Falls and Fall Prevention
Faculty of Health Sciences, Ontario Tech University
HLSC 4807U: Perspectives in Aging
Dr. Mika Nonoyama
Group 2b: Monika Berinde, Anetra Byfield, Anne-Marie Janotta, Vithika Selvarajah, Megan Tallon
https://www.performancehealth.com/articles/fall-prevention-strategies-in-hospitals
Index
Navigate the content in this E-module by clicking on the tiles:
Course Content
Introduction
Objectives
References
Quiz
Summary
Objectives
Of this E-Module on Falls and Fall Prevention
By the end of this module you will gain an understanding of:
- Key background information about falls and fall prevention including important definitions, terminology, and key statistics.
- Canadian content related to falls and fall prevention.
- Risk factors and conditions associated with falls.
- Understand the relationship between aging-related neuromuscular and functional changes (guest lecture).
- Risk reduction strategies, tools, and interventions to prevent falls and fall occurrence.
- Test your knowledge at the end with a quiz!
(Images from Genia.ly)
Introduction
Falls and Fall Prevention
Definition
FallNear Miss Fall Risk Assessment
https://www.google.com/search?q=fall+risk&rlz=1C5CHFA_enCA956CA956&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjF4NbxsvD9AhVhhIkEHdlVCPkQ_AUoAXoECAEQAw&biw=1174&bih=725&dpr=2#imgrc=Gs1cInl2Aiw8tM
(Urbint, n.d)
https://www.google.com/search?q=fall+risk&rlz=1C5CHFA_enCA956CA956&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjF4NbxsvD9AhVhhIkEHdlVCPkQ_AUoAXoECAEQAw&cshid=1679517817397710&biw=1174&bih=725&dpr=2#imgrc=qBRRzaz9GYpNrM
(U.S. National Library of Medicine, n.d)
https://www.google.com/search?q=poor+lit+hallway&rlz=1C5CHFA_enCA956CA956&source=lnms&tbm=isch&sa=X&ved=2ahUKEwifrtWbs_D9AhUZk4kEHVxQDowQ_AUoAXoECAIQAw&biw=1174&bih=725&dpr=2#imgrc=VihOOhccKUMnTM
Introduction
Falls and Fall Prevention
Statistics
- 1/5 falls cause serious injuries (Centers for Disease Control and Prevention, 2021)
- 3 million ER visits from elderly individuals per year
- >95% of hip fractures are caused by falls
- falls = most common cause for traumatic brain injuries (Government of Canada, 2013).
https://www.google.com/search?q=er+visit&tbm=isch&ved=2ahUKEwjts96esvD9AhWOF1kFHU56Ch0Q2-cCegQIABAA&oq=er+visit&gs_lcp=CgNpbWcQAzIFCAAQgAQyBQgAEIAEMgYIABAIEB4yBwgAEIAEEBgyBwgAEIAEEBgyBwgAEIAEEBgyBwgAEIAEEBgyBwgAEIAEEBgyBwgAEIAEEBgyBwgAEIAEEBg6BwgAELEDEEM6BAgAEEM6CAgAEIAEELEDOggIABCxAxCDAToGCAAQBRAeOgkIABCABBAKEBhQtAJY-CNg_CVoAnAAeACAAYUBiAGtEpIBBDcuMTWYAQCgAQGqAQtnd3Mtd2l6LWltZ7ABAMABAQ&sclient=img&ei=OWcbZK2zKI6v5NoPzvSp6AE&bih=725&biw=1174&rlz=1C5CHFA_enCA956CA956#imgrc=ticN9BuF3y1-eM
https://www.google.com/search?q=brain+injury&tbm=isch&ved=2ahUKEwiDxpyasvD9AhXVNlkFHfBhDV8Q2-cCegQIABAA&oq=brain+injury&gs_lcp=CgNpbWcQAzIICAAQgAQQsQMyBQgAEIAEMgUIABCABDIFCAAQgAQyBQgAEIAEMgUIABCABDIFCAAQgAQyBQgAEIAEMgUIABCABDIFCAAQgAQ6BwgAELEDEEM6BAgAEENQzgVYwxdgyxloAHAAeACAAbAGiAG_IZIBCzAuNS4yLjUtMS4zmAEAoAEBqgELZ3dzLXdpei1pbWfAAQE&sclient=img&ei=MGcbZIPuC9Xt5NoP8MO1-AU&bih=725&biw=1174&rlz=1C5CHFA_enCA956CA956
Introduction
Why are falls a concern for elderly people?
Falls and Fall Prevention
- Fall-related injuries are the concern
- For adults over 70 the risk of death from low level fall is 3x more than adults under 70
- Longer recovery time = longer hospital stay = increased risk of nosocomial infections
(Aging Care, n.d)
https://www.google.com/search?q=question+mark&rlz=1C5CHFA_enCA956CA956&source=lnms&tbm=isch&sa=X&sqi=2&ved=2ahUKEwjfqIfYs_D9AhU_FlkFHXJWD7IQ_AUoAXoECAIQAw&biw=1174&bih=725&dpr=2#imgrc=ZXv-2e38ZNMTjM
Risk Factors
Falls and Fall Prevention
Factors Contributing to a Fall
The complex set of conditions and circumstances that lead to this loss of balance are known as fall-related risk factors.
