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Falls in Older Persons : Prevention and Management

Falls in Older Persons : Prevention and Management. Prakong Intarasombat Ramathibodi School of Nursing. Why fall prevention is important. Are a major threat to the health and independence of older adults Falls can be devastating : serious injury (1/10) Falls can be deadly

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Falls in Older Persons : Prevention and Management

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  1. Falls in Older Persons : Prevention and Management Prakong Intarasombat Ramathibodi School of Nursing Dec. /20 /2008

  2. Why fall prevention is important Are a major threat to the health and independence of older adults Falls can be devastating : serious injury (1/10) Falls can be deadly Falls are costly, medical costs, economic burden Falls are preventable CDC, 2008 Dec. /20 /2008

  3. Dec. /20 /2008

  4. “A fall is an event which results in a person coming to rest in advertently on the ground or other lower level and other than as a consequence of the following : Sustaining a violent blow, loss of consciousness, sudden onset of paralysis, as in a stroke, an epileptic seizure.” (Kellog Group, 1987 p.4) Dec. /20 /2008

  5. Fall : Definition, researcher & seniors view “Unintentionally coming to rest on ground, floor, or other lower level : excludes coming to rest against furniture, wall, or other structure.” Buchner et al. (1991) Dec. /20 /2008

  6. “ …….. losing your balance such that your hands, arms, knees, buttocks or body touch or hit the ground or floor.” (Berg, Alessio, Mills, & Tong, 1997 p.262) Dec. /20 /2008

  7. “……. An unintentional change in position where the elder ends up on the floor or ground.” Canadian Institute for Health Information, 2002. Dec. /20 /2008

  8. “……. Inadvertently coming to rest on the ground or other lower level with or without loss of consciousness and other than as the consequence of sudden onset of paralysis, epileptic seizure, excess alcohol intake or overwhelming external force.” (Carter, et al, 2002 p.999) Dec. /20 /2008

  9. “ …….. A sudden loss of gait causing the hit of any part of the body to the floor ……” (Cesari, et al, 2002 p.M723) Dec. /20 /2008

  10. “……. Any event in which a person inadvertently or intentionally comes to rest on the ground or another lower level such as a chair, toilet or bed.” (Tideiksar, 2002 p.15) Dec. /20 /2008

  11. “การที่เกิดการเปลี่ยนท่าโดยไม่ได้ตั้งใจ และเป็นผลให้ร่างกายทรุดหรือลงนอนกับพื้น หรือปะทะสิ่งของต่าง ๆ เช่น โต๊ะ และไม่นับ รวมการหกล้มที่เกิดจากอุบัติเหตุร้ายแรง เช่น ถูกรถชน” (สุทธิชัย จิตะพันธ์กุล, 2541, หน้า 134) Dec. /20 /2008

  12. Fall : researcher & older persons view Antecedent : before falls Consequence :fall Dec. /20 /2008

  13. Epidemiology Community – dwelling older persons : 30%, 50%, 18-19% Nursing home residents Hospitalized patients Dec. /20 /2008

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  19. ICD – 9 E880 – E888 ICD – 10 WOO – W19 CDC Dec. /20 /2008

  20. Causes & Risk Factors Geographical variation One in three older people falls each year, South East Asia region : China 6% - 31% Japan 20% Thailand 19% no epidemiological data available in the developing world WHO, 2007 Dec. /20 /2008

  21. Geographical disparity in mortality rate 39:1000 people of all ages – injuries related to fall (2002) High income countries – 25% Highest in Europion regions 6.6-11.3 : 100,000 countries Highest in males in low & middle income Dec. /20 /2008

  22. Risk factors for falls among older adults Biological risk factors Behavioral risk factors Environmental risk factors Dec. /20 /2008

  23. Risk Factors Single cause – few Multifactorial – complex interactions Intrinsic & extrinsic factors Dec. /20 /2008

  24. Intrinsic factors Demographic factors Biological factors Dec. /20 /2008

  25. Extrinsic factors Environmental and behavioral factors Dec. /20 /2008

  26. Demographic factors Race – Caucasians in USA 33-60% Caucasians women are 1.6 times - African Dec. /20 /2008

  27. Socioeconomic status Low income Little education Poor housing environment Limited social connection Women-live alone Poorly designed public space Dec. /20 /2008

  28. Biological factors Age Sex women : injury rate 40-60% higher than men) Bone mass declines faster than men Osteoporosis Dec. /20 /2008

  29. (ต่อ) Biological factors Mobility Chronic health conditions Vision changes & loss Loss of sensation in feet Dec. /20 /2008

  30. Medical Conditions Diabetes Parkinson’s disease (PD) Depression Incontinence Alzheimer disease Physical condition Dec. /20 /2008

  31. Physical conditions (identified in 17 controlled trials) Muscle weakness 12 / 12 Impaired balance 10 / 10 Gait deficit 8 / 9 Visual deficit 5 / 9 Limited mobility 9 / 9 Cognitive impairment 4 / 8 impaired ADL 5 / 6 Postural hypotension 2 / 7 Dec. /20 /2008

  32. Foot Problems 30 % of older people in community Ankle flexibility Pain Dec. /20 /2008

  33. B M I low BMI - risk of falls unintentional weight loss weight loss & low BMI bone mineral density Dec. /20 /2008

  34. Behavioral factors Fear of falling (30% , 60%) Sedentary behavior - inactive Dec. /20 /2008

  35. Medication intake taking more than 4 medications the most common drugs – act on central nervous system sedatives tranquilizers benzodiazepines Dec. /20 /2008

  36. Alcohol misuse intoxicated bone density Dec. /20 /2008

  37. Inappropriate shoes walking barefoot wearing only socks high heel shoes – impair balance athletic shoes (some studies) Dec. /20 /2008

  38. Consequence of falls Hospital admission (Canadian survey, 40%) Immobility Mortality (men > women) Dec. /20 /2008

  39. Mortality lying on the floor more than 12 hours pressure sores dehydration hypothermia pneumonia high mortality Dec. /20 /2008

  40. An effective and sustainable programof fall prevention Dec. /20 /2008

  41. Fall Risk :Complex and multifactorial nature of fall risk among a rapidly aging population Dec. /20 /2008

  42. Policy Research Practice WHO, 2007 Dec. /20 /2008

  43. National Health PolicyOlder People(B.E.2545 – 2564) Dec. /20 /2008

  44. Healthy Public Policy health promotion strengthening community action developing personal skills Dec. /20 /2008

  45. Strong evidence for fall prevention Community Multifactorial approaches Single factor intervention Dec. /20 /2008

  46. Multifactorial approaches Health and environment risk factor assessment Environment risk assessment and modification balance and gait training ; medication review and modification ; managing visual concerns ; addressing orthostatic hypotension & cardiovascular problems Dec. /20 /2008

  47. Single factor interventions : Exercise, Home hazard assessment and modification Withdrawal of psychotropic medications and cardiac pacing for fallers with carotid sinus hypersensitivity Dec. /20 /2008

  48. Exercise individually tailored muscle strength & balance training group or individually? a group program using the Tai Chi Dec. /20 /2008

  49. Key practice for sustaining fall prevention program the translation of research into practice, financial and human resources for fall prevention service delivery and evaluation Dec. /20 /2008

  50. Practice : Fall prevention guidelines Dec. /20 /2008

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