Falls: Low Vision and Falls
description
Transcript of Falls: Low Vision and Falls
Falls: Low Vision and Falls
Jag Mallya1-09-2010
Definition:
A fall is an event which results in a person inadvertently coming to rest on the ground, the floor or other lower level.
No evidence of: sudden onset of paralysis, epileptic seizure, or Loss of consciousness overwhelming external force
Epidemiology of Falls > 65 years – 30% > 75 years – 40% 50% of falls in people who fall twice or more in a year.
Consequences of Falls Commonest cause of Accidental injury in older people.
Commonest cause of Accidental Death in > 75 years of age.
6% falls > 65 years result in a fracture.
Commonest cause for older people to attend A & E > 75 years hip fractures predominate.
Fragility fracture also costs £1.7 billion per year (In-patient & long term provision.)
Table 10: Cost of an individual hip fracture
Category Cost
Hospital care £4,760
Ambulance £171
Long stay residential care £20,010
GP use £164
Outpatient use £319
Total Cost £25,424
Cost of Hip Fracture in Elderly in UK.Hospital Costs: $ 430,407,013Social Care Costs: $ 933,420,670Other: $ 18,000,000
Approx Total Cost: $1,382,932,183
Ref: “The Economic cost of hip fracture in the UK.”
Social Costs of Falls By 2051 = Falls (Population of Australia: 22,403,920)
Direct health cost attributed to falls related injury will increase 3 fold.
2500 additional hospital beds will need to be permanently allocated to falls.
3320 additional Nursing Home places.
Ref: Health Service impacts and costs of falls in older age (WHO) Dongbu Fu
Falls are Multifactorial:
Intrinsic Factors Extrinsic Factors
FALLS
Medical conditions
Impaired vision and hearing
Age related changes
Medications
Improper use of
assistive devices
Environment
Falls in the Community
Accidents/environment 37%
Weakness, balance, gait 12%
Drop attack 11%
Dizziness or vertigo 8%
Orthostatic hypotension 5%
Acute illness, confusion, drugs, decreased vision
18%
Unknown 8%
Rubenstein JAGS 1988
Causes of Falls: Summary of 12 Studies
Accident/environment Gait/balance disorder Dizziness/vertigo Drop attack Confusion Postural hypotension Vision problem Other specified Unknown
31%171310 4 3 315 5
Rubenstein LZ, Josephson KR. Clin Geriatr Med. 2002(May);18(2):141-158
Age related changes affecting balance
Normal Changes with Aging Neurologic:
Increased reaction time Decreased righting reflexes Decreased Proprioception
Vision Changes: Decreased accommodation & dark adaptation
Decreased muscle mass: Strength
Assessment andManagement of Falls
Periodic case finding inPrimary Care:Ask all patients aboutfalls in past year
No falls Nointervention
Recurrent Single fallfalls
Gait/balanceproblems
Check forgait/balanceproblem
Noproblems
Fall Evaluation*
AssessmentHistoryMedicationsVisionGait and balanceLower limb jointsNeurologicalCardiovascular
Multifactorial intervention(as appropriate)Gait, balance, exercise - programsMedication - modificationPostural hypotension - treatmentEnvironmental hazards - modificationCardiovascular disorders - treatment