Falls and Fracture Prevention - Michael Kutcher, Movement for Life Physiotherapy
Falls and Fracture Prevention
Introduction • What is a fall •Falls and Aging • Scope of the Problem • Risk Factors for Falls •Role of the Physiotherapist - Predicting Falls •What Can be done (PREVENTING FALLS) • Exercises To Prevent Falls * PRACTICAL*• Getting up off the Floor – I’ve fallen, Now what? *PRACTICAL* • What can be done Right now •Identifying Hazards/Exercise • Services available
WHAT IS A FALL? A sudden, unintentional change in position causing an individual to land at a lower level of an object, the floor, orthe ground, other than as a consequence of sudden onset of paralysis, epileptic seizure or overwhelming force.
FALLS• Common in people aged 65 years and older• 1 in 3 community dwellers over 65 years old fall at least one eachyear• 1 in 2 people living residential aged care fall at least once each year• 1 in 4 Australians will be over 65years by 2051• The cost of falls is increasing exponentially• Rate of falls and severity of resulting complications increasedramatically with age• By 2051 Australia will require an additional; 3320 nursing places &2500 hospital beds permanently allocated to falls injury treatment• The total health cost attributable to fall related injury is $1357 millionper annum•It used to be thought that falls were an inevitable part of ageing.Luckily, it is now clear that falls can be prevented with well-designedexercise programs.
FALLS AND AGINGWhy does our risk of falling increase as we age?•As we age, our muscle mass, vision, reaction time andreflexes tend to diminish.•Our stride length decreases and our gait tends to slow
SCOPE OF THE PROBLEM•A number of injuries could occur after a fall, including bonefractures or soft tissue injury.•Most prevalent fall related injuries are fractures (10%) – •Hip, spine, upper arm, forearm and bones of the pelvis, hand and ankle•Most serious injury is hip fracture •Up to 80% of admissions for hip injury occur in woman
RISK FACTORS FOR FALLSPhysical •Decreased strength, balance, vision, sensation and reaction time. •People with better balance may also tend to put themselves in more challenging situations. A combination of these factors will lead to an even greater risk of falls.Behavioural: •risk taking vs. cautiousPsychoactive medication use •Example sleeping pillsEnvironmental factors •Clutter, objects, loose mats etc •Likely interactions between these factors: consider a careful person with good balance in a dangerous environment.
RISK FACTORS FOR FALLSFear of FallingOnce a person has fallen once they are more likely to be admitted to a NH-develop a fear of falling and therefore limit activities and become more frailand de-conditioned. Again increasing the chance of fallingHabitsLack of exerciseGetting out of bed or a chair immediatelyNot putting on glasses in the middle of the nightAlcohol abuseStanding in chairs to reach high placesEquipment/Assistive DevicesFailing to use a prescribed, necessary assistivedevice may result in a fallInappropriate shoes
FALLS - MYTHS Vs REALITY• Myth: If I stay seated most of the time, • Reality: Inactivity leads to muscle and I reduce my risk of falling. joint weakness which may lead to a fall• Myth: Falling is just something normal • Reality: Problems in later life are not that happens as I get older. part of ―normal‖ aging. Falling is no more ―normal‖ than memory loss and may be prevented through things like strengthening exercises for the body or changes in your environment to eliminate fall risks, a fall may be prevented.• Myth: Taking just one medication • Reality: Taking any medication may cannot increase my risk of falling. increase your risk of falling. Medications affect people in many different ways. One of the common problems is that the initial dose of the medication is too high. Be very careful when starting a new medication and take extra care until you see what affect it is going to have on you.
Role of the Physiotherapist PREDICTING FALLSThe Fall Screen Test – The fall risks calculatorContrast Sensitivity „Melbourne edge test‟:20 circular patches containing edges with reducing contrast. Correctidentification of the orientation of the edges gives a measure of CS.
PREDICTING FALLSThe Fall Screen TestProprioception:Ability to determine themselves in space and match their toes on either side onthe platform.Any difference in matching the great toes is measured in degrees.
PREDICTING FALLSThe Fall Screen TestQuadriceps Strength:The strength of three leg muscle groups (knee flexors and extensors andankle dorsiflexors) is measured while subjects are seated. In each test,there are three trials and the greatest force is recorded.
PREDICTING FALLSThe Fall Screen TestReaction time:Measures the time it takes the person to click the mouse when a lightappears. You can also test the LL by using your feet to turn offsomething or step onto something.
PREDICTING FALLSThe Fall Screen TestPostural SwayThe amount the person moves when trying to stay still (can use eyesopen, eyes closed on floor or foam).The score is then compared to the norm for the person’s age.
