Falls in elderly
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Transcript of Falls in elderly
Falls in the Elderly:a Physical Therapy
PerspectiveHana Al-Sobayel, MSc, PhD
Physical Therapy
King Saud University
Alsobayel - Geriatrics Chair Symposium 2010
Outline
Epidemiology of falls Clinical significance Risk factors Assessment Falls prevention
Alsobayel - Geriatrics Chair Symposium 2010
Falls Epidemiology
Alsobayel - Geriatrics Chair Symposium 2010
Alsobayel - Geriatrics Chair Symposium 2010
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)
Alsobayel - Geriatrics Chair Symposium 2010
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.
Alsobayel - Geriatrics Chair Symposium 2010
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
Alsobayel - Geriatrics Chair Symposium 2010
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)
Fatal falls rates by age and gender
(National Council on Aging, 2005 in WHO 2007)
Alsobayel - Geriatrics Chair Symposium 2010
Clinical Significance
Alsobayel - Geriatrics Chair Symposium 2010
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
Alsobayel - Geriatrics Chair Symposium 2010
Fall-related hospital admission
Hip fracture, traumatic brain injuries and upper limb injuries
Longer hospital stay compared to other injuries.
Alsobayel - Geriatrics Chair Symposium 2010
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)
Alsobayel - Geriatrics Chair Symposium 2010
Risk Factors
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Risk factors Intrinsic & Extrinsic
(Steinweg, 1997)
Risk factor model
(WHO, 2007)
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(Rubenstein, 2006)
Causes of falls in elderly
Alsobayel - Geriatrics Chair Symposium 2010
(Rubenstein, 2006)
Risk factors of falls
Alsobayel - Geriatrics Chair Symposium 2010
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)
Alsobayel - Geriatrics Chair Symposium 2010
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)
Alsobayel - Geriatrics Chair Symposium 2010
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)
Alsobayel - Geriatrics Chair Symposium 2010
Single-task performance
Assess postural maintenance or physical performance
Simple, require minimal time and equipment
Single domain
Alsobayel - Geriatrics Chair Symposium 2010
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
Alsobayel - Geriatrics Chair Symposium 2010
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
Alsobayel - Geriatrics Chair Symposium 2010
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
Alsobayel - Geriatrics Chair Symposium 2010
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
Alsobayel - Geriatrics Chair Symposium 2010
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
Alsobayel - Geriatrics Chair Symposium 2010
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
Alsobayel - Geriatrics Chair Symposium 2010
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)
Alsobayel - Geriatrics Chair Symposium 2010
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)
Alsobayel - Geriatrics Chair Symposium 2010
Summary
Alsobayel - Geriatrics Chair Symposium 2010
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
Alsobayel - Geriatrics Chair Symposium 2010