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Determinants of Fall Risk and Injury in Hispanic Elderly Living in El Paso Community Guillermina Solis, PhD, RN, F/GNP Vanessa Guerrero, RN Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013
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Guillermina Solis, PhD, RN, F/GNPAnd
Vanessa Guerrero, RN
Determinants of Fall Risk and
Injury in Hispanic
Elderly Living in El Paso
Community
Objectives• Describe the prevalence of falls & injuries in elderly
• Explore effects and consequences of falls injuries and its relation to quality of life
• Analyze results of fall risk factors and reported causes of fall injuries
• Identify clinical implications of study and value of multidisciplinary research
Epidemiology of Aging
World59%, 249 million in developing countries (WHO, 2011)
United States 13.3% , 41.4 million in 2011Baby boomers: Started Jan. 2011
• 10,000 new 65 yr. old/ year
Texas10.9%, 2.9 million
El Paso City11.2%, 74,000
U.S. Census Bureau, 2010
Prevalence of Falls
• Fourth leading cause of death in U.S. • 1 of every 3 elderly fall yearly• Increase number of fall increase risk of injury• 20-30% sustain injury• Major cause of ER visits and hospital admissions• Common injuries: fractures & TBI• Fear of falling: limit physical activity, isolation• Influences level of independence
(CDC, 2012)
Significance of Falls and Injuries
• Personal Effect
• Family
• Function
• Quality of Life
• Cost: Direct and Indirect
Causes of FallsIntrinsic: within person• Age• Physical state• Illnesses• Medications
Extrinsic: outside person• Social support• Environment• Assistive devices• Walking aids
Research StudyPurpose: to evaluate the risks for falls in home bound elderly residing in El Paso county utilizing a multidisciplinary approach to evaluate the physical, medical, and environmental components of the participant . Limited studies in Hispanics
Methodology: Descriptive study • Inclusion: • Hispanic • 55 years and older• Self-report fall within the last 3months, • Lives in a non-institutionalized setting• Receiving services from a home health agency• Willingness to participate
IRB approval: UTEP
Process• Recruitment• Coordinating visits• Challenges
• Data collection• Home visits• Informed consent• Compensation
• Roles of various disciplines• Benefits• Challenges• Perception: participant and professional
Demographics (N=30)AgeMean 77.4
Range 58-91
GenderMale: 20% (n=6)
Female: 80% (n=24)
Education
≤6th grade: 30%
12th grade: 20%
Income
Majority below poverty
Family support
Lived alone
Chronic Illness• Arthritis 23 78%• Hypertension 21 70%• Diabetes 18 60%• High Chol. 15 50%• Anxiety 13 43%• Heart disease 12 40%• Depression 8 27%• Renal Disease 4 13%
Medications• Average number• Prescription: 10.8• Non-prescription• Over the counter: 1.2• Alternative: 1.5
•Most used• Anti-hypertensives
• Beer’s Criteria• Sedatives
BMI
BMI (n=30) Range (16-39) Weight Status
Below 18.5 (1) Underweight
18.5 – 24.9 (7) Normal
25.0 – 29.9 (11) Overweight
30.0 and Above (11) Obese
The fall story:Where did they fall?• 53% Indoor• 47% Outdoor: yard and outside activities like stores,
restaurant
What were they doing?• Activities: while doing something such as walking,
picking up objects, slid off furniture• Tripped with objects
When did they fall?• AM: 48%• PM: 37%• Night: 13%
TUG and Reach TestTUG (measure of function/balance)• 11 fell outside cut off = 13 seconds • 5 considered high risk = ≥20 seconds
Reach test (measure of flexibility)• No deficits identified• All able to extend beyond 6” from baseline
Uncorrected Vision• OD (n=29)
≥40 but < 200 = 23
≥200 = 7• OS
≥40 but < 200 = 20
≥200 = 5• OU
≥40 but < 200 = 20
≥200 = 2
Corrected Vision• OD (n=29)
≥40 but < 200 = 16
≥200 = 3• OS
≥40 but < 200 = 14
≥200 = 3• OU
≥40 but < 200 = 11
≥200 = 0
SUMMARY• Over 75 greater prevalence•Women a majority • High number of chronic illness• High prevalence Hypertension and Hypoglycemia
• Most fall occurred during activity• Resulted in fractures• Vision: unilateral impairment• High Obesity rate• TUG test: lower function
Implications for practiceNeed for comprehensive fall risk assessment• Community• Admission• Discharge
Minimize medications
Monitor for adverse effects
Control of chronic illnesses: BMI
Education• Professionals• Patients • Families
Prevention• Physical activity• Environment modification• Awareness of medication adverse effect• Control of chronic illness• Communication among health care provideres
Future ResearchMultidisciplinary intervention studies of various age groups Incorporate EBP programs• Experimental studies to evaluate various groups• Longitudinal prevention studies
Evaluate various psychological and physical components that affect balance• Sensory• Strength• Mobility• Learning styles• Fear of falling
Conclusion
Fall risk is multifactorial and requires careful individual evaluation BUT may be lessened by taking a proactive approach …