KNOWLEDGE •EXERCISE•WHAT TO DO ONCE FALLEN •REMOVING HAZARDS •SERVICES AVAILABLE•WHAT CAN BE DONE NOW
Role of the Physiotherapist Example Case Study - Mr C (aged 79) was referred to a falls clinic for assessment after experiencing a number of falls.Mr C had six falls in the past year, all as a result of losing hisbalance on sloping ground in the garden and on the steep driveway.He was grazed but had suffered no major injury. Mr C had limitedmobility as a result of angina and shortness of breath. He hadprevious knee replacements. He had also recently been in hospitaland so was out of condition. Previously he had been walking 2 kmdaily with regular stops every 100 m to rest. His medical assessmentshowed some health problems which could contribute to falling, andsome of his medications were changed.His physiotherapy assessment showed that he had weakness of thehip muscles, and pain and muscle weakness of the right knee. Hescored only 50% on the balance test, his walking was abnormallyslow with small shuffling steps, and he limped due to knee pain. Hisconfidence was low and he was afraid of falling again.
Role of the Physiotherapist Example Case StudyMr C had home-based physiotherapy treatment to settle his kneepain and improve his strength and balance. He was prescribed adaily home exercise program. He improved his exercise capacity, hispain settled, and he was then able to participate in a falls preventionstrength and balance exercise group, which he attended weekly for 6weeks. He continued his daily home exercise program.When reassessed three months later in the clinic, Mr C reportedfeeling much more confident, and was back to walking 2 km dailywith less frequent need for rests. He had no further falls. He scored100% on reassessment of his balance, his walking speed wasnormal, and he was no longer shuffling.
WHY EXERCISE - MYTHS Vs REALITY • Myth 1: There‟s no point to exercising. • Fact: Exercise and strength training helps I‟m going to get old anyway. you look and feel younger and stay active longer. Regular physical activity lowers your risk for a variety of conditions, including Alzheimer’s and dementia, heart disease, diabetes, colon cancer, high blood pressure, and obesity. • Myth 2: Elderly people shouldn‟t • Fact: Research shows that a sedentary exercise. They should save their strength lifestyle is unhealthy for the elderly. Period. and rest. • Inactivity often causes seniors to lose the ability to do things on their own and can lead to more hospitalizations, doctor visits, and use of medicines for illnesses. • Myth 3: Exercise puts me at risk of falling • Fact: Regular exercise, by building strength down. and stamina, prevents loss of bone mass and improves balance, actually reducing your risk of falling • Fact: You’re never too old to exercise! If • Myth 4: It‟s too late. I‟m already too old, you’ve never exercised before, or it’s been a to start exercising while, start with light walking and other gentle activities • .Myth 5: I‟m disabled. I can‟t exercise • Fact: Chair-bound people face special sitting down.. challenges but can lift light weights, stretch, and do chair aerobics to increase range of motion, improve muscle tone, and promote cardiovascular health
WHY EXERCISE?•IMPROVE BALANCE•IMPROVE LOWERLIMB STRENGTHand FLEXIBILITY•IMPROVE FITNESS•IMPROVECONFIDENCE•GIVE PEACE OF MIND
What Happens When We Fall?•DO NOT PANIC • The way you react after a fall, can cause more injuries than the fall would.•Take several deep breaths and determine if you arehurt.•If you believe you are hurt, do not get up.•Call 000, use your pendant alarm to call for help orcall for a family member•While you wait for help, keep yourself warm the bestyou can
What Happens When We Fall?GETTING UPSTEP 1 ….• LYING ON YOUR BACK• ROLL ONTO YOUR SIDE• TUCK ELBOW UNDER AND PUSH INTOSTRAIGHT ARMS
What Happens When We Fall?GETTING UPSTEP 2 ….• ON STRAIGHT ARMS, PUSH BOTTOM UP INTO 4POINT KNEELING POSITION• IN THIS POSITION YOU CAN CRAWL TOSOMETHING CLOSE BY.