The factors that contribute to a loss of balance are represented by four categories:
- Biological
- Behavioural
- Social & Economic
- Environmental
(What Contributes to falls, 2017)
01
Risk Factors
Falls and Fall Prevention
Biological Factors
- Acute illness
- Balance deficiency
- Chronic disabilities
- Cognitive impairments
- Reduced vision
- Muscle weakness
(Seniors’ falls in Canada, 2014)
Image from Genia.ly
01
Risk Factors
Falls and Fall Prevention
Behavioural factors
- Assistive Devices
- Uncontrolled alcohol intake
- Fear of falling
- History of falls
- Inadequate diet
- Medications
- Hazardous behaviours
(Seniors’ falls in Canada, 2014)
Images from Genia.ly
Risk Factors
Falls and Fall Prevention
Social & Economic Factors
- Protective effect of marriage
- Low-socio economic status; poor environment, poor diet, barriers in accessing healthcare services- Low education, low health literacy
(Seniors’ falls in Canada, 2014)
Images from Genia.ly
Risk Factors
Falls and Fall Prevention
Environmental Factors
- Community
- Living environment
- Weather and climate
(Seniors’ falls in Canada, 2014)
Images from Genia.ly
Chronic Conditions Associated with Falls
Figure 1.
Chronic conditions can increase fall risks significantly (Philips Lifeline, 2016).
Guest Lecture - Week 7c
Falls and Fall Prevention
Aging-Related Neuromusclar and Functional Changes by Dr. Chetan Phedke
Dr. Chetan divided his presentation into 3 subcategories to which all relate back to Falls and Falls Prevention and Aging
1. Balance
2. Nervous System
3. Muscles
Photo retrieved from: https://www.carefecthomecareservices.com/ways-to-help-your-elderly-loved-one-manage-balance-issues/
Summary of the 3 Basis of Age-related Neuromuscular and Functional Changes
Nervous System
Balance
Muscles
Reflexes play an essential role in our movements, these are movements that are heavily controlled by the brain, occur without thinking (subconsciously), and adjust to the situation's demand-Reflexes are slower with age.-Soleus H- Reflex -Motor neurons decrease in supplying muscles = muscle degeneration over time - Decrease in brain volume and reflex inhibition
Grip, Ankle and Knee strength take a gradual decline with age-Muscle Weakness and Muscle Mass-Both suffer decline with age -Strength declines faster than the Mass - Trends of muscle atrophy over time is consistent amongst different races (all races)
- 1/3 of adults over 65 years old fall at least once per year-Balance and falling are directly related Swaying is the act of moving backward to forward or side to side. - Walking is a complex mechanism that requires balance to prevent falling.- Walking speed decreases with age
Risk Assessment Partners and Screening
Falls and Fall Prevention
Fall prevention starts with the assessment of risk and is most effective when it involves interdisciplinary collaboration between the patient and:
- Primary Care Providers (Physicians or Nurse Practitioners)
- Pharmacists
- Physiotherapists
- Occupational Therapists
- Optometrists
- Nursing Staff and Personal Support Workers
- Community Care Partners and Family Caregivers
These care providers and partners are able to actively screen for risk factors or conditions that may contribute to increased risk for falls such as orthostatic hypotension (either induced by medication or not), frailty, vestibular issues, visual changes, neuromuscular decline, cognitive impairment, mobility challenges, and lifestyle or environmental factors such as ill-fitting footwear, lighting and the use of assistive devices.(Callis, 2016)
Fall prevention is critical to improving the health outcomes of elderly populations by decreasing the instance of falls and the severity of related injury.
https://www.kfpl.ca/news-and-reviews/upcoming-programs-and-events/2018/11/22/fall-prevention-for-older-adults
Risk Assessment Tools
Falls and Fall Prevention
These tools can be simple or complex, and test a variety of functional abilities. Examples include:
- The 30 Second Chair Stand
- Timed Up and Go (TUG)
- 4 Stage Balance Test
- Tinetti Balance and Gait Assessment (POMA)
Functional ability testing (a risk assessment tool) should be done annually to assist in developing a care plan and determining the appropriate interventions to prevent falls in seniors.
- There are a variety of risk assessment methods available to practitioners and care partners in different settings, that range in sensitivity and specificity.
- Standardized assessment tools provide consistent results that are comparable across multiple assessments.
- Using several assessments can increase predictive accuracy, especially in high-risk patients.
(Park, 2018)
Risk Assessment Tools: STEADI
Falls and Fall Prevention
STEADI (Stopping Elderly Accidents, Deaths & Injuries) is a CDC initiative to assist providers working with older adults who may be at risk for falls.
- This initiative offers a standardized approach, is low-cost, and easily administered in different setting types.
- It utilizes a patient questionnaire to screen risk level and provides an algorithm for in depth assessments to then design interventions to reduce risk.
(Ritchey et al., 2022)
Provider Algorithm
Patient Questionnaire
Spotlight on Canadian Programming and Resources
Falls and Fall Prevention
These Canadian initiatives provide resources to reduce the risk of falls that include interventions which are easily implemented by the elderly and their care providers.
PHAC: You CAN prevent falls!
Professional Resources
General Information
Parachute is a Canadian charity focused on injury prevention.
- They are endorsed by the Public Health Agency of Canada (PHAC) and aggregate information, statistics, and resources for both the general public and professionals.
