A presentation of the importance of falls in the geriatric population

1. Falls in the Geriatric
Population
Alexandria Amici

2. Introduction
Falls and Older Adults:
https://www.youtube.com/watch?v=y9f3aVKHImY
• “Falls are the leading cause of injury-related visits to emergency departments in the
United States and the primary etiology of accidental deaths in persons over the age
of 65 years”
• As a patient gets older, they have a greater decrease in function-
• “The mortality rate for falls increases dramatically with age in both sexes and in all
racial and ethnic groups, with falls accounting for 70 percent of accidental deaths in
persons 75 years of age and older”

3. Importance
• Falls are important because there are a heavy amount of problems that stem
from them occurring
• Falls can mean there is something physically wrong with the individual which
can cause problems of its own
• Falls decrease the quality of life for the patients involved
• Patients are not receiving follow ups after incidents so they chance of
another fall increases

4. History on Falls
• Fall deaths have increased in the years due to lack of reporting of incidents
• “From 1992 through 1995, 147 million injury-related visits were made to
emergency departments in the United States”
• The recent rise in the death rate from falls of older Americans during 1999–
2007 was primarily due to the previously unreported dramatic nearly
sevenfold increase in mortality from the subset other falls on the same level
• Falls are said to increase within the 21st century

5. Impact of the Issue
• Falls impact the patient, family, health care system and society as a whole
• “Falls lead to increased use of emergency room resources, increased costs from hospital
admissions and extended stays”-this affects cost and availability of the health care system
• Falls are the leading cause of an elderly person being put in an assisted living facility
• Financial burden on family
• “20-30% of those who fall suffer moderate to severe physical injuries including breaks, cuts,
and bruising”
• Mental- depression, isolation, self esteem, affects mobility
• Emotional- fear, fear for family

6. Patient and Family Needs
• Occupational therapy can be used to prevent a future fall and help maintain
safety and health.
• Physical therapy can be used to rehabilitate an injury.
• Counseling can help an emotionally traumatized patient.
• Family may need financial help for any doctor visits or move to skilled living
facility

7. Interventions
• Home safety checklist
• Gait training or assistive device
• Evaluation of falls
• Assess strength of patient: Timed up and Go Test, One leg balance test-The one leg
balance they stand on their leg for five seconds which measures strength. The up
and go test helps evaluate gait by having patients walk a distance and evaluate their
ability to do so
• Things to reduce fall risk: https://www.youtube.com/watch?v=H3cIF-bFI3E

8. Evaluation of Falls
Home Safety Check List

9. Risks and Effectiveness of Interventions
• Risk factors -Demographic :Older age, race
• Housebound status: Living alone
• Historical factors: Use of cane or walker, previous falls, acute illness, chronic conditions, especially neuromuscular disorders
• Medications: use of four or more prescription drugs
• Physical deficits: Cognitive impairment, reduced vision, importantly age increased changes, decreased night vision, decline in
peripheral vision, difficulty rising from a chair, foot problems
• Neurologic changes like postural instability; slowed reaction time; diminished sensory awareness for light touch, vibration and
temperature, decreased hearing, impaired speech discrimination
• Falls usually occur again because fall is not evaluated properly or interventions are not used
• Physician orders not followed by patient out of pride or family out of lack of education

10. Education
• Mnemonic to help determine any physical issues: I HATE FALLING: It stands for
I-Inflammation of joints (or joint deformity)
• H-Hypotension (orthostatic blood pressure changes
• A-Auditory and visual abnormality
• T-Tremor (Parkinson's disease or other causes of tremor)
• E-Equilibrium (balance) problem
• F-Foot problems, A-Arrhythmia, heart block or valvular disease, L-Leg-length
discrepancy-Lack of conditioning (generalized weakness),I-Illness-Nutrition (poor;
weight loss), and G-Gait disturbance(Fuller 2000).

11. Causes of Falls and Barriers to preventing falls
• Common Causes of Falls in the Elderly include :Accident, environmental
hazard, fall from bed, Gait disturbance, balance disorders or weakness, pain
related to arthritis, Vertigo, Medications or alcohol, Acute illness, Confusion
and cognitive impairment, Postural hypotension, Visual disorder, Central
nervous system disorder, syncope, drop attacks, epilepsy
• Any of these causes are barriers to living safely without falls happening
• A barrier to preventing falls is not following interventions, directions, or
physician orders properly. Proper education is needed

12. Services that help with Falls
• The National conference of State Legislatures has taken action towards
preventing falls and maintaining a safe environment for those who are
impacted by these accidents. The CDC has developed a fall prevention tool
kit called STEADI (Stopping Elderly Accidents Deaths and Injuries).

13. Politics and legislatures
• The list of states who have created legislatures are California, Connecticut,
Florida, Hawaii, Maine, Minnesota, Massachusetts, New Mexico, New Jersey,
Oregon, and Texas.
• California created the “Cal. Health and Safety Code §125704 (California
Osteoporosis Prevention and Education Act) and it requires the department
of health services to develop effective protocols for the prevention of falls
and fractures and establish these protocols in community practice to improve
the prevention and management of osteoporosis

14. Conclusion
• Falls are an issue that needs heavy focus because of the serious injuries and large increase of falls
that have been occurring
• It is important to educate oneself on falls to help prevent them
• Follow intervention techniques and directions properly
• Outpatient evaluation of a patient who has fallen includes a focused history with an emphasis on
medications, a directed physical examination and simple tests of postural control and overall
physical function
• Treatment is directed at the underlying cause of the fall and can return the patient to baseline
function.
• Evaluations are extremely important to find the cause for it to be treated properly and prevent
and further damage

15. References
• (2016, January). ELDERLY FALLS PREVENTION LEGISLATION AND STATUTES.
National Conference of State Legislatures. Retrieved from http://www.ncsl.org/research/health/elderly-falls-
prevention-legislation-and-statutes.aspx
• Falls: How Big is the Problem? (2004). The Trustees of Indiana University. Retrieved from
http://www.indiana.edu/~bioofag/module2/kw_unit3_HAA2/falls/content/01_03_impact. htm
• Fuller, G. (2000, April 1). Falls in the Elderly. American Family Physician. Retrieved from
http://www.aafp.org/afp/2000/0401/p2159.html
• Stevens, J. (2016, October). Older Adult Falls. Center for Disease Control and Prevention.
Retrieved from https://www.cdc.gov/homeandrecreationalsafety/falls/index.html
• Woodhouse, K. (2013). 10 Topics in Reducing Harm from Falls. Retrieved from
http://www.hqsc.govt.nz/assets/Falls/10-Topics/topic1-falls-in-older-people-15-April- 2014.pdf