Falls: Low Vision and Falls

1. Falls: Low Vision and Falls Jag Mallya 1-09-2010

2. Definition: • A fall is an event which results in a person inadvertently coming to rest on the ground, the floor or other lower level. • No evidence of: • sudden onset of paralysis, • epileptic seizure, or Loss of consciousness • overwhelming external force

3. Epidemiology of Falls > 65 years – 30% > 75 years – 40% 50% of falls in people who fall twice or more in a year.

4. Consequences of Falls Commonest cause of Accidental injury in older people. Commonest cause of Accidental Death in > 75 years of age. 6% falls > 65 years result in a fracture. Commonest cause for older people to attend A & E > 75 years hip fractures predominate. Fragility fracture also costs £1.7 billion per year (In-patient & long term provision.)

5. Table 10: Cost of an individual hip fracture Category Cost Hospital care £4,760 Ambulance £171 Long stay residential care £20,010 GP use £164 Outpatient use £319 Total Cost £25,424

6. Cost of Hip Fracture in Elderly in UK. Hospital Costs: $ 430,407,013 Social Care Costs: $ 933,420,670 Other: $ 18,000,000 Approx Total Cost: $1,382,932,183 Ref: “The Economic cost of hip fracture in the UK.”

7. Social Costs of Falls By 2051 = Falls (Population of Australia: 22,403,920) Direct health cost attributed to falls related injury will increase 3 fold. 2500 additional hospital beds will need to be permanently allocated to falls. 3320 additional Nursing Home places. Ref: Health Service impacts and costs of falls in older age (WHO) Dongbu Fu

9. Falls are Multifactorial: Intrinsic Factors Extrinsic Factors Medical conditions Impaired vision and hearing Age related changes Medications Improper use of assistive devices Environment FALLS

10. Falls in the Community Accidents/environment 37% Weakness, balance, gait 12% Drop attack 11% Dizziness or vertigo 8% Orthostatic hypotension 5% Acute illness, confusion, drugs, decreased vision 18% Unknown 8% Rubenstein JAGS 1988

11. Causes of Falls: Summary of 12 Studies Rubenstein LZ, Josephson KR. Clin Geriatr Med. 2002(May);18(2):141-158 Accident/environment Gait/balance disorder Dizziness/vertigo Drop attack Confusion Postural hypotension Vision problem Other specified Unknown 31% 17 13 10 4 3 3 15 5

12. Age related changes affecting balance

13. Normal Changes with Aging Neurologic: Increased reaction time Decreased righting reflexes Decreased Proprioception Vision Changes: Decreased accommodation & dark adaptation Decreased muscle mass: Strength

14. Periodic case finding in Primary Care: Ask all patients about falls in past year Assessment and Management of Falls No intervention No falls Recurrent Single fall falls No problems Gait/balance problems Check for gait/balance problem Fall Evaluation* Assessment History Medications Vision Gait and balance Lower limb joints Neurological Cardiovascular Multifactorial intervention (as appropriate) Gait, balance, exercise - programs Medication - modification Postural hypotension - treatment Environmental hazards - modification Cardiovascular disorders - treatment