- These resources cover a range of topics including home safety, physical activity guides and training.
There is evidence that interventions such as lifestyle modifications (exercise), and multifactorial assessments/treatments have the greatest statistically significant impact on fall reductions. (Guirguis-Blake et al., 2018)
Interventions
Falls and Fall Prevention
Exercise
- Weight-bearing
- Strengthening Training
- Balance -Posture
Environmental Changes
- Decluttering
- Removing Tripping Hazards
Medication Review
- More than 5 medications
- Over-the-counter medications
- Side effects/Adverse effects
Mobility aids and Devices
- Glasses
- Hearing Aids
- Walker
- Grab Bars
Managing Chronic Diseases(e.g. Diabetes, Hypertension, Asthma, Arthritis).
(Alshammari et al., 2018) (Osteopososis Canada, 2022) (Images from Genia.ly,
Interventions
Falls and Fall Prevention
Other Strategies for Reducing the Risk of Falls
Fall Prevention Interventions require a multidimentional approach.
Nutrition-Eating regularly.Hydration-Lowers BP. Sleep-Interferes with alertness. Proper Footwear- right size and non-skid sole. Fall Clinics /Regular checkups -Education, fall prevention interventions.
Fall Prevention Interventions may focus on multiple risk factors.
Fall Prevention Interventions vary from one individual to another.
(Osteoporosis Cadana., 2022) (Images from Genia.ly. )
01
Summary - Key Takeaways
Falls and Fall Prevention
Older adults take longer to heal from falls and as a result, spend more time in the hospital to recover, these long hospital stays increase their risk of contracting nosocomial infections (healthcare-associated infections).
Actively screening and assessing older adults for their fall risk level and other risk factors helps improve health outcomes of older aged populations.
Three main bodily functions that begin to diminish with age are : Balance, Muscle Mass & Muscle Strength and The Nervous System.
The use of the following intervention strategies will help reduce the risk factors of falls.
- Exercise
- Removing clutter from the environment
- Mobility aids/devices
- Managing chronic disease
Photo retrieved from:https://blog.acplus.com/the-5-ps-of-fall-prevention
01
Falls Prevention Inforgraphic
This poster/inforgraphic was retrieved from:https://aaa1b.org/fall-prevention-tips-that-can-keep-seniors-out-of-the-hospital-and-nursing-home/
Quiz
Question 1
True or FalseFalls are the most common cause of traumatic brain injuries.
Question 2
Right!
Which chronic health condition is seen to contribute to the increase in falls significantly?
Hypertension
Diabetes
Obesity
Arthritis
Question 3
Right!
Which of the below functional ability test has the highest degree of complexity/specificity?
30 Second Chair Stand
Timed Up and Go (TUG)
Tinetti Balance and Gait Assessment
4 Stage Balance Test
Question 4
Right!
Check the box of interventions that can prevent falls or fall injuries.
Daily YogaHaving regular meals Having vision and hearing checked
Falls are inevitable with aging.
Polypharmaceuticals Higher hills footwear
Borrowing a walker from someoneTaking more than 5 medications
References
Falls and Fall Prevention
Alshammari, S. A., Alhassan, A. M., Aldawsari, M. A., Bazuhair, F. O., Alotaibi, F.K., Aldakhil, A. A., & Abdulfattah, F. W. (2018). Falls among elderlyand its relation with their health problems and surrounding environmental factors in Riyadh. Journal of Family & Community Medicine, 25(1), 29–34. https://doi.org/10.4103/jfcm.JFCM_48_17 Aging Care. (n.d). Why are falls so dangerous for the elderly? Retrieved March 20, 2023, from https://www.agingcare.com/Articles/falls-prove- fatal-for-elderly-patient-149687.htmBoschung, K. (2018, September 24). How to Prevent Falls with Good Nutrition. islandhealth.ca. Retrieved March 23, 2023, fromhttps://www.islandhealth.ca/sites/default/files/2018-09/Avoid-falls-good-nutrition.pdf Callis, N. (2016). Falls prevention: Identification of predictive fall risk factors. Applied Nursing Research, 29, 53–58. https://doi.org/10.1016/j.apnr.2015.05.007 Centers for Disease Control and Prevention. (2021, August 6). Facts about falls. Retrieved March 10, 2023, from https://www.cdc.gov/falls/facts.html#:~:text=Each%20year%2C%203%20million%20older,emergency%20departments%20for%20fall%20injuries.&text=Over%20800%2C000%20patients%20a%20year,head%20injury%20or%20hip%20fracture.&text=Each%20year%20at%20least%20300%2C000%20older%20people%20are%20hospitalized%20for%20hip%20fractures.
