with the number of medications consumed.

The National Health and Nutrition Examination Survey (NHANES), a large-scale survey including balance testing for more than 5000 individuals between 2001 in 2004 found that vestibular dysfunction significantly increases the likelihood of falls among older individuals.

Inability to get up, without help, after a fall which occurs in half of elderly patients may result in dehydration, pressure ulcers and rhabdomyolysis (Tinneti ME).

Single intervention of cardiac pacing in patients with carotid sinus hypersensitivity who have fallen is associated with a reduced falling rate (Kenny RA).

Single intervention of expedited first cataract surgery reduces the incidence of falls, while a second such surgery offers no benefit (Harwood RH, Foss AJ).

A vision intervention study including treatment for glaucoma, referral for cataract surgery and new refraction did not decrease the risk of falling (Cumming RG).

Individuals with falls or with fall risk benefit from home safety modifications (Gillespie LD).

Medication reductions can reduce fall risk.

Exercise interventions show fall risk reductions of 22%-46%, and all positive trials include balance training.

Get up and go test: a patient is asked to get up from a chair, walk ten feet and return to the chair and sit down-any unsafe movement suggests a balance or gait impairment and increased risk of falling and the patient needs physical therapy for complete evaluation and treatment.

Gravity destabilizes the body’s alignment of the torso over the legs.

Occur when the center of gravity of the trunk moves outside the base of support of the feet against the floor.

Ability to avoid falls complex activity involving the brain, muscles, tendons, muscle and bones and nerves.

May be a stronger predictor of fractures than bone mineral density.

Women are at higher risk than men for falling and for sustaining fall related injury.

Prevalence in community-dwelling women 65 or older 19%-42%.

Falls result in fractures 4%-9% of the time.

5-10% of falls cause serious injuries to include head trauma, major lacerations, or fractures.

Fractures of the hip, wrist, humerus, and pelvis are the most frequent serious injuries associated with falls.

Account for 10% of emergency department visits.

Account for 6% of hospitalizations among patients over the age of 65 years.

Occur in approximately one third of community dwelling older adults and one half of nursing home patients annually.

Accounted for 62% of injuries among 2.7 million nonfatal injured patients over the age of 65 years presenting to emergency departments in the U.S. in 2001.

In 2003 13,700 people older than 65 years died from falls and 1.8 million of individuals 65 years or older were treated in emergency departments.

More than half of individuals sustain some minor injury.

Predict for placement to a skilled nursing facility.

Occur in 30% per year of those 65 years of age or older and 40-50% in individuals older than 80 years.

Fall incidence of 40% per year in community dwellers aged 80 years or over.

Pain contributed to functional decline in the elderly is associated muscle weakness, mobility limitations that could increase the risk of falls.

The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) study, a population based longitudinal study of falls involving 749 adults age 70 years or older: Patients with chronic pain at baseline were at greater risk for falls, and the greatest risk for falls were in those with 2 or more pain sites (Leveille SG).

Studies have shown 7.7-12% of nursing home patients with falls were taking first generation antiepileptic drugs and 42% using the drugs for non seizure conditions.

Taking 4 or more medications, in a study of 47,000 adults with type 2 diabetes associated with 11.94 falls poer 1000 person years, almost twice the rate of 6.61 falls per 1000 person years in those taking fewer medications (Huang ES et al).

In the elderly psychoactive medications, particularly antidepressants, antianxiety medications, and medications for insomnia are most likely to cause falls.

Medications are important contributors to falls and the risk of falling in the elderly.

Medications are the most common modifiable extrinsic risk factors for falls.

Psychoactive, anticholinergic, cardiovascular, and analgesic medications are associated with falls via sedation, orthostatic hypotension, or other mechanisms.

Loop diuretics prescribed to older adults are associated with falls, as are gabapentinoid medications.

Leading cause of injury, emergency room visits, hospitalization and institutionalization among older people.

Risk factors include: advancing age, medication use, COPD, arthritis, congestive heart failure, alcohol consumption, incontinence, neurological disease, cognitive impairment, the presence of impaired strength, mobility, flexibility, impaired balance, decreased cardiovascular conditioning, the presence of safety hazards in the home and personal risk-taking behaviors.

Interventions to prevent falls effective and can reduce fall rate by approximately 12 falls per 100 person-months, or about 30-40% relative reduction.

Regular strength and balance training can reduce the risk of falling in community-dwelling older adults by 15-50%.

Physical activity programs are effective for the prevention of falls among elderly persons living in the community.

Use of vitamin D results in a 22% reduction in risk of falling compared to placebo or calcium as a result of improved muscle function.

Decreased serum 25-hydroxy vitamin D levels are associated with increased bone loss and risk of fractures as well as increased fall rates.

In a randomized double-blind placebo controlled vitamin D and exercise trial the rate of injurious falls and injury to fallers more then halved with strength and balance training in home-dwelling older women, while neither exercise or vitamin D affected the rate of falls (Uusi-Rasi K et al).

Assessment of patients with falls includes medication review, assessment of activities of daily living, evaluation of orthostatic blood pressure, vision assessment, cognitive evaluation, gait and balance evaluation, and assessment of environmental hazards.

In the elderly tend to fall sideways or backwards applying a load different from load bearing axis of the involved bone.

Because of bone microarchitecture variability (anisotropy) falling sideways or backwards increased bone susceptibility to fracture.

Fear can be a helpful signal, bringing attention to balance disorders, reduced vision, or muscle weakness.

Fear of falling may cause limitation in the range of motion unnecessarily, and avoid activities.

One-third to one-half of older adults are concerned enough about potential falls that they restrict or avoid activities that would be beneficial for their health.

Exercise is essential for helping to maintain strength in the legs, buttocks, and core, all of which are important for balance.

Certain types of exercise, such as Pilates, yoga, and tai chi are particularly helpful for balance.

Gait training includes strengthening muscles, and improving posture and developing good walking form to move more fluidly.