Falls Flashcards
What does the WHO define as a “fall”?
An event which results in a person coming to rest inadvertently on the floor, ground, or another lower level
(exclusion: major internal event such as stroke, being hit by an external force (being knocked over)
Why are falls especially significant in older adults?
For an older adult, a fracture can mean the end of their independence and a transition into long term care
What are the 4 quality indicators of residential home settings?
- depression
- pain
- pressure ulcers
- falls
Falls account for __% of injury hospitalizations among seniors and __% of all ER visits among seniors.
81%; 60%
Which type of fall-related injury is most prevalent in Canada? What are its consequences?
Hip fracture (23,000/yr in Canada, 95% are caused by falls)
25% die within one year
50% lose independence
Wrist fractures have a similar frequency and 90% are caused by falls.
What are other fall-related injuries prevalent in Canada?
Traumatic brain injury (80% caused by falls)
Spinal cord injuries (50% caused by falls)
Why do we see a higher rate of hip and wrist fractures?
There is a very tight correlation between the impact of someone’s wrist and someone’s pelvis
What are the 3 most common types of falls, in order?
- Slips and trips
- Falls on stairs
- Falls from furniture
What are the most common actions that lead to falls?
- turning
- incorrect weight shifting
- transferring (from bed to chair, toilet to chair/ tub)
- forward walking
What are the 3 domains that predispose someone to a fall?
Physiological
Environmental
Behavioural
What are some intrinsic (demographic, biological) risk factors for falls?
Advanced age
Previous falls
Fear of falling (inactivity can lead to frailty; fear causes one to look at feet and not at surroundings, shifts centre of gravity)
muscle weakness gait/balance problems poor vision orthostatic hypotension chronic conditions
What are some extrinsic (behaviour, environmental, medications) risk factors for falls?
Lack of stair handrails/ grab bars poor stair design dim lighting/glare obstacles, tripping hazards, slippery surfaces psychoactive meds improper use of assistive devices
Which intrinsic risk factors are modifiable?
Intrinsic: muscle weakness gait/balance problems vision problems psychoactive meds (most) chronic medical conditions
Extrinsic: restraints medications alcohol use footwear
How do drugs contribute to falls?
decreased mental awareness impairs cognitive function and judgment impairs postural stability hypotension OH arrythmias
What are risk factors for significant injury due to falling?
Current use of anticoagulants (prevents bleeding from stopping – excessive bruising)
Osteoporosis
Post surgery (increased weakness, disorientation due to pain meds)
Hx of falls (risk ^ with each preop fall)
What is osteoporosis
A bone disease that occurs when the body loses too much bone, makes too little bone, or both. Bones become weak and may break from a fall.
Risk factors for osteoporosis
Gender (woman) Advanced age Race (white, asian) Family hx Body size (small body size bc less bone mass to draw from)
What are the 4 clinical practice guidelines for fall prevention?
- Screening (for falls and risk of falling)
- Evaluation of gait and balance (timed up and go test)
- Multifactorial fall risk assessment (reveals factors that put OA at risk, can help identify appropriate interventions(
- Initiate multifactorial interventions
What does a risk factor assessment require in order to be effective?
Direct intervention that are designed to prevent falls in the specific older adult
- minimize medications
- tailored exercise program
- treat vision impairments
- manage OH
- manage cardio conditions
- supplement vitamin d
- manage foot problems
- modify home enviro
- educate
What are environmental concerns in the clinical setting?
- cluttered path
- spill on floor
- cords
- lighting to bright or too low
- table far from bed
- bed at a high awkward height
- brake not on equipment and/or table or bed
- sheets or blanket hanging off the bed loosely
What are environmental concerns in the home setting?
- Rugs
- bed skirts hanging on the ground
- glare from windows
- cluttered night standards with no room for light sources, or assistive devices (glasses)
- things that are out of reach
- toys
- things in high places
- unsteady furniture
- no hand rails or grab bars
- toilet too low
- too dim
What are some technologies to study and prevent falls?
- cameras to detect that you have fallen?
- hip protectors (effective, can reduce injury rates by 40%, problem is people don’t like to wear them cause it gets hot, hard to clean often when soiled, come in different sizes so they can get mixed up)
- wearable sensors that enable people to call help easily if they have fallen
- a different type of sensors detect speed and sends signals that the person has fell