Centers for Disease Control and Prevention (CDC). (2022a, September 6). 4-Stage Balance Test [Video]. YouTube. https://www.youtube.com/watch?v=VUq6IgQAVJM
Centers for Disease Control and Prevention (CDC). (2022b, September 6). 30-Second Chair Stand Test [Video]. YouTube. https://www.youtube.com/watch?v=qkV0UvjXgcs
Centers for Disease Control and Prevention (CDC). (2022c, September 6). The Timed Up and Go (TUG) Test [Video]. YouTube. https://www.youtube.com/watch?v=tNay64Mab78
Falls in seniors. (n.d.). Parachute. https://parachute.ca/en/injury-topic/fall-prevention-for-seniors/
References
Falls and Fall Prevention
Franklin, M., & Hunter, R. M. (2020). A modelling-based economic evaluation of primary-care-based fall-risk screening followed by fall-prevention intervention: a cohort-based Markov model stratified by older age groups. Age and Ageing, 49(1), 57–66. https://doi.org/10.1093/ageing/afz125 Government of Canada. (2013, October 23). The Chief Public Health Officer's Report on the State of Public Health in Canada 2013 – Healthcare-associated infections – Due diligence. Canada.ca. Retrieved March 22, 2023, from https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/chief-public-health-officer-report-on-state-public-health-canada-2013-infectious-disease-never-ending-threat/healthcare-associated-infections-due-diligence.html Guirguis-Blake, J. M., Michael, Y. L., Perdue, L. A., Coppola, E. L., & Beil, T. L. (2018). Interventions to prevent falls in older adults: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA : the Journal of the American Medical Association, 319(16), 1705–1716. https://doi.org/10.1001/jama.2017.21962Images from Genia.ly, https://app.genial.ly/editor/640563f759e17800143cfe5a Kaylie, D. M. (n.d.). Dizziness and Vertigo. Merck Manuals Professional Edition. https://www.merckmanuals.com/en-ca/professional/ear,- nose,-and-throat-disorders/approach-to-the-patient-with-ear-problems/dizziness-and-vertigo Lenartowicz, M. (n.d.). Prevention of Frailty. Merck Manuals Professional Edition. https://www.merckmanuals.com/en-ca/professional/geriatrics/prevention-of-disease-and-disability-in-older-adults/prevention-of-frailty Levin, M. C. (n.d.). Weakness. Merck Manuals Professional Edition. https://www.merckmanuals.com/en-ca/professional/neurologic-disorders/symptoms-of-neurologic-disorders/weakness O’Rourke, B., Walsh, M. E., Brophy, R., Vallely, S., Murphy, N., Conroy, B., Cunningham, C., & Horgan, N. F. (2020). Does the shoe really fit? Characterising ill-fitting footwear among community-dwelling older adults attending geriatric services: an observational cross-sectional study. BMC Geriatrics, 20(1), 55–55. https://doi.org/10.1186/s12877-020-1448-9
References
Falls and Fall Prevention
Park S. H. (2018). Tools for assessing fall risk in the elderly: a systematic review and meta-analysis. Aging Clinical and Experimental Research, 30(1), 1–16. https://doi.org/10.1007/s40520-017-0749-0Pasquetti, P., Apicella, L., & Mangone, G. (2014). Pathogenesis and treatment of falls in elderly. National Center for Biotechnology Information. Retrieved March 10, 2023, from https://www.ncbi.nlm.nih.gov/pmc/ Phadke, C. P. (2022). Aging-related neuromuscular and functional changes [PowerPoint slides]. https://learn.ontariotechu.ca/courses/20515/pages/week-7-activities?module_item_id=482576 Philips Lifeline. (n.d.). Explaining epidemiological factors of falls to older adults. Retrieved March 13, 2023, from https://www.lifeline.ca/wp-content/uploads/2016/11/Falls-Booklet-Eng-WEB.pdf Province of British Columbia. (2017, November 29). What contributes to Falls? Province of British Columbia. Retrieved March 14, 2023, from https://www2.gov.bc.ca/gov/content/family-social-supports/seniors/health-safety/disease-and-injury-care-and-prevention/fall-prevention/what-contributes-to-falls#:~:text=from%20a%20fall.-,Environmental%20factors,poor%20lighting%2C%20especially%20on%20stairs. Public Health Agency of Canada. (2014, April 10). Government of Canada. Canada.ca. Retrieved March 15, 2023, from https://www.canada.ca/en/public-health/services/health-promotion/aging-seniors/publications/publications-general-public/seniors-falls-canada-second-report.html
Public Health Agency of Canada. (2016, April 28). You CAN Prevent Falls! Canada.ca. https://www.canada.ca/en/public-health/services/health-promotion/aging-seniors/publications/publications-general-public/you-prevent-falls.html
Ritchey, K., Olney, A., Chen, S., & Phelan, E. A. (2022). STEADI self-report measures independently predict fall risk. Gerontology and Geriatric Medicine, 8, 23337214221079222–23337214221079222. https://doi.org/10.1177/23337214221079222
