Evidence based geriatric physical therapy

Ahmad Osailan

Falls

• One of the most common incidents and cause for hospital admission for elderly. Even considered one of the leading causes for sudden death.

• What are the risk factors for falls?• - balance impairments • - strength impairments• - difficulty in walking

History of fall prevention

• Most common interventions:• Moderate to high intensity Balance exercise

training• Exercise + multifactorial interventions.• Q: What is the minimum dose of exercise to

prevent falls?• A: 50 Hrs of exercise

Incidence of falls

• Falls are the leading cause of traumatic brain injury and fractures in older adults.

• For individuals aged 65 and older, falls outpace motor vehicle accidents as the leading cause of unintentional death by several thousands

• Falls are the leading cause of emergency department visits by older adults, and the number one cause of hospital admissions due to trauma

Some Definitions

Some Definitions

Falls prevention

• According to Shubert 2011, it is recommended by the American geriatric society to do screening for falls for those Aged 65 and above.

• Effective fall prevention intervention should focus on the contributing risk factor.

• Doing a triage to find the impairments that can lead to fall.

Example

Screening for falls• American geriatric association recommended

screening for balance and immobility. • The screen consist of:• 1- Hx of fall in the past year ( how many times)• 2- any difficutly in walking or in balance (y/n)• 3- observe walking performance and balance

changes by doing tests (Time up and go test, berg balance test)

• If one of these is positive, he/she should be referred for a comprehensive multifactorial assessment

Falls screening

• There are many balance and mobility assessment tests, but most of theses tests do not take into account the medical risk factor.

Examples for studies

What do we learn from this study

• All risk factors must be assessed and triaged properly.

• Physical therapist must use clinical judgement to determine which risk factor should be assessed first.

•

Exercise dose

Mode of exercise

Static activities

Dynamic Activities

Dual task training

Strength training

walking

conclusion