Falls Risk Reduction And Prevention

Why Are Falls Important to Me? 1

More than 1/3 of adults 65 and older fall each year

in the United States.

Among older adults, falls cause over 39% of injury deaths, making them the leading cause by a wide margin.

In 2007, 18,334 people 65 and older died from injuries related to falls.

1 Centers for Disease Control and Prevention, http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html.

Why Are Falls Important to Me? 1

In 2009, 2.2 million people 65 and older were

treated in emergency departments for nonfatal injuries from falls, and more than 581,000 of these patients were hospitalized.

20% to 30% of people who fall suffer moderate-to-severe injuries such as bruises, hip fractures, or head traumas.

Fall injuries can limit mobility and independent living, and can increase the risk of early death.

1 Centers for Disease Control and Prevention, http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html.

What Are the Risk Factors For Falling?

Research shows that a combined effect of many interacting factors increases fall risk.2

Difficulty With Walking/Balance

Multiple Medications

Dizziness

Muscle Weakness

Foot Problems

Heart Rate/ Rhythm Problem

History of Falls

Vision Problems

2Panel on Prevention of Falls in Older Persons. Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. American Geriatrics Society/British Geriatric Society. http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2010.

Am I at Risk for Falling As I Age?

There are certain changes that may cause people to fall: • Less flexibility in the lower extremity joints • Decreased muscle strength around the ankles,

knees, and hips • Slower walking speed, tendency to take smaller

steps

Am I at Risk for Falling As I Age?

There are certain changes that may cause people to fall (cont’d): • Decreased balance • Less coordination • Decreased reflexes and longer reaction time • Changes in vision and sensation • Decreased activity

• Can restrict a person’s normal activities causing less independence

• Includes these risk factors: Fair/poor perceived health, feeling unsteady, having 2 or more falls4

4Lach HW. Incidence and risk factors for developing fear of falling in older adults. Public Health Nurs. 2005;22:45-52.

Fear of Falling …

Am I at Risk for Falling As I Age?

Am I at Risk for Falling As I Age?

Certain medical conditions may increase the risk of falling as you age: • Diabetes (peripheral

neuropathy, visual & sensation changes)

• Arthritis • Osteoporosis (changes

in posture, increased risk of fracture with fall)

• Stroke

• Cardiovascular conditions (irregular heart rate, dizziness when standing (orthostatic hypotension)

• Neurological diseases (Parkinson)

• Others

What Else Can Cause Me to be at Risk for a Fall?

Lower extremity weakness Previous falls Gait & balance disorders Decline in vision Depression Functional & cognitive impairment Dizziness Low body mass index Urinary incontinence Female sex Being over age 80

Taking over 4 prescription medications Stairs Clutter Wet surfaces Loose rugs/carpets Cords Poor lighting Hurrying/rushing

Intrinsic Factors Extrinsic Factors

AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older Persons (2010). http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2010/

Environmental Modifications

Includes physical changes: • To the place where you live • To your vehicle • To your workplace Environmental modifications help you to live with greater independence and safety.

Environmental Modifications

• Protect all stairs and steps with a secure banister or hand-rail on both sides and keep them clear of clutter.

• Use the highest safe wattage in light fixtures. Nightlights can help light the way during night-time hours.

Environmental Modifications

• Use a non-slip mat, or install adhesive safety strips or decals in bathtubs and showers.

• Install grab bars in bath and shower stalls.

• Choose a latex-backed bath mat to avoid slipping when getting out of the tub and shower.

Keep Your Bathroom Falls Free

• Add grab bars in the shower, tub, and toilet areas.

• Use nonslip adhesive strips or a rubber mat inside and outside the shower/tub.

• Sit on a shower bench or chair in the shower/tub.

• Use an elevated toilet seat.

How do I Find Out My Risk for Falls?

To assess your fall risk, you should see a physical therapist for a fall risk assessment. The physical therapist will take a thorough history, perform tests and measures, and provide you with interventions to reduce your risk for falling. To find a physical therapist in your area go to: www.apta.org/findapt.

What Is My Risk for Falls?

Here is a quick test: • If you are unable to balance 5

seconds on one leg you are at risk for INJURIOUS falls.

• Goal is 30 seconds for single leg stance.

Do not attempt to do this test alone—make sure that you have someone next to you to decrease the potential risk of falling.

If you have a history of falls, you are at risk.

What Can I Do to Decrease My Risk of Falls?

Successful programs for fall prevention may include: • Physical therapy • Exercise • Education • Medication management • Environmental modification • Other approaches targeted to individual risk factors

that may contribute to falls (such as impairments in vision, foot problems, continence)

The expertise of many health professionals may be involved in your fall prevention program.