References
Falls and Fall Prevention
Seniors’ falls collection. (n.d.). Parachute. https://parachute.ca/en/professional-resource/seniors-falls-collection/?resources=online-courses The importance of fall prevention in reducing the risk of a broken bone: Osteoporosis Canada. Osteoporosis Canada |. (2022, February 22). https://osteoporosis.ca/oc-blog/the-importance-of-fall-prevention-in-reducing-the-risk-of-a-broken-bone/
Thompson, A. D., & Shea, M. J. (n.d.). Dizziness or Light-Headedness When Standing Up. MSD Manual Consumer Version.https://www.msdmanuals.com/home/heart-and-blood-vessel-disorders/symptoms-of-heart-and-blood-vessel-disorders/dizziness-or-light-headedness-when-standing-up Urbint. (n.d.). Understanding safety indicators: Near miss, near hit, and more. Understanding Safety Indicators: Near Miss, Near Hit, and More. Retrieved March 13, 2023, from https://www.urbint.com/blog/safety-indicator-near-miss#:~:text=A%20near%20miss%20is%20a,example%20of%20a%20near%20hit. U.S. National Library of Medicine. (n.d.). Fall risk assessment. Medline Plus. Retrieved March 14, 2023, from https://medlineplus.gov/lab-tests/fall-risk-assessment/#:~:text=A%20fall%20risk%20assessment%20is,reduce%20the%20chance%20of%20injury.Winnipeg Regional Health Authority. (n.d.). Older adults- Healthy Eating & Vitamin D. Staying On Your Feet – Taking Steps to Prevent Falls . Retrieved March 15, 2023, from https://preventfalls.ca/older-adults/nutrition-vitamin-d/ Year4Geriatrics. (2015, March 2). Tinetti Balance Test (POMS) [Video]. YouTube. https://www.youtube.com/watch?v=t4H0Y6FyW1Y
Falls and Fall Prevention
Anne-marie Janotta
Created on March 6, 2023
Group 2 B
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Transcript
Falls and Fall Prevention
Faculty of Health Sciences, Ontario Tech University HLSC 4807U: Perspectives in Aging Dr. Mika Nonoyama
Group 2b: Monika Berinde, Anetra Byfield, Anne-Marie Janotta, Vithika Selvarajah, Megan Tallon
https://www.performancehealth.com/articles/fall-prevention-strategies-in-hospitals
Index
Navigate the content in this E-module by clicking on the tiles:
Course Content
Introduction
Objectives
References
Quiz
Summary
Objectives
Of this E-Module on Falls and Fall Prevention
By the end of this module you will gain an understanding of:
(Images from Genia.ly)
Introduction
Falls and Fall Prevention
Definition
FallNear Miss Fall Risk Assessment
https://www.google.com/search?q=fall+risk&rlz=1C5CHFA_enCA956CA956&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjF4NbxsvD9AhVhhIkEHdlVCPkQ_AUoAXoECAEQAw&biw=1174&bih=725&dpr=2#imgrc=Gs1cInl2Aiw8tM
(Urbint, n.d)
https://www.google.com/search?q=fall+risk&rlz=1C5CHFA_enCA956CA956&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjF4NbxsvD9AhVhhIkEHdlVCPkQ_AUoAXoECAEQAw&cshid=1679517817397710&biw=1174&bih=725&dpr=2#imgrc=qBRRzaz9GYpNrM
(U.S. National Library of Medicine, n.d)
https://www.google.com/search?q=poor+lit+hallway&rlz=1C5CHFA_enCA956CA956&source=lnms&tbm=isch&sa=X&ved=2ahUKEwifrtWbs_D9AhUZk4kEHVxQDowQ_AUoAXoECAIQAw&biw=1174&bih=725&dpr=2#imgrc=VihOOhccKUMnTM
Introduction
Falls and Fall Prevention
Statistics
https://www.google.com/search?q=er+visit&tbm=isch&ved=2ahUKEwjts96esvD9AhWOF1kFHU56Ch0Q2-cCegQIABAA&oq=er+visit&gs_lcp=CgNpbWcQAzIFCAAQgAQyBQgAEIAEMgYIABAIEB4yBwgAEIAEEBgyBwgAEIAEEBgyBwgAEIAEEBgyBwgAEIAEEBgyBwgAEIAEEBgyBwgAEIAEEBgyBwgAEIAEEBg6BwgAELEDEEM6BAgAEEM6CAgAEIAEELEDOggIABCxAxCDAToGCAAQBRAeOgkIABCABBAKEBhQtAJY-CNg_CVoAnAAeACAAYUBiAGtEpIBBDcuMTWYAQCgAQGqAQtnd3Mtd2l6LWltZ7ABAMABAQ&sclient=img&ei=OWcbZK2zKI6v5NoPzvSp6AE&bih=725&biw=1174&rlz=1C5CHFA_enCA956CA956#imgrc=ticN9BuF3y1-eM
https://www.google.com/search?q=brain+injury&tbm=isch&ved=2ahUKEwiDxpyasvD9AhXVNlkFHfBhDV8Q2-cCegQIABAA&oq=brain+injury&gs_lcp=CgNpbWcQAzIICAAQgAQQsQMyBQgAEIAEMgUIABCABDIFCAAQgAQyBQgAEIAEMgUIABCABDIFCAAQgAQyBQgAEIAEMgUIABCABDIFCAAQgAQ6BwgAELEDEEM6BAgAEENQzgVYwxdgyxloAHAAeACAAbAGiAG_IZIBCzAuNS4yLjUtMS4zmAEAoAEBqgELZ3dzLXdpei1pbWfAAQE&sclient=img&ei=MGcbZIPuC9Xt5NoP8MO1-AU&bih=725&biw=1174&rlz=1C5CHFA_enCA956CA956
Introduction
Why are falls a concern for elderly people?
Falls and Fall Prevention
(Aging Care, n.d)
https://www.google.com/search?q=question+mark&rlz=1C5CHFA_enCA956CA956&source=lnms&tbm=isch&sa=X&sqi=2&ved=2ahUKEwjfqIfYs_D9AhU_FlkFHXJWD7IQ_AUoAXoECAIQAw&biw=1174&bih=725&dpr=2#imgrc=ZXv-2e38ZNMTjM
Risk Factors
Falls and Fall Prevention
Factors Contributing to a Fall
The complex set of conditions and circumstances that lead to this loss of balance are known as fall-related risk factors.
