Falls in elderly

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Falls in the Elderly: a Physical Therapy Perspective Hana Al-Sobayel, MSc, PhD Physical Therapy King Saud University

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Falls in elderly

Transcript of Falls in elderly

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Falls in the Elderly:a Physical Therapy

PerspectiveHana Al-Sobayel, MSc, PhD

Physical Therapy

King Saud University

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Outline

Epidemiology of falls Clinical significance Risk factors Assessment Falls prevention

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Falls Epidemiology

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Definition

A fall is an event which results in a person coming to rest inadvertently on the ground or floor or other lower level

(WHO)

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Frequency of falls

28-35% of people aged of 65 and over fall each year

32-42% for those over 70 years of age

Increase with age and frailty level.

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Frequency of falls

Older people who are living in nursing homes fall more often than those who are living in community.

30-50% of people living in long-term care institutions fall each year, and 40% of them experienced recurrent falls

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Fall mortality rate

Falls account for 40% of all injury deaths

Unintentional falls: #1 leading cause of death in USA for people above 55 years of age (CDC, 2006)

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Fatal falls rates by age and gender

(National Council on Aging, 2005 in WHO 2007)

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Clinical Significance

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Need for medical attention

20-30% of mild to severe injuries

Underlying cause of 10-15% of all emergency department visits

50% of injury related hospitalizations among people over 65 years and older

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Fall-related hospital admission

Hip fracture, traumatic brain injuries and upper limb injuries

Longer hospital stay compared to other injuries.

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Fall-related hospital admission

Hip fractures: Hospital stay extend to 20 days Older person are likely to remain in hospital

for the rest of their life 20% die within a year subsequent to falls

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Post-fall syndrome

Dependence Loss of autonomy Depression Confusion Immobilization Restriction in daily activities.

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National Crisis

Diseases of civilization Aging and medical advances that preserve and prolong life

High inactivity rates

High Fallscomplications

(MOH statistics 2008)(Al-Nozha et al. 2007)

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Risk Factors

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Risk factors Intrinsic & Extrinsic

(Steinweg, 1997)

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Risk factor model

(WHO, 2007)

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(Rubenstein, 2006)

Causes of falls in elderly

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(Rubenstein, 2006)

Risk factors of falls

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Falls & Fractures

The strongest determinant of a fracture is the actual fall rather than bone fragility

Abnormalities in gait and balance are the most frequent and sensitive risk factors that predispose to fractures

Physical limitations and physical inactivity reduce bone strength and increase fracture risk

(Karinkanta et al., 2010)

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Assessment

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Self-report scales

Identify high risk individuals:

History of fall within a past time frame Details on frequency, surrounding

circumstances & injury severity

(Rubenstein et al., 2002)

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Self-report scales

The Falls Risk for Older People in the Community Scale (FROP-Com):

Covers 13 risk factors in 26 questions Dichotomous or ordinal scoring, from 0 to 3 An overall score of falls risk, ranging from 0 to 60,

with higher scores indicative of greater risk Sensetivity = 66% ; Specificity = 65%

(Russell et al., 2008)

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Single-task performance

Assess postural maintenance or physical performance

Simple, require minimal time and equipment

Single domain

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Single-task performance

Five Times Sit to Stand/Chair Rise (FTSS)

Good predictor of recurrent falls

(Buatois et al., 2008)

An individual is asked to rise from sitting to standing with arms crossed and repeat the task 5 times

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Single-task performance

Stepping: Maximal Step Length

Significantly correlated with measures of balance & mobility

Good predictor of frequent falling

(Buatois et al., 2008)

Arms crossed on chest, stepping out with one leg as far as possible, maintaining position on the other leg, return to initial position in one step

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Single-task performance

Timed Up & Go (TUG)

Individuals with falls slower than non-fallers

(Shumway-Cook et al., 2000)

Time needed to get up from a chair, stand up, walk 3 meters, return back to sitting on the chair

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Multi-task performance

Comprehensive approach to fall assessment

Incorporate multiple measures (single-task & questionnaires)

Provide detailed information Time consuming

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Multi-task performance

Performance Oriented Mobility Assessment (POMA) (Tinetti, 1986)

Good inter-rater reliability

Moderate ability to differentiate between fallers & non-fallers(Raiche et al., 2000)

Assess balance & gait

Direct observationScore range 0-40

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Multi-task performance

Berg Balance Scale (BBS)

(Berg et al., 1989)

High inter-rater, intra-rater, test-retest reliability

BBS & history of falls, best predictors of falls in community dwelling individuals(Shumway-cook et al., 1997)

14 mobility tasksScored from 0-4Maximum score of

56

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Multi-task performance

Physical Performance Tests (PPT)

High inter-rater reliability

Good predictor of falls in community dwelling individuals

(Reuben & Sui, 1990)

7 itemsTimed tasksScores according to

timeHigher score faster

performance

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Environment Assessment

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Prevention

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Physical Therapy Approach

Must consider individual risk factors, such as functional limitations or reduced bone strength, and environmental hazards. (Karinkanta et al., 2010)

Multi-component exercise beneficial for bone health and maintaining functional ability in older community-dwelling adults. (Petridou et al., 2009)

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Physical Therapy Approach

Whole-body vibration training has shown potential to improve muscle performance, balance and bone strength

(Mikhael et al., 2010)

Home hazard assessment and modification and use of hip protectors are efficient for frail older adults at the highest risk of falling.

(Gillespie et al., 2009)

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Summary

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Elder population at high risk of falls Fractures mainly results from falls in

elder populations Risk assessment is integral part of fall

prevention Physical therapy is required for falls

prevention among elderly Urgent need for risk assessment and

reduction locally and internationally

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