Falls in elderly

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Falls in elderly

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Falls in elderly

  1. 1. Falls in the Elderly: a Physical Therapy Perspective Hana Al-Sobayel, MSc, PhD Physical Therapy King Saud University
  2. 2. Outline      Epidemiology of falls Clinical significance Risk factors Assessment Falls prevention Alsobayel - Geriatrics Chair Symposium 2010
  3. 3. Falls Epidemiology Alsobayel - Geriatrics Chair Symposium 2010
  4. 4. Alsobayel - Geriatrics Chair Symposium 2010
  5. 5. Definition A fall is an event which results in a person coming to rest inadvertently on the ground or floor or other lower level (WHO) Alsobayel - Geriatrics Chair Symposium 2010
  6. 6. Frequency of falls  28-35% of people aged of 65 and over fall each year  32-42% for those over 70 years of age  Increase with age and frailty level. Alsobayel - Geriatrics Chair Symposium 2010
  7. 7. Frequency of falls   Older people who are living in nursing homes fall more often than those who are living in community. 30-50% of people living in long-term care institutions fall each year, and 40% of them experienced recurrent falls Alsobayel - Geriatrics Chair Symposium 2010
  8. 8. Fall mortality rate   Falls account for 40% of all injury deaths Unintentional falls: #1 leading cause of death in USA for people above 55 years of age (CDC, 2006) Alsobayel - Geriatrics Chair Symposium 2010
  9. 9. Fatal falls rates by age and gender (National Council on Aging, 2005 in WHO 2007)
  10. 10. Clinical Significance Alsobayel - Geriatrics Chair Symposium 2010
  11. 11. Need for medical attention    20-30% of mild to severe injuries Underlying cause of 10-15% of all emergency department visits 50% of injury related hospitalizations among people over 65 years and older Alsobayel - Geriatrics Chair Symposium 2010
  12. 12. Fall-related hospital admission   Hip fracture, traumatic brain injuries and upper limb injuries Longer hospital stay compared to other injuries. Alsobayel - Geriatrics Chair Symposium 2010
  13. 13. Fall-related hospital admission  Hip fractures:  Hospital stay extend to 20 days  Older person are likely to remain in hospital for the rest of their life  20% die within a year subsequent to falls Alsobayel - Geriatrics Chair Symposium 2010
  14. 14. Post-fall syndrome       Dependence Loss of autonomy Depression Confusion Immobilization Restriction in daily activities. Alsobayel - Geriatrics Chair Symposium 2010
  15. 15. National Crisis Diseases of civilization Aging and medical advances that preserve and prolong life High inactivity rates (MOH statistics 2008) (Al-Nozha et al. 2007) Alsobayel - Geriatrics Chair Symposium 2010 High Falls complications
  16. 16. Risk Factors Alsobayel - Geriatrics Chair Symposium 2010
  17. 17. Risk factors Intrinsic & Extrinsic (Steinweg, 1997) Alsobayel - Geriatrics Chair Symposium 2010
  18. 18. Risk factor model (WHO, 2007)
  19. 19. Causes of falls in elderly (Rubenstein, 2006) Alsobayel - Geriatrics Chair Symposium 2010
  20. 20. Risk factors of falls (Rubenstein, 2006) Alsobayel - Geriatrics Chair Symposium 2010
  21. 21. Falls & Fractures    The strongest determinant of a fracture is the actual fall rather than bone fragility Abnormalities in gait and balance are the most frequent and sensitive risk factors that predispose to fractures Physical limitations and physical inactivity reduce bone strength and increase fracture risk Alsobayel - Geriatrics Chair Symposium 2010 (Karinkanta et al., 2010)
  22. 22. Assessment Alsobayel - Geriatrics Chair Symposium 2010
  23. 23. Self-report scales    Identify high risk individuals: History of fall within a past time frame Details on frequency, surrounding circumstances & injury severity (Rubenstein et al., 2002) Alsobayel - Geriatrics Chair Symposium 2010
