Falls Prevention


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Falls Prevention

  1. 1. FALLS PREVENTION Conor Murray PhysioIreland PROGRAMME Clinic www.physioireland.ie
  2. 2. BACKGROUND Section 1
  3. 3. WHAT IS A FALL?“unintentionally coming to rest on the ground, floor or other lower level!!”.
  4. 4. 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.
  5. 5. 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.
  6. 6. RISK OF FALLING Section 2
  7. 7. FALL RISKS: VISIONMacular DegenerationGlaucomaCataractsDiabetic RetinopathyNot wearing glasses or wrong prescription in lenses
  8. 8. FALL RISKS: ENVIRONMENTCluttered walk spacesLow lightingSlippery flooringLack of handrails and grab barsOut of reach cabinets and storage spacesUnsecured area rugsUnsecured electrical cordsUnfamiliar environment
  9. 9. 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
  10. 10. 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?
  11. 11. 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?
  12. 12. BEDROOMS Is the light near the bed hard to reach? Is the path from your bed to the bathroom dark?
  13. 13. FALL RISKS: MEDICATIONBlood pressure medicationsSedativesMuscle relaxersMood medicationsDiureticsMixing medications and alcoholNot keeping a record of your medications
  14. 14. FALL RISKS: FEARFear of falling often results in inactivity which leads to muscle weakness, increasing the risk of falling
  15. 15. FALL RISKS: HABITSLack of exerciseGetting out of bed or a chair immediatelyNot putting on glasses in the middle of the nightAlcohol abuseStanding on chairs to reach high places
  16. 16. FALL RISKS: ASSISTIVE DEVICESFailing to use a prescribed, necessary assistive device may result in a fallInappropriate shoes
  17. 17. FALL PREVENTION Section 3
  18. 18. 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
  19. 19. 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
  20. 20. 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
  21. 21. 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
  22. 22. FALLS PREVENTION EXERCISE PROGRAMMELeg muscle strengthening and balance retraining exercises designed specifically to prevent falls.Individually prescribed and delivered at home by trained instructors.
  23. 23. GETTING STRONGERStrengthening muscles is essential for maintaining healthy bones and muscles necessary for waling and being independentAim to do the following exercises 3 times a weeks with a rest day in betweenLift the weight slowly through the entire range of movementYou may feel a bit stiff after you first start to exercise – this is normal!!
  24. 24. 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
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  32. 32. BALANCEBalance is important for everyday activities.The following balance retraining exercises should be done every day.
  33. 33. 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
  34. 34. 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
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  56. 56. WALKING PLANAim 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.
  57. 57. 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!
  58. 58. 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.
  59. 59.  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?
  60. 60.  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
  61. 61. 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?
  62. 62. THANK YOU FOR YOUR ATTENTION PhysioIreland clinic Block 4, floor 3 Quayside Mill St Dundalk Tel: 042 933 9302 Email: betterhealth@physioireland.ie