Week 2 - Falls Prevention Flashcards
What is the purpose of conducting Short Physical Performance Battery (SPPB)?
To evaluate lower extremity functioning in older adults
What are the classifications and recommendations for SPPB scorings?
- Score of 0-3: very low physical function -> conduct geriatric ax + recommendation to visit geriatrician for evaluation and appropriate intervention
- Score of 4-6: low physical function -> geriatric ax + self-help strength training programme + recommend HPB ‘Stronger Together’ Programme (12 weeks)
- Score of 7-9: moderate physical function -> encourage to take part in various form of physical activity (brisk walk, health qigong, HPB fabulous community)
- Score of 10-12: high physical function -> encourage to keep it up
Odds Ratio (OR)
- 0.75 = 25% less likely
- 1.5 = 50% more likely
- 1 = baseline
What are some fall data collection method to use with elderly?
- Fall calendars / diary
- Remind postcards
- Telephone interviews
- Phone message reminders
Common fall locations
Home, community, NHs, hospitals
What are the risk factors associated with increased falls among elderly?
According to OR:
Female, Malay race, taking more than 2 medications daily, more than 75 years old, presence of HTN, MBI < 20, poor vision
What are the consequences of falls?
- Reduced balance & mobility
- Increased dependency
- Lost of time from work
- Reduced QOL
- Depression / anxiety
- Smaller social network
- FOF (risk factor & consequence)
Fear of falling (FOF)
Low perceived self-efficacy at avoiding falls during essential non-hazardous ADLs
What are the fall risk factors for community living older adults?
- History of falls (2.77)
- PD (2.71)
- Use of walking aid (2.18)
- Gait problems (2.06)
- Use of anti-epileptic drugs (1.88)
- Vertigo (1.80)
- Depression (1.63)
- Physical disability (1.56)
- Fear of falling (1.55)
- Poor self-perceived health (1.5)
What are the fall risk factors in community living stoke survivors?
- Recurrent fallers (4.19)
- Impaired mobility; reduced balance (3.87)
- Use of sedatives / psychotropic medications (3.19)
- Disability in self-care (2.51)
- Depression (2.11)
- Cognitive impairment (1.75)
- History of falls (1.67)
What are the fall risk factors for people with PD?
- History of falls
- Freezing gait
- Impaired balance & mobility
- Use of walking aid
- Depression
- Physical disability
What are the fall risk factors in acute setting?
- History of falls (2.85)
- Antidepressants (1.98)
- Sedative medication (1.89)
- Cognitive impairment (1.52)
What are the fall risk factors in nursing homes?
- History of falls (3.06)
- Use of walking aid (2.08)
- Disability (2.06)
- Wandering (1.89)
- Cognitive impairment (1.79)
- PD (1.65)
- Antipsychotics (1.61)
- Dizziness (1.52)
What are the common fall risk factors for NH and community dwelling residents?
- Dizziness
- PD
- Cognitive impairment
What are the risk factors in community dwelling residents but not NH?
- Incontinence
- Depression
- Stroke
- Vision impairment
What are some intrinsic factors that causes falls?
- Medications
- Sedentary behaviour
- Nutrition deficits
- Foot problems
- Polypharmacy
What are some extrinsic factors that causes falls?
- Hazardous home environment
- Improper use of mobility aids & assistive devices
- Improper footwear
What are some assessments to measure gait & balance?
- Timed Up & Go (TUG): > 13.5 seconds = predictive of falls; >30 seconds = high risk of falls
- Functional Reach Test: less than or = 6 inch = significant increased risk of falls; between 6-10 inches = moderate risk of falls
- Berg Balance Test: 45/56 as general cut-off score; <45 = higher risk of falls
- Four Step Square Test: commonly used by PT; > 15 seconds is indicative of fall risk
- Fall Efficacy Scale International (FES-I): 16-19 = low concern; 20-27 = moderate concern; 28-64 =-36 high concern
- The Activity-Specific Balance Confidence Scale (ABC): <67% = risk of falling; predictive of future falls
Stratify Risk Assessment Tool
To measure risk of falling during hospitalisation period
Morse Fall Scale
To measure falls in nursing home settings
- score of 0-24 = no risk
- score of 25-50 = low risk
- score of more than 51 = high risk
Fall Risk for Older People - Community Setting (FROP-COM)
- Score of 0-11 = mild fall risk
- Score of 12-18 = moderate fall risk
- Score of 19-60 = high fall risk
STEADI
3 key screening questions - ‘yes’ to any = increased fall risk + further evaluation; ‘no’ to all = low risk
- Have you fallen in the past year? (how many times; were you injured?)
- Do you feel unsteady when standing / walking?
- Do you worry about falling?
Effectivness of Otago Exercise Program (Community-based)
- Features: strengthening, balance, walking
- Effective in reducing falls & injuries
- 5 leg strengthening exercises with 4 levels of difficulty
- 12 balancing exercise with 4 levels of difficulty
- Advice about walking
Other evidence based fall prevention
- Taichi (8 single forms; 12 weeks; 2x 60 mins per week in class; 40-45 mins of core exercise; 30 mins weekly at home)
- Vitamin D
- Home safety assessment & modification
Stepping-on Program (Multi-component intervention)
- Program leader to facilitate group
- Mobility goal setting, weekly homework
- Key components: balance & strength exercise, home hazards, medication review, vision, vitamin D, public transport safety
- Key conceptual framework: adult learning principles, decision-making framework, self-efficacy beliefs, follow through with safety behaviours
What are some ways to prevent falls in the hospitals?
- Communication: chart, tag, patient education
- Hospital environment: floor condition, footwear, lighting
- Individually targeted multifactorial interventions
- Clinical management: close monitoring, medication management, rehabilitation therapy
What are some ways to prevent falls in nursing homes?
- The Sunbeam Program: progressive resistance & balance training (2x 1 hr session per week x 25 weeks + maintenance program - 2 x 30 mins per week of non-progressive exercise x 6 months)
- Residential aged care facilities: individualised exercise programs for patients, medication review, vitamin D supplements
Fall prevention in different diagnostic groups
- PD: no effective fall prevention due to nature of disease
- Dementia: exercise programs may assist in preventing falls for those in community
- Stroke: vitamin D for women in institutionalised setting; Stepping On that is adapted for stroke population
Stepping On After Stroke
- 6 to 8 participants per group
- 2 caregiver education session
- Coping strategies after stroke
- Introducing new leisure activities (i.e. Taichi)