The factors that contribute to a loss of balance are represented by four categories:
(What Contributes to falls, 2017)
01
Risk Factors
Falls and Fall Prevention
Biological Factors
(Seniors’ falls in Canada, 2014)
Image from Genia.ly
01
Risk Factors
Falls and Fall Prevention
Behavioural factors
(Seniors’ falls in Canada, 2014)
Images from Genia.ly
Risk Factors
Falls and Fall Prevention
Social & Economic Factors
- Social systems
- Protective effect of marriage- Socio-economic status
- Low-socio economic status; poor environment, poor diet, barriers in accessing healthcare services- Low education, low health literacy(Seniors’ falls in Canada, 2014)
Images from Genia.ly
Risk Factors
Falls and Fall Prevention
Environmental Factors
(Seniors’ falls in Canada, 2014)
Images from Genia.ly
Chronic Conditions Associated with Falls
Figure 1.
Chronic conditions can increase fall risks significantly (Philips Lifeline, 2016).
Guest Lecture - Week 7c
Falls and Fall Prevention
Aging-Related Neuromusclar and Functional Changes by Dr. Chetan Phedke
Dr. Chetan divided his presentation into 3 subcategories to which all relate back to Falls and Falls Prevention and Aging
1. Balance 2. Nervous System 3. Muscles
Photo retrieved from: https://www.carefecthomecareservices.com/ways-to-help-your-elderly-loved-one-manage-balance-issues/
Summary of the 3 Basis of Age-related Neuromuscular and Functional Changes
Nervous System
Balance
Muscles
Reflexes play an essential role in our movements, these are movements that are heavily controlled by the brain, occur without thinking (subconsciously), and adjust to the situation's demand-Reflexes are slower with age.-Soleus H- Reflex -Motor neurons decrease in supplying muscles = muscle degeneration over time - Decrease in brain volume and reflex inhibition
Grip, Ankle and Knee strength take a gradual decline with age-Muscle Weakness and Muscle Mass-Both suffer decline with age -Strength declines faster than the Mass - Trends of muscle atrophy over time is consistent amongst different races (all races)
- 1/3 of adults over 65 years old fall at least once per year-Balance and falling are directly related Swaying is the act of moving backward to forward or side to side. - Walking is a complex mechanism that requires balance to prevent falling.- Walking speed decreases with age
Risk Assessment Partners and Screening
Falls and Fall Prevention
Fall prevention starts with the assessment of risk and is most effective when it involves interdisciplinary collaboration between the patient and:
- Primary Care Providers (Physicians or Nurse Practitioners)
- Pharmacists
- Physiotherapists
- Occupational Therapists
- Optometrists
- Nursing Staff and Personal Support Workers
- Community Care Partners and Family Caregivers
These care providers and partners are able to actively screen for risk factors or conditions that may contribute to increased risk for falls such as orthostatic hypotension (either induced by medication or not), frailty, vestibular issues, visual changes, neuromuscular decline, cognitive impairment, mobility challenges, and lifestyle or environmental factors such as ill-fitting footwear, lighting and the use of assistive devices.(Callis, 2016)Fall prevention is critical to improving the health outcomes of elderly populations by decreasing the instance of falls and the severity of related injury.
https://www.kfpl.ca/news-and-reviews/upcoming-programs-and-events/2018/11/22/fall-prevention-for-older-adults
Risk Assessment Tools
Falls and Fall Prevention
These tools can be simple or complex, and test a variety of functional abilities. Examples include:
Functional ability testing (a risk assessment tool) should be done annually to assist in developing a care plan and determining the appropriate interventions to prevent falls in seniors.
- Using several assessments can increase predictive accuracy, especially in high-risk patients.
(Park, 2018)Risk Assessment Tools: STEADI
Falls and Fall Prevention
STEADI (Stopping Elderly Accidents, Deaths & Injuries) is a CDC initiative to assist providers working with older adults who may be at risk for falls.
- It utilizes a patient questionnaire to screen risk level and provides an algorithm for in depth assessments to then design interventions to reduce risk.
(Ritchey et al., 2022)Provider Algorithm
Patient Questionnaire
Spotlight on Canadian Programming and Resources
Falls and Fall Prevention
These Canadian initiatives provide resources to reduce the risk of falls that include interventions which are easily implemented by the elderly and their care providers.
PHAC: You CAN prevent falls!
Professional Resources
General Information
Parachute is a Canadian charity focused on injury prevention.
There is evidence that interventions such as lifestyle modifications (exercise), and multifactorial assessments/treatments have the greatest statistically significant impact on fall reductions. (Guirguis-Blake et al., 2018)
Interventions
Falls and Fall Prevention
Exercise
- Weight-bearing
- Strengthening Training
- Balance -Posture
Environmental Changes- Decluttering
- Removing Tripping Hazards
Medication Review- More than 5 medications
- Over-the-counter medications
- Side effects/Adverse effects
Mobility aids and Devices- Glasses
- Hearing Aids
- Walker
- Grab Bars
Managing Chronic Diseases(e.g. Diabetes, Hypertension, Asthma, Arthritis).(Alshammari et al., 2018) (Osteopososis Canada, 2022) (Images from Genia.ly,
Interventions
Falls and Fall Prevention
Other Strategies for Reducing the Risk of Falls
Fall Prevention Interventions require a multidimentional approach.