Physical Therapy A physical therapist will: • Conduct an examination and evaluation for fall risk • Design an individual plan of care to address:

– Strength – Mobility – Balance – Posture – Gait

• Complete a home assessment for safety to: – Eliminate hazards – Recommend safety equipment and task re-design – Recommend structural changes

– Flexibility – Appropriate footwear – Need for assistive devices – Pain – Function/ADL

Exercise to Prevent Falls

Benefits: • Reduce fear of falling • Improve flexibility,

strength, endurance • Improve cardiovascular

health • Help decrease depression • Reduce sleep disorders

Exercise to Prevent Falls

• Have sufficient intensity to improve muscle strength

• Are regular and sustainable • Include dynamic balance

activities • Can be done at home or at a

center/clinic • Can be group or individual

programs • Are simple and low cost

Characteristics of successful programs:

Exercise and Programs

• Walking program • Tai Chi • Yoga • Aerobic exercises • Bowling, dancing, gardening

Examples:

Exercise and Programs

• Tai Chi Moving for Better Balance • Walk with Ease (Arthritis.org) • Land Based Exercise (Arthritis.org) • Aquatics (Arthritis.org)

Specific Program Examples:

Balance Exercises

1. Hand support 2. No hand support 3. Eyes closed 4. Unstable surface

Progression:

Hand support

No hand support

Sample Balance Exercises

1. Stand straight; hold onto a sturdy table or chair for balance.

2. Slowly stand on tip toe, as high as possible.

3. Hold position for 1 second. 4. Slowly lower heels all the

way back down. Pause. 5. Repeat 10 to 15 times.

Heel Rises

Sample Balance Exercises

1. Stand straight; hold onto a sturdy table or chair for balance.

2. Slowly bend your right knee toward your chest—do not bend at the waist.

3. Hold position for 1 second. 4. Slowly lower the leg all the way

back down. Pause. 5. Repeat with the left leg. 6. Alternate legs so you have repeated

10 to 15 times on each leg.

Hip Bending

Sample Balance Exercises

1. Stand straight, feet slightly apart; hold onto a sturdy table or chair for balance.

2. Slowly lift your right leg straight out to the side—keep your back straight and your toes pointing forward.

3. Hold position for 1 second. 4. Slowly lower the leg all the way back

down. Pause. 5. Repeat with the left leg. 6. Alternate legs so you have repeated

10 to 15 times on each leg.

Side Leg Raise

Sample Balance Exercises

1. Stand up and sit down from a chair without using your hands and keeping your back straight.

2. Stand on 1 leg while waiting in line (you can use a counter or other stable object for balance).

Exercises you can do anywhere

What Can I Do to Prevent Falls?

• Exercise regularly. • Review your medications with your

health care provider or pharmacist. • Have your vision and hearing checked. • Correct common home safety hazards.

Resources The American Physical Therapy Association: http://www.moveforwardpt.com/ Centers for Disease Control and Prevention: http://www.cdc.gov/Homeandrecreationalsafety/Falls/adultfalls.html/ Home Safety Council: http://www.homesafetycouncil.org/SafeSeniors/sen_safeseniors_w001.asp

Resources Center for Healthy Aging: http://www.healthyagingprograms.com/content.asp?sectionid=107 National Council on Aging: http://www.ncoa.org/ National Safety Council: http://www.nsc.org/safety_home/Resources/Pages/Falls.aspx The National Blueprint: http://www.agingblueprint.org/tips.cfm

Management of Arthritis

ICE

ACUTE INJURIES OR FLARE-UPS DUE TO EXCESS ACTIVITY DECREASES SWELLING AND INFLAMMATION BY CONSTRICTING BLOOD VESSELS ICING TIME USUALLY 15-20 MINUTES

HEAT

STIFF JOINT AND MUSCLE SPASM/TIGHTNESS INCREASES BLOOD FLOW TO MUSCLES AND JOINTS AND CREATES RELAXATION USE 10-15 MINUTES BEFORE ACTIVITY

CARDIO EXERCISE AQUATICS, WALKING AND BIKING

AQUATICS • SOOTHING WARMTH AND BOUYANCY

OF WATER MAKE IT SAFE, IDEAL ENVIRONMENT FOR RELEIVING PAIN AND SITFFNESS

• WATER SUPPORTS JOINTS TO ENCOURAGE FREE MOVEMENT AND ACT AS RESISTANCE TO BUILD MUSCLE STRENGTH

WALKING

• STRENGTHENS HEART • WEIGHT-BEARING EXERCISE THAT

STRENGTHENS BONES TO REDUCE OSTEOPOROSIS

• STRENGTHENS MUSCLES AND MAINTAINS JOINT FLEXIBILITY

• IMPROVES SLEEP, MOOD AND DECREASES STRESS

BIKING • STRENGTHENS LEG MUSCLES IN A

LOWER IMPACT POSITION FOR THOSE WITH MORE ADVANCED ARTHRITIS

• STRENGTHENS HEART • IMPROVES SLEEP, CONTROLS

WEIGHT AND DECREASES STRESS AND ANXIETY

STRENGTHENING • Strengthening exercises such as weight

training help you build the muscles that support your joints. This can be done using hand weights or even a 1-liter water bottle.

STRETCHING

IMPROVES JOINT RANGE OF MOTION AND DECREASES STIFFNESS ALLOWS FOR GREATER MOBILITY THROUGH INCREASED BLOOD FLOW IMPROVES POSTURE DECREASES STRESS WHEN COMBINED WITH DIAPHRAGMATIC BREATING