Fall Prevention

1. Fall Prevention Haley Gladfelter University of Findlay DPT May 2012 gladfelterh@findlay.edu Cindy Nagel MA, BSN, RNBC Trauma Program Manager St. Rita’s Medical Center cdnagel@health-partners.org

2. Objectives • What is considered a fall • Staggering statics about falling in older adults • Dangers of falling • What to do if you fall • How to prevent and protect yourself from falling • Balance exercises

3. What Is A Fall? • A fall, as defined by The Technical Assistance Program (TAP) of the Ohio Department of Health includes: • An intercepted fall is still a fall. • An episode where and individual lose his or her balance but catches themselves before they fall. • A fall without an injury is still a fall. • If you fall but do not acquire an injury it is still considered to be a fall. • A fall to the ground where the individual is found on the ground and or acquired an injury.

4. Falling Epidemic • The Ohio Department of Health (ODH) and The Ohio Prevention Partnership reports: • Falls in older adults 65 and older have reached epidemic proportions • Falls and fall-related injury seriously affect older adults’ quality of life and present a substantial burden to the Ohio health-care system. • They surpass all other mechanisms of injury as a cause of ER visits, hospitalization and death and are higher than rates for all other injuries combined.

5. SRMC Trauma Statistics

8. Fall Related Statistics - Ohio • Fall-related ER visit and hospitalization rates increased 61% and 51% respectively from 2002 to 2009. • In 2009, there were 4 fall-related ER visits for every 100 Ohio older adults and 10 fall-related hospitalizations for every 1,000 Ohio older adults • From 2000 to 2009, Ohioans aged 65 and older experienced a 125% increase in the number of fatal falls and 112% increase in the fall death rate. • On average, 2.3 older Ohioans suffered fatal falls each day in 2009.  

9. Fall Related Statistics • Ohioans 65 and older accounted for approximately 82% of fatal falls in 2009; while they represent only 14% of the population. • Risk for suffering serious injury after a fall increases dramatically with advancing age. Females 85 years and older account for half of fatal falls, while they account for only 3% of the female population

10. Fatal Falls per Year between 2000-2006 http://www.odh.ohio.gov/sitecore/content/HealthyOhio/default/vipp/~/link.aspx?_id=6A91950F498E4D048648B21DA985BEE7&_z=z

11. Fall Related Costs • Falls among older adults cost Ohio and its residents $4.2 billion in 2003, more than two-thirds (68 percent), of the total annual costs of nonfatal, hospital-admitted falls. Direct medical costs represent only a fraction (8%) of the total cost. Costs Associated with Falls Among Older Adults, Ages 65+, Ohio, 2003

12. Dangers Of Falls • In older adults • Falls are the leading cause of injury- related deaths • The most common cause of nonfatal injuries and hospital admissions for trauma • The most common fractures are • Spine • Hip, pelvis, and leg • Forearm, upper arm, hand • Ankle

13. Dangers of Falling • The psychological consequences of any fall, whether injury-causing or not, can be severe, resulting in • Fear • Decreased quality of life from self‐imposed restriction of activities, • Social isolation and depressive symptoms. • These “near-miss” falls can put someone at risk for future falls as well if they are not adequately assessed and managed by a health care professional.

14. Why do falls occur in older adults? • Biological changes secondary to age • Decreased balance and coordination • Slowed reaction time • Overall decline in strength and conditioning • Sensation issues • Peripheral Neuropathy • Decreased skin sensation • FALLS ARE NOT A NORMAL PART OF AGING! • Simple steps discussed later can significantly decrease your risk of falling

15. What To Do If You Fall • If an upper extremity injury • Use elbow to push up to side sitting position • Then use good arm to push to kneeling position • Last use legs to help move to standing position • Stationary object can be used to help stand

16. What To Do If You Fall • If a lower extremity injury • If lateral fall on side of hip • Try to roll onto your back • Sit up to your bottom • Then scoot backwards across the floor using good leg • Keep affected leg still if possible • If you fall on your bottom • Try to scoot along the floor on the opposite side of the hip • Do not try to stand • Always have a phone at that can be reached at floor level such as an end table.

