Falls

Question 1

What does the WHO define as a “fall”?

Answer 1

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)

Question 2

Why are falls especially significant in older adults?

Answer 2

For an older adult, a fracture can mean the end of their independence and a transition into long term care

Question 3

What are the 4 quality indicators of residential home settings?

Answer 3

• depression
• pain
• pressure ulcers
• falls

Question 4

Falls account for __% of injury hospitalizations among seniors and __% of all ER visits among seniors.

Answer 4

81%; 60%

Question 5

Which type of fall-related injury is most prevalent in Canada? What are its consequences?

Answer 5

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.

Question 6

What are other fall-related injuries prevalent in Canada?

Answer 6

Traumatic brain injury (80% caused by falls)

Spinal cord injuries (50% caused by falls)

Question 7

Why do we see a higher rate of hip and wrist fractures?

Answer 7

There is a very tight correlation between the impact of someone’s wrist and someone’s pelvis

Question 8

What are the 3 most common types of falls, in order?

Answer 8

1. Slips and trips
2. Falls on stairs
3. Falls from furniture

Question 9

What are the most common actions that lead to falls?

Answer 9

• turning
• incorrect weight shifting
• transferring (from bed to chair, toilet to chair/ tub)
• forward walking

Question 10

What are the 3 domains that predispose someone to a fall?

Answer 10

Physiological
Environmental
Behavioural

Question 11

What are some intrinsic (demographic, biological) risk factors for falls?

Answer 11

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

Question 12

What are some extrinsic (behaviour, environmental, medications) risk factors for falls?

Answer 12

Lack of stair handrails/ grab bars
poor stair design
dim lighting/glare
obstacles, tripping hazards, slippery surfaces
psychoactive meds
improper use of assistive devices

Question 13

Which intrinsic risk factors are modifiable?

Answer 13

Intrinsic: 
muscle weakness
gait/balance problems
vision problems
psychoactive meds
(most) chronic medical conditions

Extrinsic:
restraints
medications
alcohol use
footwear

Question 14

How do drugs contribute to falls?

Answer 14

decreased mental awareness
impairs cognitive function and judgment
impairs postural stability
hypotension
OH
arrythmias

Question 15

What are risk factors for significant injury due to falling?

Answer 15

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)

Question 16

What is osteoporosis

Answer 16

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.

Question 17

Risk factors for osteoporosis

Answer 17

Gender (woman)
Advanced age
Race (white, asian)
Family hx
Body size (small body size bc less bone mass to draw from)

Question 18

What are the 4 clinical practice guidelines for fall prevention?

Answer 18

1. Screening (for falls and risk of falling)
2. Evaluation of gait and balance (timed up and go test)
3. Multifactorial fall risk assessment (reveals factors that put OA at risk, can help identify appropriate interventions(
4. Initiate multifactorial interventions

Question 19

What does a risk factor assessment require in order to be effective?

Answer 19

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

Question 20

What are environmental concerns in the clinical setting?

Answer 20

• 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

Question 21

What are environmental concerns in the home setting?

Answer 21

• 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

Question 22

What are some technologies to study and prevent falls?

Answer 22

• 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