Lecture 14: Unintentional Injury - Falls in older adults Flashcards
what are all countries experiencing in terms of aging?
- persons aged 65 or over make up the worlds’ fastest-growing age group
- all countries are experiencing this
what trends are shown here?
as time goes on we expect to see smaller proportions of young people and a greater proportion of older people
what trends are being shown here?
we expect that people ages 65+ grow faster than any other age group in terms of population
what mindset should people have about ageing populations?
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
what is the definition of falls?
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
what are some statistics regarding falls?
- 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
what trends are shown here?
Incidence of falls is high in high-income countries
incidence of falls is low in low-income countries
what does this show? why might this be?
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
what has ACC found to be the biggest risk factor of falls?
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
what are the consequences of falls in older people?
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
what is being shown here?
- 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
what types of injuries can result from falls?
- fractures (especially of neck of femur and forearm)
- traumatic brain injury
- spinal injury
- open wounds
- bruising
why might some people die from falls?
- 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
what is a cycle older people can fall into in terms of falls?
this is why primary preventions of falls are very important!
what are important risk factors/causes to consider when a fall occurs?
- Intrinsic factors (self)
- extrinsic factors (environment)
what are some intrinsic/host factors of falls in older adults?
what are some extrinsic/environmental factors of falls in older adults?
what types of interventions are useful for falls?
- evidence-based
- multidisciplinary
- focused on individuals and environment
what are crucial primary preventions for falls?
- optimal medical management
- multidisciplinary care
what are some conditions/situations which require optimal medical management?
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
what are some multidisciplinary care options?
- physiotherapy
- occupational therapy
- pharmacy
- optometry
- dietitian
- podiatry
what is required for diabetes management?
- optimal medical management (primary and secondary care)
- multidisciplinary care
- e.g. pharmacy, dietitian, podiatry.
what is required for osteoporosis management and prevention and cardiovascular disease management?
- optimal medical management (primary and secondary care)
- multidisciplinary care
- both could use a dietitian, osteoporosis could also use a physiotherapist
what is required for physical training - strength and balance?
physiotherapy
occupational therapy
what can be used to prevent over-medication?
- optimal medical management (primary and secondary care)
multidisciplinary care:
- e.g. pharmacy
what multidisciplinary care is useful for home aids such as rails and grab bars?
occupational therapy
what multidisciplinary care could be useful for vision correction?
optometry
what multidisciplinary care could be useful for the use of good footware?
podiatry
what are some things people can do for osteoporosis prevention and management?
- 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
what was the aim of the Otago exercise programme?
- a home-based, individualised, exercise program designed to improve balance and increase lower limb strength
what results were found from the Otago exercise programme?
- 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%
what are some environmental interventions that can be used in home and residential areas?
- non-slip floors
- grab bars
- better lighting
- remove clutter
- repair flooring
- hand rails
what are some environmental interventions that can be used in other areas?
- 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
