Factors Contributing to the Increased Risk of Falls Among

the ElderlyPresented by:

Mary Ann Zelinsky, M.A., COMS, CVRT, BROS

2009 Regional AER Conference

November 13-15, 2009

Why Talk about Falls?

• Aging and Risk

• 341 people ages 65+ died from falls, public officials reviewed death certificates

• Rates of falls among MA 85+ nearly doubled

2James H. Quillen VAMC Mt. Home, TN

Zelinsky, M.A.

Why Talk about Falls?

• Cost

• Nursing Homes

3James H. Quillen VAMC Mt. Home, TN

Zelinsky, M.A.

Why Falls Occur?

• Intrinsic

• Extrinsic

• Complex Events

4James H. Quillen VAMC Mt. Home, TN

Zelinsky, M.A.

Intrinsic FactorsAge-Related Changes

1. Vision

2. Balance

3. Gait

4. Musculoskeletal system

5. Cardiovascular system

6. Diseases

5James H. Quillen VAMC Mt. Home, TN

Zelinsky, M.A.

Intrinsic FactorsNon-age Related

• Medications

• Fear

6James H. Quillen VAMC Mt. Home, TN

Zelinsky, M.A.

Vision

• Adapt to darkness• Glare• Depth perception• Visual acuity• Visual field• Contrast sensitivity

7James H. Quillen VAMC Mt. Home, TN

Zelinsky, M.A.

BalancePostural Sway

Age 6-9 yrs old

80 yrs old

Zelinsky, M.A. James H. Quillen, VAMC 8 Mt. Home, TN

Balance

• Righting Reflex

• Body displaced– Ankle strategy– Hip strategy

Zelinsky, M.A. James H. Quillen, VAMC 9 Mt. Home, TN

Gait

• Two phases

-Stance

-Swing

• Step length, speed,

and height

• Gender Differences

10James H. Quillen VAMC Mt. Home, TN

Zelinsky, M.A.

Musculoskeletal System

Zelinsky, M.A. James H. Quillen, VAMC 11 Mt. Home, TN

• Lower extremities

• Calcification

• Limited extension

Cardiovascular System

• Baroreflex

• Syncope

• Postural hypotension

12James H. Quillen VAMC Mt. Home, TN

Zelinsky, M.A.

• Prodomal Falls

• Acute Diseases

-Stroke

-Parkinson’s

-Osteoporosis

Diseases

Zelinsky, M.A. James H. Quillen, VAMC 13 Mt. Home, TN

Visual Impairments

Cataracts Glaucoma

14James H. Quillen VAMC Mt. Home, TN

Zelinsky, M.A.

Medications

• Polypharmacy

• Meds mostly associated

with falls include

Diuretics Psychotropics

Hypnotics Anti-hypertensive

Sedatives NSAIDs

Laxatives Anti-DepressantsZelinsky, M.A. James H. Quillen, VAMC 15

Mt. Home, TN

Fear

• Number 1 worry among older adults in U.S.

• Avoidance

• Inactive cycle/Depression

Zelinsky, M.A. James H. Quillen, VAMC 16 Mt. Home, TN

Extrinsic Factors• Indoors -

1. Floors, 2. Stairways, 3.Bathroom

(Yale School of Medicine)• Outdoors-

1.Uneven sidewalks, 2. Crowds, 3. Bus

steps• Other –

1. Shoes (type/sole), 2. Glasses

Zelinsky, M.A. James H. Quillen, VAMC 17 Mt. Home, TN

Minimize Risk FactorsAssessments

• One leg balance test• Get-Up and Go Test

<10 sec =Freely mobile

<20 sec = Mostly Independent

• Frequency of Falls• Checklist for Home

-www.cdc.gov

18James H. Quillen VAMC Mt. Home, TN

Zelinsky, M.A.

Minimizing Risk Factors

• Frequency of Falls

-Include area and suggest way to resolve

• Checklist for Home

-www.cdc.gov

Zelinsky, M.A. James H. Quillen VAMC Mt. Home, TN

19

Minimizing Risk Factors

• Programs – A Matter of Balance• Exercise• -Tai Chi• -Strengthening• -Range of Motion

Zelinsky, M.A. James H. Quillen VAMC 21

Mt. Home, TN

• Guardian Alert 911

• www.logicmark.com

• One time cost - $199

21James H. Quillen VAMC Mt. Home, TN

Zelinsky, M.A.

Minimizing Risk Factors at Home

Minimizing Risk Factors

• Bed mats• www.pelicanmanufac-

turing.com

• Gait belts• www.dmesupplygroup

.com

22James H. Quillen VAMC Mt. Home, TN

Zelinsky, M.A.

Minimizing Risk Factors with Medicine Management

• www.envisionamerica.com

• Microchip embedded in label

• Any size bottle, box, vial, or tube

• Provides drug name, dosage instructions,

doctor name, prescription #Scrip

Talk 23James H. Quillen VAMC

Mt. Home, TN Zelinsky, M.A.

• Motion Sensing LED Stair Light

• 15’ motion range, over 270º, $30

• www.improvements-catalog.com

• www.mrbeams.com• Uses 3 C batteries• Outdoors/indoors

24James H. Quillen VAMC Mt. Home, TN

Zelinsky, M.A.

Minimizing Risk Factors with Lighting

Zelinsky, M.A. James H. Quillen VAMC 24 Mt. Home, TN

Reviewing FallsO&M instructors prefer these types

References

• Arabadjis, Peter, “The Fundamentals of Geriatric Rehabilitation,” handout from presentation as part of the UMO Center on Aging-Geriatric Series. Hutchinson Center, Belfast, ME , April 30, 2003.

• Gandel, Catherine, “Going Steady”, AARP July –August 2003, (http://www.aarpmagazine.org/health/Articles/a2003-08-20).

• Fuller, George F., Falls in the Elderly. American Academy of Family Physician, 2000. (http://www.aafp.org/afp/20000401/2159.html).

• Hogan, David B., MacDonald, F.A., Betts, J., Brikcer, S., and et al. A randomized controlled trial of a community-based consultation service to prevent falls. Canadian Medical Association Journal. 2001: 165(5), 537-543.

• Hyman, Marybeth, Trzop-Haiden, S., “Pharmacotherapy in the Elderly,” handout from presentation as part of the UMO Center on Aging-Geriatric Series, EMMC, Bangor, ME. March 18, 2003.

References Cont’d

• Kleinfield, N.R. The elderly and fear of falling. The New York Times, March 6, 2003 as found in The International Herald Tribune (www.iht.com).

• Lord, Stephen, R. Sherrington, C, and Menz, H. B. Falls in older people Risk factors and strategies for prevention. Cambridge University Press: Cambridge, United Kingdom, 2001 (http://www.cambridge.org).

• Northridge, Mary E., Nevitt, M.C., Kelsey, J.L., and Link, B. Home Hazards and Falls in the Elderly: The Role of Health and Functional Status. American Journal of Public Health. 1995:85 (4), 509-515.

• Tideiksaar , Rein. Falls in Older People Prevention and Management. Health Professions. Press: Baltimore, 2002 (www.healthpropress.com).

Websites

• Administration on Aging (AOA), www.aoa..gov• American Associaiton of Retired Persons (AARP), www.aarp.org• American Geriatrics Society (AGS), www.americangeriatrics.org• American Society on Aging (ASA), www.asaging.org• The Boston University (BU)Roybal Center for the Enhancement of

Late-Life Function,• www.bu.edu/roybal (A Matter of Balance –falls prevention program)• The Centers for Disease Control and Prevention (CDC),

www.cdc.gov