17. Safety Features Around the Home • Hand rails • Into and out of home • Going up and down steps between levels in the home • Hand rails on both sides is best, yet one side will still increase your safety significantly • Do not leave clutter on the floor • News papers and magazines can increase risk of falls http://www.familyhandyman.com/DIY-Projects/Home-Safety/ http://www.mitrecontracting.com/railings/

18. Safety Features Around the Home • Remove all throw rugs • Throw rugs are a HUGE cause of falls in older adults • The rug can slip under your feet or a toe can get caught • One small ruffle in the rug can cause you to lose your balance and fall • Furniture arrangement • Critical during nighttime hours • When arising from bed you could be slightly dizzy and disoriented • Arrange furniture to ensure that there is always a clear pathway to enter and exit a room. http://www.boomer-livingplus.com/article/an_ounce_of_prevention

19. Safety Features Around the Home • Increase lighting in the home • Dull lighting can affect how your view your surroundings leading to falls • Can be a simple as increasing the bulb watt • Be mindful of small dogs and cats • Small dogs and cats can end up under your feet causing you to lose your balance http://info.aia.org/aiarchitect/thisweek08/0801/0801p_lighting.cfm

20. Safety Features Around the Home • Bathroom Features • Grab bars • Should be installed in the shower and beside the toilet • “Walk in showers” with a seat • Removes the risk of falling while stepping into a tub shower • The seat allows for you to shower without the risk of slipping and falling • Elevated toilet seat • Decreases the risk of falling while getting up and down from the toilet http://acmedical.com/blog/?Tag=Adaptive%20home%20remodeling http://www.seabridgewalkinbathau.com/avalon-walkin-shower.html

21. Reducing Your Risk • Increase Physical Activity • 15 minutes of daily activities can increase muscle strength, and balance. • Walking • Biking • Swimming • Tia Chi • Yearly Eye Examinations • Age related disease can increase risk of falling • Cataracts • Macular degeneration • Diabetic retinopathy • Early detection is the key!!

22. Reducing Your Risk Cont. • Review Your Medications • Ask your doctor if the medicine your are taking can cause dizziness or drowsiness. • Discuss if your are taking your medicine safely • Decrease risk of mixing medicine or taking too much medication. • Remove Environmental Hazards • Increase lighting • Remove all throw rugs • Watch for slippery floor • Linoleum • Wood floors • Tile • Eliminate unsteady furniture

23. Reducing Your Risk Cont. • Think, Plan, Slow Down • Many falls are caused by rushing • Slow down and think though task you are performing before completing the task • Be mindful of all safety concerns/fall risks and plan your tasks accordingly • Always Have Emergency Phone • It is very important that you always have a cell phone or life alert device for emergency situations • Always have a phone that can be reached from the floor level (end table) • BE PREPARED!

24. Increasing Your Balance • 4 way hip • Calf raises (going up on toes) • Single leg standing • All the above should be done by standing at a stationary table or counter top for support. • Side-walking • Mini squats against a wall • Toe taps at household objects

25. Take Home Message • Fall risks are a serious danger for older adults. The following precaution may significantly decrease you risk of falling. • Remove environmental hazards and add additional safety features to your home. • Have annual eye examinations and asking your doctors about your medications. • Think, plan, and slow down before implementing and completing a task. • Always be prepared by having an emergency phone ready. • Stay active with at least 15 minutes of exercise daily

26. Additional Information • http://www.nsc.org/nsc_events/Nat_Safe_Month/Documents/2012_Falls_Preventionpublic.pdf • http://www.odh.ohio.gov/sitecore/content/HealthyOhio/default/vipp/~/link.aspx?_id=6A91950F498E4D048648B21DA985BEE7&_z=z

27. Contact Information • St. Rita’s Medical Center • Trauma Services and Injury Prevention Program • Cindy Nagel MA, BSN, RNBC • 419-226-9150 • cdnagel@health-partners.org • University of Findlay • DPT Class of 2013 • Haley Gladfelter • 419-204-7342 • gladfelterh@findlay.edu

28. References • Ohio Injury Prevention Partnership. Falls Among Older Adults. Revised April 19, 2012. Available at:http://www.odh.ohio.gov/sitecore/content/HealthyOhio/default/vipp/~/link.aspx?_id=6A91950F498E4D048648B21DA985BEE7&_z=z.Accessed May 16, 2012. • National Safety Council. Preventing Slips, Trips and Falls. Revised 2012. Available at:http://www.nsc.org/nsc_events/Nat_Safe_Month/Documents/2012_Falls_Preventionpublic.pdf. Accessed May 16, 2012.