  24. 24. Self-report scales      The Falls Risk for Older People in the Community Scale (FROP-Com): Covers 13 risk factors in 26 questions Dichotomous or ordinal scoring, from 0 to 3 An overall score of falls risk, ranging from 0 to 60, with higher scores indicative of greater risk Sensetivity = 66% ; Specificity = 65% (Russell et al., 2008) Alsobayel - Geriatrics Chair Symposium 2010
  25. 25. Single-task performance    Assess postural maintenance or physical performance Simple, require minimal time and equipment Single domain Alsobayel - Geriatrics Chair Symposium 2010
  26. 26. Single-task performance   Five Times Sit to Stand/Chair Rise (FTSS) Good predictor of recurrent falls An individual is asked to rise from sitting to standing with arms crossed and repeat the task 5 times (Buatois et al., 2008) Alsobayel - Geriatrics Chair Symposium 2010
  27. 27. Single-task performance    Stepping: Maximal Step Length Significantly correlated with measures of balance & mobility Good predictor of frequent falling Arms crossed on chest, stepping out with one leg as far as possible, maintaining position on the other leg, return to initial position in one step (Buatois et al., 2008) Alsobayel - Geriatrics Chair Symposium 2010
  28. 28. Single-task performance   Timed Up & Go (TUG) Individuals with falls slower than non-fallers (Shumway-Cook et al., 2000) Time needed to get up from a chair, stand up, walk 3 meters, return back to sitting on the chair Alsobayel - Geriatrics Chair Symposium 2010
  29. 29. Multi-task performance     Comprehensive approach to fall assessment Incorporate multiple measures (singletask & questionnaires) Provide detailed information Time consuming Alsobayel - Geriatrics Chair Symposium 2010
  30. 30. Multi-task performance  Performance Oriented Mobility Assessment (POMA) (Tinetti, 1986)   Assess balance & gait Direct observation Score range 0-40 Good inter-rater reliability Moderate ability to differentiate between fallers & non-fallers (Raiche et al., 2000) Alsobayel - Geriatrics Chair Symposium 2010
  31. 31. Multi-task performance  Berg Balance Scale (BBS) (Berg et al., 1989)   High inter-rater, intra-rater, testretest reliability BBS & history of falls, best predictors of falls in community dwelling individuals 14 mobility tasks Scored from 0-4 Maximum score of 56 (Shumway-cook et al., 1997) Alsobayel - Geriatrics Chair Symposium 2010
  32. 32. Multi-task performance    Physical Performance Tests (PPT) High inter-rater reliability Good predictor of falls in community dwelling individuals 7 items Timed tasks Scores according to time Higher score faster performance (Reuben & Sui, 1990) Alsobayel - Geriatrics Chair Symposium 2010
  33. 33. Environment Assessment Alsobayel - Geriatrics Chair Symposium 2010
  34. 34. Prevention Alsobayel - Geriatrics Chair Symposium 2010
  35. 35. Physical Therapy Approach  Must consider individual risk factors, such as functional limitations or reduced bone strength, and environmental hazards. (Karinkanta et al., 2010)  Multi-component exercise beneficial for bone health and maintaining functional ability in older community-dwelling adults. (Petridou et al., 2009) Alsobayel - Geriatrics Chair Symposium 2010
  36. 36. Physical Therapy Approach  Whole-body vibration training has shown potential to improve muscle performance, balance and bone strength (Mikhael et al., 2010)  Home hazard assessment and modification and use of hip protectors are efficient for frail older adults at the highest risk of falling. (Gillespie et al., 2009) Alsobayel - Geriatrics Chair Symposium 2010
  37. 37. Summary Alsobayel - Geriatrics Chair Symposium 2010
  38. 38.      Elder population at high risk of falls Fractures mainly results from falls in elder populations Risk assessment is integral part of fall prevention Physical therapy is required for falls prevention among elderly Urgent need for risk assessment and reduction locally and internationally Alsobayel - Geriatrics Chair Symposium 2010
  39. 39. Alsobayel - Geriatrics Chair Symposium 2010

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