What Happens When We Fall?GETTING UPSTEP 3 ….•CRAWL TO FURNITURE CLOSE BY•USE HANDS TO PULL YOURSELF UP
What Happens When We Fall?GETTING UPSTEP 4 ….• SLOWLY BEGIN TO RISE, USING STRONGESTLEG FIRST, ONE LEG AT A TIME• THEN OTHER LEG
What Happens When We Fall?GETTING UP•STEP 5 ….• STAND UP•SLOWLY, TWIST AROUND ANDSIT IN THE CHAIR
What Happens When We Fall?I CAN‟T GET UPCAN I ATTRACT ATTENTION?• MAKE LOUD NOISES AND SCREAM• USE YOUR PENDANT ALARM OR USE THETELEPHONE IF POSSIBLE
What Happens When We Fall?I CAN‟T GET UPCAN I GET COMFORTABLE?• USE A NEARBY CUSHION OR USE A ROLLED UPPIECE OF CLOTHING
What Happens When We Fall?I CAN‟T GET UPCAN I KEEP WARM?• COVER YOURSELF WITH NEARBY CLOTHING,BLANKET OR RUG
What Happens When We Fall?I CAN‟T GET UPCAN I KEEP MOVING?•Move position to avoid getting pressure sores•Move joints to avoid stiffness and help circulation•Roll away from damp area if your bladder "lets go"
What Happens When We Fall? ALWAYS TELL YOUR DOCTOR AFTER A FALL
What Can be Done Right NowIts never too late to start exercising! - balance is a skill you can keep orrecapture at any age.Exercise regularly - this keeps the balance tuned up and bones and musclesstrong.Exercise within your limits - problems such as diabetes, arthritis or asthmashould not stop you exercising. Your physiotherapist can tailor a specific exerciseprogram for you.Maintain good posture - good spinal care throughout your life will assist yourbalance.Walking aids such as sticks and frames should be correctly prescribed andfitted - not borrowed from other people.Choose proper footwear - firm fitting, flat shoes improve your stability.Take extra care on uneven ground - surfaces such as gravel and grass are morechallenging to the balance.Good vision helps your balance. Be careful if lighting is poor and avoid walkingin the dark.Be aware of home hazards - slippery mats, dangling electrical cords and cluttercan turn your home into an obstacle course.Have a Falls Emergency Plan - know how to summon help if you do have a fall.
What Can be Done Right Now IDENTIFYING HAZARDS•Unsecured scatter mats and floor rugs •Uneven Footpaths•Shower or bath •Water Spills•Clutter •Poorly Lit places •Stairs without•Cords and cables Handrails•Garden Areas – free from moss & tools •Stairs poorly lit•Cane or walker that is the wrong height •Medications•Unsafe – slippery footwear •Poor eyesight
What Can be Done Right NowMake Your Home SafeIn Stairways,• Handrails on both sides of the stairs, and make sure they are tightlyfastened.•Hold the handrails when you use the stairs, going up or down.•If you must carry something while you’re on the stairs, hold it in one handand use the handrail with the other.•Don’t let what you’re carrying block your view of the steps.•Make sure there is good lighting with light switches at the top and bottomof stairs and on each end of a long hall. Remember to use the lights!Hallways, And Pathways•Keep areas where you walk tidy. Don’t leave books, papers, clothes, andshoes on the floor or stairs.•Check that all carpets are fixed firmly to the floor so they won’t slip. Put no-slip strips on tile and wooden floors. You can buy these strips at thehardware store.•Don’t use throw rugs or small area rugs.
What Can be Done Right NowMake Your Home SafeIn Bathrooms And Powder Rooms•Mount grab bars near toilets and on both the inside and outside ofyour tub and shower.•Place non-skid mats, strips, or carpet on all surfaces that may getwet.•Remember to turn on night lights.In Your Bedroom•Put night lights and light switches close to your bed.•Keep your telephone near your bed.
What Can be Done Right NowMake Your Home SafeIn Other Living Areas•Keep electric cords and telephone wires near walls and away from walking paths.•Tack down all carpets and large area rugs firmly to the floor.•Arrange your furniture (especially low coffee tables) and other objects so they arenot in your way when you walk.•Make sure your sofas and chairs are the right height for you to get in and out ofthem easily.•Don’t walk on newly washed floors—they are slippery.•Keep items you use often within easy reach.•Don’t stand on a chair or table to reach something that’s too high—use a “reachstick” instead or ask for help. Reach sticks are special grabbing tools that you canbuy at many hardware or medical-supply stores. If you use a step stool, make sureit is steady and has a handrail on top. Have someone stand next to you.•Don’t let your cat or dog trip you. Know where your pet is whenever you’restanding or walking.•Keep emergency numbers in large print near each telephone.
What is Available to Us?•Gym programsMovement for Life Physiotherapy•Balance and Falls Prevention ClassesMASONIC TIWI GARDENS•Hydrotherapy SessionsIn warm water, to decrease pain, increasestrength, flexibility, fitness and balance.Clinical PilatesExercise regime using specific floor based exercisesand spring resisted equipment to train the bodys deeppostural muscles..To provide stability, strength and control to the lowerback, pelvic and hip joints, upper back, neck andshoulder regions.