WHAT IS A FALL?“unintentionally coming to rest on the ground, floor or other lower level!!”.
THE PROBLEM WITH FALLING Falls are a major public health problem because they are common in people aged 65 and older and are the leading cause of injury in this age group. Falls can have serious consequences: Trauma Pain impaired function loss of confidence in carrying out everyday activities, loss of independence and autonomy even death.
FALLS: THE FACTS Around one-third of generally healthy people aged 65 and older will have at least one fall each year. The rate of falls and severity of the resulting complications increase dramatically with age. What causes people to fall? leg muscle weakness Impaired balance multiple medications Arthritis Dizziness Heart problems Visual problems.
FALL RISKS: VISIONMacular DegenerationGlaucomaCataractsDiabetic RetinopathyNot wearing glasses or wrong prescription in lenses
FALL RISKS: ENVIRONMENTCluttered walk spacesLow lightingSlippery flooringLack of handrails and grab barsOut of reach cabinets and storage spacesUnsecured area rugsUnsecured electrical cordsUnfamiliar environment
FLOORS: LOOK AT THE FLOOR IN EACH ROOM Do you have to walk around furniture? Do you have rugs on the ﬂoor? Are there papers, books, towels, s hoes, magazines, boxes , blankets, or other objects on the ﬂoor? Do you have to walk over or around wires or cords
STAIRS AND STEPS Are there papers, shoes, books, or other objects on the stairs? Are some steps broken or uneven? Are you missing a light over the stairway? Do you have only one light switch for your stairs (only at the top or at the bottom of the stairs)? Is the carpet on the steps loose or torn? Are the handrails loose or broken?
KITCHENS & BATHROOMS Are the things you use Is the tub or shower often on high shelves? ﬂoor slippery? Is your step stool Do you need some unsteady? support when you get in and out of the tub or up from the toilet?
BEDROOMS Is the light near the bed hard to reach? Is the path from your bed to the bathroom dark?
FALL RISKS: MEDICATIONBlood pressure medicationsSedativesMuscle relaxersMood medicationsDiureticsMixing medications and alcoholNot keeping a record of your medications
FALL RISKS: FEARFear of falling often results in inactivity which leads to muscle weakness, increasing the risk of falling
FALL RISKS: HABITSLack of exerciseGetting out of bed or a chair immediatelyNot putting on glasses in the middle of the nightAlcohol abuseStanding on chairs to reach high places
FALL RISKS: ASSISTIVE DEVICESFailing to use a prescribed, necessary assistive device may result in a fallInappropriate shoes
WHAT CAN BE DONE TO STOP FALLS?Get in contact with the right services: GP visit to check your overall health and investigate your symptoms - for example, a medication you are taking may be causing you to feel dizzy Tests to check how well your heart is working See an occupational therapist to talk about how you cope at home as there may be some equipment such as grab rails that you could use to make things easier Have your eyes or feet checked. See a physiotherapist who can check your muscle strength and balance and recommend exercises to improve these
The Otago Exercise Programme The Otago Programme is an evidence based exercise programme proven to lower the risk of falls and death after 12 months The programme comprises of both balance and strength exercises. The programme can be recommended by a nurse or delivered by a physiotherapist. There is a large amount of evidence to suggest that exercise can particularly benefit older community dwelling adults ie respite patients. We feel that these adults would most benefit for a referral to begin the Otago Exercise Programme
BASELINE MEASUREMENTS: CHAIR STAND TEST Use a straight-backed firm chair with no armrests. Place the chair with a wall behind for safety. Person is instructed to stand up and sit down as quickly as possible five times with the arms folded. Time taken is recorded. A maximum of 2 minutes is allowed to complete the testGuralnik JM, et al. J Gerontol Med Sci 1994;49:M85-94
BASELINE MEASUREMENTS: 4-TEST BALANCE SCALE Feet together stand Semi-tandem stand Tandem stand One leg standRossiter-Fornoff JE, et al. J Gerontol Med Sci 1995;50A:M291-297
FALLS PREVENTION EXERCISE PROGRAMMELeg muscle strengthening and balance retraining exercises designed specifically to prevent falls.Individually prescribed and delivered at home by trained instructors.
GETTING STRONGERStrengthening muscles is essential for maintaining healthy bones and muscles necessary for waling and being independentAim to do the following exercises 3 times a weeks with a rest day in betweenLift the weight slowly through the entire range of movementYou may feel a bit stiff after you first start to exercise – this is normal!!