Nutrition-Eating regularly.Hydration-Lowers BP. Sleep-Interferes with alertness. Proper Footwear- right size and non-skid sole. Fall Clinics /Regular checkups -Education, fall prevention interventions.
Fall Prevention Interventions may focus on multiple risk factors.
Fall Prevention Interventions vary from one individual to another.
(Osteoporosis Cadana., 2022) (Images from Genia.ly. )
01
Summary - Key Takeaways
Falls and Fall Prevention
Older adults take longer to heal from falls and as a result, spend more time in the hospital to recover, these long hospital stays increase their risk of contracting nosocomial infections (healthcare-associated infections).
Actively screening and assessing older adults for their fall risk level and other risk factors helps improve health outcomes of older aged populations.
Three main bodily functions that begin to diminish with age are : Balance, Muscle Mass & Muscle Strength and The Nervous System.
The use of the following intervention strategies will help reduce the risk factors of falls.
Photo retrieved from:https://blog.acplus.com/the-5-ps-of-fall-prevention
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Falls Prevention Inforgraphic
This poster/inforgraphic was retrieved from:https://aaa1b.org/fall-prevention-tips-that-can-keep-seniors-out-of-the-hospital-and-nursing-home/
Quiz
Question 1
True or FalseFalls are the most common cause of traumatic brain injuries.
Question 2
Right!
Which chronic health condition is seen to contribute to the increase in falls significantly?
Hypertension
Diabetes
Obesity
Arthritis
Question 3
Right!
Which of the below functional ability test has the highest degree of complexity/specificity?
30 Second Chair Stand
Timed Up and Go (TUG)
Tinetti Balance and Gait Assessment
4 Stage Balance Test
Question 4
Right!
Check the box of interventions that can prevent falls or fall injuries.
Daily YogaHaving regular meals Having vision and hearing checked
Falls are inevitable with aging.
Polypharmaceuticals Higher hills footwear
Borrowing a walker from someoneTaking more than 5 medications
References
Falls and Fall Prevention
Alshammari, S. A., Alhassan, A. M., Aldawsari, M. A., Bazuhair, F. O., Alotaibi, F.K., Aldakhil, A. A., & Abdulfattah, F. W. (2018). Falls among elderlyand its relation with their health problems and surrounding environmental factors in Riyadh. Journal of Family & Community Medicine, 25(1), 29–34. https://doi.org/10.4103/jfcm.JFCM_48_17 Aging Care. (n.d). Why are falls so dangerous for the elderly? Retrieved March 20, 2023, from https://www.agingcare.com/Articles/falls-prove- fatal-for-elderly-patient-149687.htmBoschung, K. (2018, September 24). How to Prevent Falls with Good Nutrition. islandhealth.ca. Retrieved March 23, 2023, fromhttps://www.islandhealth.ca/sites/default/files/2018-09/Avoid-falls-good-nutrition.pdf Callis, N. (2016). Falls prevention: Identification of predictive fall risk factors. Applied Nursing Research, 29, 53–58. https://doi.org/10.1016/j.apnr.2015.05.007 Centers for Disease Control and Prevention. (2021, August 6). Facts about falls. Retrieved March 10, 2023, from https://www.cdc.gov/falls/facts.html#:~:text=Each%20year%2C%203%20million%20older,emergency%20departments%20for%20fall%20injuries.&text=Over%20800%2C000%20patients%20a%20year,head%20injury%20or%20hip%20fracture.&text=Each%20year%20at%20least%20300%2C000%20older%20people%20are%20hospitalized%20for%20hip%20fractures. Centers for Disease Control and Prevention (CDC). (2022a, September 6). 4-Stage Balance Test [Video]. YouTube. https://www.youtube.com/watch?v=VUq6IgQAVJM Centers for Disease Control and Prevention (CDC). (2022b, September 6). 30-Second Chair Stand Test [Video]. YouTube. https://www.youtube.com/watch?v=qkV0UvjXgcs Centers for Disease Control and Prevention (CDC). (2022c, September 6). The Timed Up and Go (TUG) Test [Video]. YouTube. https://www.youtube.com/watch?v=tNay64Mab78 Falls in seniors. (n.d.). Parachute. https://parachute.ca/en/injury-topic/fall-prevention-for-seniors/
References
Falls and Fall Prevention
Franklin, M., & Hunter, R. M. (2020). A modelling-based economic evaluation of primary-care-based fall-risk screening followed by fall-prevention intervention: a cohort-based Markov model stratified by older age groups. Age and Ageing, 49(1), 57–66. https://doi.org/10.1093/ageing/afz125 Government of Canada. (2013, October 23). The Chief Public Health Officer's Report on the State of Public Health in Canada 2013 – Healthcare-associated infections – Due diligence. Canada.ca. Retrieved March 22, 2023, from https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/chief-public-health-officer-report-on-state-public-health-canada-2013-infectious-disease-never-ending-threat/healthcare-associated-infections-due-diligence.html Guirguis-Blake, J. M., Michael, Y. L., Perdue, L. A., Coppola, E. L., & Beil, T. L. (2018). Interventions