Lecture 14: Unintentional Injury - Falls in older adults Flashcards

1
Q

what are all countries experiencing in terms of aging?

A
  • persons aged 65 or over make up the worlds’ fastest-growing age group
  • all countries are experiencing this
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2
Q

what trends are shown here?

A

as time goes on we expect to see smaller proportions of young people and a greater proportion of older people

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3
Q

what trends are being shown here?

A

we expect that people ages 65+ grow faster than any other age group in terms of population

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4
Q

what mindset should people have about ageing populations?

A

we should look at ageing populations as a bad thing or a burden.
it is a “triumph of development”
- as a result of humanities improvements in nutrition, sanitation, medical advances, health care, education and economic well-being

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5
Q

what is the definition of falls?

A

a fall is defined as an event which results in a person coming to rest inadvertently on the ground on the ground or floor or other lower level. fall-related injuries may be fatal or non-fatal, though most are non-fatal

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6
Q

what are some statistics regarding falls?

A
  • falls are the second leading cause of unintentional injury deaths worldwide.
  • each year an estimated 684,000 individuals die from falls globally of which over 80% are in low- and middle - income countries
  • adults older than 60 years of age suffer the greatest number of fatal falls
  • globally 37.3 million falls that are severe enough to require medical attention occur each year
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7
Q

what trends are shown here?

A

Incidence of falls is high in high-income countries

incidence of falls is low in low-income countries

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8
Q

what does this show? why might this be?

A

high income countries have a high incidence of falls. especially NZ. 2017 data

  • this may be because we have good data collection. we also have ACC which means more people will present with falls in NZ than low income countries
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9
Q

what has ACC found to be the biggest risk factor of falls?

A

age!

  • older people have more severe falls and therefore worse injuries on average
  • every year, 1 in 3 people over 65 injure themselves in a fall
  • this rises to 1 in 2 once you reach 80
  • falls accounted for 2/3 of all ACC claims in the 85+ group
  • a serious fall, resulting in a fracture can cost up to $120,000 to repair and rehabilitate
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10
Q

what are the consequences of falls in older people?

A

when you become an older adult, you fall different from a child or adult.

  • they walk slower which means less forward momentum
  • reflexes are slower (cant protect themselves)
  • more likely to fall on bottom or side
  • breaking hip is an adverse consequence of falling over as an older adult
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11
Q

what is being shown here?

A
  • Years lived with disability from a fall drastically increases with age
  • different types of injury that become important change too
  • e.g. fracture of hip and femur neck become more important in older adults
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12
Q

what types of injuries can result from falls?

A
  • fractures (especially of neck of femur and forearm)
  • traumatic brain injury
  • spinal injury
  • open wounds
  • bruising
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13
Q

why might some people die from falls?

A
  • usually because of complications as a result of injuries
    e. g.
  • deep vein thrombosis
  • loss of mobility
  • functional decline
  • decrease in cognitive function
  • this is likely to lead to loss of confidence and self-efficacy which could result in anxiety and depression
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14
Q

what is a cycle older people can fall into in terms of falls?

A

this is why primary preventions of falls are very important!

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15
Q

what are important risk factors/causes to consider when a fall occurs?

A
  • Intrinsic factors (self)
  • extrinsic factors (environment)
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16
Q

what are some intrinsic/host factors of falls in older adults?

A
17
Q

what are some extrinsic/environmental factors of falls in older adults?

A
18
Q

what types of interventions are useful for falls?

A
  • evidence-based
  • multidisciplinary
  • focused on individuals and environment
19
Q

what are crucial primary preventions for falls?

A
  • optimal medical management
  • multidisciplinary care
20
Q

what are some conditions/situations which require optimal medical management?

A

primary and secondary care is required for:

  • diabetes management
  • osteoporosis management and prevention
  • cardiovascular disease management
  • physical training - strength and balance
  • home aids (rails and grab bars)
  • visual correction
  • good footwear
21
Q

what are some multidisciplinary care options?

A
  • physiotherapy
  • occupational therapy
  • pharmacy
  • optometry
  • dietitian
  • podiatry
22
Q

what is required for diabetes management?

A
  • optimal medical management (primary and secondary care)
  • multidisciplinary care
  • e.g. pharmacy, dietitian, podiatry.
23
Q

what is required for osteoporosis management and prevention and cardiovascular disease management?

A
  • optimal medical management (primary and secondary care)
  • multidisciplinary care
  • both could use a dietitian, osteoporosis could also use a physiotherapist
24
Q

what is required for physical training - strength and balance?

A

physiotherapy
occupational therapy

25
Q

what can be used to prevent over-medication?

A
  • optimal medical management (primary and secondary care)

multidisciplinary care:
- e.g. pharmacy

26
Q

what multidisciplinary care is useful for home aids such as rails and grab bars?

A

occupational therapy

27
Q

what multidisciplinary care could be useful for vision correction?

A

optometry

28
Q

what multidisciplinary care could be useful for the use of good footware?

A

podiatry

29
Q

what are some things people can do for osteoporosis prevention and management?

A
  • primary and secondary prevention
  • maintain calcium intake
  • avoid Vit D deficiency
  • regular weight-bearing exercise
  • maintain body weight >58kg
  • low alcohol intake
  • avoid systemic steroids
  • smoke smoking
  • assesment bone density DEXA scanning
  • pharmacological intervention
30
Q

what was the aim of the Otago exercise programme?

A
  • a home-based, individualised, exercise program designed to improve balance and increase lower limb strength
31
Q

what results were found from the Otago exercise programme?

A
  • there were large reductions in falling regardless of the delivery method

RCT: physiotherapist delivered 1 and 2 years, falls reduced 32%
RCT: nurse delivered, falls reduced by 46%
Pragmatic trial: nurse delivered, control population, falls reduced 30%

32
Q

what are some environmental interventions that can be used in home and residential areas?

A
  • non-slip floors
  • grab bars
  • better lighting
  • remove clutter
  • repair flooring
  • hand rails
33
Q

what are some environmental interventions that can be used in other areas?

A
  • repair uneven walking surfaces
  • provide ramps with skid-resistant surfaces
  • keep parking lots and sidewalks clean and in good repair condition
  • use moisture-absorbent mats with bevelled edges in entrance areas. make sure they have backing material that will not slide on the floor
  • ensure adequate lighting
  • walkable communities!
  • encourages older people to go out for walks
  • also useful as people are less likely to fall over when they go out