STRENGTHENING EXERCISES Strengthening exercisesKnee extensor (front knee All 4 levelsstretch) Ankle cuff weights are used to provide resistance toKnee flexor (back knee the muscles and 10 repetitions of each exercise arestretch) carried outHip abductor (side hipstretch)Ankle plantarflexors (calf Level C Level Draises) 10 repetitions, hold 10 repetitions, no support, support, repeat repeatAnkle dorsiflexors (toe 10 repetitions, hold 10 repetitions, no support,raises) support, repeat repeat
BALANCEBalance is important for everyday activities.The following balance retraining exercises should be done every day.
BALANCE RETRAINING EXERCISES Balance retraining exercisesKnee bends Level A Level B Level C Level D 10 repetitions, 10 reps no 10 reps, hold 3x10 reps, no hold support support OR support, repeat support 10 reps, hold support, repeatBackwards 10 steps, 4 10 steps, 4walking times, hold times, no support supportWalking & Figure of 8 twice Figure of 8 twice,turning around with walking aid no supportSideways 10 steps x 4 with 10 steps x 4 nowalking walking aid supportTandem 10 seconds, hold 10 seconds, nostance support supportTandem walk 10 steps, hold 10 steps, no support, repeat support, repeat
BALANCE RETRAINING CONT’ Level A Level B Level C Level DOne leg stand 10 seconds, hold 10 seconds, no 30 seconds, no support hold holdHeel walking 10 steps, 4 10 steps, 4 times, hold times, no support supportToe walk 10 steps, 4 10 steps, 4 times, hold times, no support supportHeel/toe Walk 10 steps,walking no support,backwards repeatSit to stand 5 stands, 2 5 stands, 1 hand 10 stands no 10 stands, no hands for or 10 stands 2 support or 10 support repeat support hands stands 1 hand repeatStair walking As instructed As instructed repeat
WALKING PLANAim for up to 30 minutes, walking at usual pace, at least twice a week, if safe.The walking can be broken up into shorter sessions, for example three 10-minute sessions.
TIPS FOR WALKING Walking is an excellent way to enhance your general fitness. Try going for a walk on the days between your exercises. Try to increase the distance you walk and the time you spend walking. Take advantage of fine weather to go walking. General tips Wear comfortable shoes and clothing. Start with a warm-up – marching on the spot for two minutes. when you walk the shoulders are relaxed and the arms gently swing. Look ahead, not down. With each step the heel lands first, then you push off on the toes. Finish with a warm-down – marching on the spot for two minutes. Enjoy yourself!
DOES IT WORK? 4 controlled trials assessed whether the programme reduced falls and injuries in community-living older people. 1016 women and men aged 65 to 97 were invited by their doctors to take part. Overall the exercise programme reduced by 35% both the number of falls and the number of injuries resulting from falls. It was effective when delivered by a research physiotherapist and by trained nurses from a community home health service and primary healthcare practices.
We have seen the common risk factors of falling and the habits that can be formed We have looked at what can be done about falls, including: A GP check Have feet or eyes tested See a physiotherapist who can check your muscle strength and balance recommend exercise to improve these Liaise with an occupational therapist But what can be done for residents with dementia?
Many nursing home residents suf fer some form of dementia Exercise may benefit any resident with dementia, as it has been established that exercise can improve quality of life. For the same level of brain deterioration, physically active people exhibit higher levels of functioning than sedentary people. It is thought that physically active people have a cognitive reserve that is used when other areas of the brain are damaged. An exercise routine may decrease the severity of symptoms of dementia as well as lead to increased mobility and independence. One to one exercise programmes with a physiotherapist focussing on strength and balance can reduce risk of falls in people with dementia
SAFE TRANSFERRING If a resident is engaged in an exercise programme with a physiotherapist a baseline will be taken for the level of assistance (if any) needed to make a safe transfer – the residents progress will be monitored and reviewed regularly. And of course ensuring safe manual handling allows for a safe transfer for both the resident and yourself Has anybody had any trouble transferring or mobilising any residents? What was your experience? Any other questions?
THANK YOU FOR YOUR ATTENTION PhysioIreland clinic Block 4, floor 3 Quayside Mill St Dundalk Tel: 042 933 9302 Email: firstname.lastname@example.org