to prevent falls in older adults: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA : the Journal of the American Medical Association, 319(16), 1705–1716. https://doi.org/10.1001/jama.2017.21962Images from Genia.ly, https://app.genial.ly/editor/640563f759e17800143cfe5a Kaylie, D. M. (n.d.). Dizziness and Vertigo. Merck Manuals Professional Edition. https://www.merckmanuals.com/en-ca/professional/ear,- nose,-and-throat-disorders/approach-to-the-patient-with-ear-problems/dizziness-and-vertigo Lenartowicz, M. (n.d.). Prevention of Frailty. Merck Manuals Professional Edition. https://www.merckmanuals.com/en-ca/professional/geriatrics/prevention-of-disease-and-disability-in-older-adults/prevention-of-frailty Levin, M. C. (n.d.). Weakness. Merck Manuals Professional Edition. https://www.merckmanuals.com/en-ca/professional/neurologic-disorders/symptoms-of-neurologic-disorders/weakness O’Rourke, B., Walsh, M. E., Brophy, R., Vallely, S., Murphy, N., Conroy, B., Cunningham, C., & Horgan, N. F. (2020). Does the shoe really fit? Characterising ill-fitting footwear among community-dwelling older adults attending geriatric services: an observational cross-sectional study. BMC Geriatrics, 20(1), 55–55. https://doi.org/10.1186/s12877-020-1448-9
References
Falls and Fall Prevention
Park S. H. (2018). Tools for assessing fall risk in the elderly: a systematic review and meta-analysis. Aging Clinical and Experimental Research, 30(1), 1–16. https://doi.org/10.1007/s40520-017-0749-0Pasquetti, P., Apicella, L., & Mangone, G. (2014). Pathogenesis and treatment of falls in elderly. National Center for Biotechnology Information. Retrieved March 10, 2023, from https://www.ncbi.nlm.nih.gov/pmc/ Phadke, C. P. (2022). Aging-related neuromuscular and functional changes [PowerPoint slides]. https://learn.ontariotechu.ca/courses/20515/pages/week-7-activities?module_item_id=482576 Philips Lifeline. (n.d.). Explaining epidemiological factors of falls to older adults. Retrieved March 13, 2023, from https://www.lifeline.ca/wp-content/uploads/2016/11/Falls-Booklet-Eng-WEB.pdf Province of British Columbia. (2017, November 29). What contributes to Falls? Province of British Columbia. Retrieved March 14, 2023, from https://www2.gov.bc.ca/gov/content/family-social-supports/seniors/health-safety/disease-and-injury-care-and-prevention/fall-prevention/what-contributes-to-falls#:~:text=from%20a%20fall.-,Environmental%20factors,poor%20lighting%2C%20especially%20on%20stairs. Public Health Agency of Canada. (2014, April 10). Government of Canada. Canada.ca. Retrieved March 15, 2023, from https://www.canada.ca/en/public-health/services/health-promotion/aging-seniors/publications/publications-general-public/seniors-falls-canada-second-report.html Public Health Agency of Canada. (2016, April 28). You CAN Prevent Falls! Canada.ca. https://www.canada.ca/en/public-health/services/health-promotion/aging-seniors/publications/publications-general-public/you-prevent-falls.html Ritchey, K., Olney, A., Chen, S., & Phelan, E. A. (2022). STEADI self-report measures independently predict fall risk. Gerontology and Geriatric Medicine, 8, 23337214221079222–23337214221079222. https://doi.org/10.1177/23337214221079222
References
Falls and Fall Prevention
Seniors’ falls collection. (n.d.). Parachute. https://parachute.ca/en/professional-resource/seniors-falls-collection/?resources=online-courses The importance of fall prevention in reducing the risk of a broken bone: Osteoporosis Canada. Osteoporosis Canada |. (2022, February 22). https://osteoporosis.ca/oc-blog/the-importance-of-fall-prevention-in-reducing-the-risk-of-a-broken-bone/ Thompson, A. D., & Shea, M. J. (n.d.). Dizziness or Light-Headedness When Standing Up. MSD Manual Consumer Version.https://www.msdmanuals.com/home/heart-and-blood-vessel-disorders/symptoms-of-heart-and-blood-vessel-disorders/dizziness-or-light-headedness-when-standing-up Urbint. (n.d.). Understanding safety indicators: Near miss, near hit, and more. Understanding Safety Indicators: Near Miss, Near Hit, and More. Retrieved March 13, 2023, from https://www.urbint.com/blog/safety-indicator-near-miss#:~:text=A%20near%20miss%20is%20a,example%20of%20a%20near%20hit. U.S. National Library of Medicine. (n.d.). Fall risk assessment. Medline Plus. Retrieved March 14, 2023, from https://medlineplus.gov/lab-tests/fall-risk-assessment/#:~:text=A%20fall%20risk%20assessment%20is,reduce%20the%20chance%20of%20injury.Winnipeg Regional Health Authority. (n.d.). Older adults- Healthy Eating & Vitamin D. Staying On Your Feet – Taking Steps to Prevent Falls . Retrieved March 15, 2023, from https://preventfalls.ca/older-adults/nutrition-vitamin-d/ Year4Geriatrics. (2015, March 2). Tinetti Balance Test (POMS) [Video]. YouTube. https://www.youtube.com/watch?v=t4H0Y6FyW1Y