Fall Prevention Programs

1
Fall Prevention Programs

• A BALANCING ACT

2
Scope of the Problem

• gt30 of community dwelling seniors (over 65) fall
  each year (La Prévention des chutes dans un
  continuum de services pour les aînés vivant à
  domicile Cadre de Référence 2004 Direction
  générale de la santé publique Santé et Services
  Sociaux Québec p.3)
• Falls result in 12,000 hospitalizations and 600
  deaths per year in Quebec, (IBID)
• 15 of seniors have repeated falls in a given
  year (IBID)

3
Scope

• 60 of those who fall in a year will fall again
  (Wolf, Sattin, Kutner et al Intense tai chi
  exercise training and fall occurrences in older,
  transitionally frail adults a randomized
  controlled trial. J Am Geriatr Soc 2003
  511693)
• Falls are the primary cause of accidental death
  in the senior population (Kiel, D.P. Falls in
  the elderly Risk factors and patient evaluation
  www.uptodate.com, August 2007, p.3)

4
Consequences

• 10-30 need medical care (Francoeur, L, Institut
  universitaire de gériatrie de Montréal Les
  chutes Tomber justeOctobre 2001)
• 5-15 have minor injuries (IBID)
• 2-6 will have a fracture (hip, shoulder, wrist)
  90 of hip fractures result from a fall(IBID)

5
Consequences

• Fifth leading cause of death among seniors (La
  Prév..p.3)
• 20 of fallers who fracture a hip die within six
  months (La Prévention des chutes dans un
  continuum de services pour les aînés vivant à
  domicile Cadre de référenceDirection générale
  de la santé publique 2004 Santé et Services
  sociaux Québec, p.3)
• 80 of older women in one study preferred death
  to a bad hip fracture that would result in
  nursing home admission (Salkeld, Cameron,
  Cumming, et al Quality of life related to fear
  of falling and hip fracture in older women A
  time trade off study BMJ 2000 320341)

6
consequences

• 50 of hip fractures never regain their former
  level of independence (La Prévention des
  chutes.p.3)
• Fear of falling again is a major result for 40
  of fallers (Francoeur, L )

7
Consequences

• Decreased mobility Physical and psychological
  dependence effect on family
  over-protection, restrictions, ??placement

8
Consequences

• Reduced social interaction
• Depression
• Loss of self-confidence and self-esteem

9
Consequences

• Cost to the system
• 6,321 per hospitalization for fall in 1996-1997
  in Quebec (La préventionp.3)
• 11,000 for treatment fractured hip (1996-1997)
• (La prévention..p.3)
• 76 million per year in Quebec (IBID)

10
Causes of Falls

• Causes that relate to the person intrinsic
  causes
• Causes related to the environment, habits,
  behaviour extrinsic causes

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Intrinsic Causes

• Vision problems
• Hearing deficits
• Cognitive problems
• Medications

12
Intrinsic causes

• Lower limb arthritis
• Slowed reaction time
• Difficulty with balance and/or walking
• Cardiovascular problems orthostatic
• hypotension, arrhythmia

13
Intrinsic Causes

• Illness, either acute or chronic
• Dehydration
• Depression
• Inadequate nutrition

14
Intrinsic causes

• Generalized weakness or deconditioning, for
  example after acute illness
• Cardiac problems
• Alcohol
• Incontinence

15
Intrinsic causes

• Anemia
• Hypoglycemia
• Neurological problems stroke, Parkinsons,
  neuropathy
• COPD

16
Extrinsic Risk Factors

• Inappropriate clothing
• Inappropriate footwear
• Inadequate lighting

17
Extrinsic Risk Factors

• Issues with flooring
• Type of floor
• Uneven floors
• Cute little carpets
• Wet or slippery kitchen, bathroom, entryway
• Stairs
• Uneven risers
• Inadequate railing

18
Extrinsic Risk Factors

• Sidewalks, curbs
• Characteristics of products used in home
• Absence of necessary gait aid
• Poor organization of often-used items in the home

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Extrinsic Risk Factors

• Wires, cords, vacuum hoses, items left on floor
• Pets
• Risk taking
• Climbing, reaching
• Walking hands in pockets, purse/bags in hands
• Carrying loads that block view

20
Prevention

• Group exercise and education sessions PIED/STAND
  UP
• Tai Chi
• Dancing
• Vie Active
• Individualised exercise and education

21
PIED STAND UP

• Programme implemented across the province,
  animated by trained professionals, either Physio,
  TRP, Phys Ed teacher, Kinesiologist or OT
• For active seniors 65 years or older, either
  have had no more than one fall in the past 12
  months, or are quite afraid of falling

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PIED / STAND UP

• 12 weeks of sessions twice a week, about an hour
  each
• Each session Exercises in group for strength,
  flexibility and balance
• 11 education capsules to inform on how to
  minimize fall risk factors

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PIED / STAND UP

• Home exercise program to be done at least once a
  week during the course taught during first
  sessions
• First session Evaluation of each participants
  balance, strength and flexibility
• Last session Re-evaluate balance, strength an
  flexibility to see improvement

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PIED / STAND UP

• Theoretically
• Improved balance reduces risk of fall
• Improved muscle mass reduces injury in case of
  fall
• Improved flexibility and muscle strength make
  individual steadier on their feet
• Information on risk factors empowers individual
  to reduce those risks

25
PIED / STAND UP

• Program mandated by Ministry of Health in every
  Region of Quebec
• Funds in budget to each health care institution
  to offset costs of doing PIED
• Each institution has a target number of seniors
  to take PIED each year, and this number varies by
  institution

26
PIED / STAND UP

• Problems with PIED
• Recruitment
• Seniors in target group already busy
• In some areas, not used to taking courses
• Many who havent fallen dont see the need
• Transportation Areas without public transit,
  winter weather, rural areas

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PIED / STAND UP

• Does it work?
• No data in our Region have been compiled to prove
  that this approach is better than any other
• Personally I have seen improvements in test
  scores after completion of the program, but dont
  know if this translates into fewer falls

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PIED / STAND UP

• Positive fact that other group exercise programs
  in our area have grown out of STAND UP
• If participants are encouraged to be more active
  by taking STAND UP then this can only be a plus

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As the saying goes

• MOVE IT
• Or
• LOSE IT!