Title: Risk Factors for Falls (and injuries)
1Risk Factors for Falls (and injuries)
- - intrinsic
- - extrinsic
- - modifiable with exercise
2A Risk continuum ?
- Over 200 risk factors documented in the literature
D Drugs and alcohol A Age related
physiological changes M Medical E Environment
3Intrinsic vs Extrinsic - we are all trippers
- Over HALF the falls experienced in the home are
due to environmental hazards - trips, slips,
unsafe or unlit stairways - A decline in a persons intrinsic risk factors
(declining function and balance) mean that the
extrinsic risk factors (loose mats, slippery
floors) no longer just cause a correctable trip -
they cause an injurious fall
4D - Drugs and Alcohol
- Cumulative effect of medication / time of day
- Prescribed medications / multiple drug regimes
- Analgesics - Antidepressants
- Sedatives - Antipscyhotics
- Diuretics - ANY 4 OR MORE MEDICATIONS
- Heavy drinkers (gt7 units per week) (Campbell et
al., 1989, OLoughlin et al., 1993) - Mixing medications with alcohol
5A - Age related physiological changes
- Deterioration in physical functions and systems
(strength, power, endurance, coordination,
reaction, balance, proprioception and neural
control, asymmetry) - Decrease in functional capacity, mobility and
activity - Deterioration in feet (bunions, corns,
circulation, neuropathies) - Increase in cognitive impairment and depression
6Psychological risk factors
- Fear of falling
- Avoidance of activity
- Reduced quality of life
- Increased anxiety
-
7M - Medical
- Acute Infections
- Cardiovascular control - postural hypotension,
drop attacks, heart disease, stroke, tias - Dementia, Alzheimers Disease
- Parkinsons Disease
- Thyroid dysfunction
- Peripheral Neuropathies or myopathies
- Malignancies
- Impaired hearing or vestibular function (Menieres
Disease, Tinnitus) - Impaired vision (macular degeneration, glaucoma,
cataracts, visual acuity, contrast sensitivity,
adaptation to dark)
8M - Medical 2
- Foot deformities - bunions, corns, hard skin,
arthritis, oedema - Urinary incontinence or urgency
- Receiving community health or social services
- Recent discharge from hospital
- Use of assistive walking aids - cane, zimmer
- Malnutrition / Anaemia - Nutritional
recommendations are 10-20?g rda Vitamin D and
1,000mg rda calcium, Vit B12 deficiency leads to
sensory abnormalities
9E - Environment
- Personal risk factors
- glasses (bifocals and varifocals)
- footwear and clothing
- Outdoors
- Poorly lit pathways
- Uneven pavements
- Slippery leaves
- Rubbish, building materials,
obstacles - Bus drivers!
- Indoors
- Loose carpets
- Wires and cables
- Unstable furniture
- Change of level
- Poor lighting
- Cold rooms
Sentimentality or never been a problem before
10Not modifiable with tailored exercise
- vision problems gender
- multiple medications social class
- chronic medical conditions poor housing
- hypothermia poor heating
- malnutrition poor footwear
- age
- exercise may not have a major effect
11Modifiable with tailored exercise
- low strength depression
- low power postural hypotension
- poor gait cognitive impairment
- poor mobility urinary urgency
- poor balance fear of falling
- arthritis
- exercise is likely to have
- a major positive effect
12How can we identify older people at high risk of
falling?
- AGS/BGS guidelines - get up and go test as a
filter for a full assessment by a specialist
clinician for people who have fallen at least
once. J Am Geriatr Soc 2001 49 664 672. - Falls Risk Assessment Tool (FRAT)
- 5 questions to assess risk. J Public Health
2004 26138-143.
?? Usefulness in residential/nursing settings
13FRAT - Assessment of falls risk in older people
14PROFET targeting risk factors (Close et al.
Lancet 1999)
- Referral / intervention
- Day hospital
- GP
- O/P
- Optician
- Social services
- Supply minor equipment
- Medical assessment
- General medical
- Postural hypotension
- Visual acuity
- Balance
- Cognition and affect
- Corotid sinus syndrome
- Occupational Therapy
- Function
- Physical handicap
- Psychological handicap
- Environmental hazards
The rate of falls was reduced by 60
15Tinetti (1994) - Multifactorial
The rate of falls was reduced by 30