Falls in the Elderly: Who Why What Happens Next

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Falls in the ElderlyWho? Why? What Happens
Next?

• Rhonda Bugbee, RN, CEN
• Trauma Consultant

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Help! Ive Fallen and I Cant Get Up!
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Emergency Visits

• Falls are the leading cause of external injuries
• Most common in children less than 5 years old and
  adults 65 and older
• Trauma is the 5th cause of death in those gt65
  years
• Falls are responsible for 70 of accidental
  deaths in people over 75 years old
• 1/4 of the elderly people who fracture their hips
  die within 6 months of the injury

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Leading Causes of Death
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Death by Injury Severity Scores
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Hip Fractures

• In 1996 more than 250,000 older Americans had
  fractured hips
• 90 are associated with falls
• Excess of 10 billion
• Leading fall-related injury that results in
  hospitalization which are often prolonged and
  costly.

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Traumatic Brain Injury

• Also a common injury following a fall
• Many elderly on blood thinners
• Symptoms may be subtle and not apparent at the
  time of injury.

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Risk Factors for Falls

• Increased age
• Living alone
• Previous falls
• Use of a cane or walker
• Acute illness
• Reduced vision
• Glare intolerance
• Altered depth perception
• Decreased night vision
• Decline in peripheral vision

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Risk Factors for Falls

• CVA that results in hemiparesis, sensory and/or
  motor function deficits
• Decreased range of motion and flexibility in
  lower legs and spine
• Weakness
• Decreased step length (short shuffling steps)
• Alzheimers or dementia
• Arthritis
• Parkinsons disease
• Foot problems
• Toenail length, callouses, bunions, deformities

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Risk Factors for Falls

• Difficulty rising from a chair
• Neurologic changes
• Slowed reaction times
• Diminished sensory awareness for light touch,
  vibration, and temperature
• Decline in proprioception
• Decreased hearing
• Impaired speech discrimination
• Excessive cerumen accumulation
• Loss of high frequency tones
• Risky behaviors

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Risk Factors for Falls

• Medications
• Some antidepressants
• Sedatives
• Some antihypertensive and cardiac medications
• Hypoglycemic drugs
• Alcohol

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Preventing Falls

• Exercise
• Physical Therapy assessment
• Review all medications by the health care
  provider
• Vision exam
• Podiatrist exam

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Preventing Falls in the Home

• Remove throw rugs
• Secure carpet edges
• Reduce clutter
• Remove cords and wires on the floor
• Avoid floor wax
• Push in the drawers

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Preventing Falls in the Home

• Check lighting for adequate illumination at night
  and on the stairs
• Install handrails on both sides of the stairwell
• Eliminate chairs that are too low to sit in and
  get out of easily
• Keep often used items in cabinets that can be
  reached easily without using a step stool.
• Wear well-fitting shoes and slippers with
  non-skid bottoms.

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Preventing Falls in the Bathroom

• Install grab bars in the shower and by the toilet
• Use rubber mats in the bathtub and shower
• Install a raised toilet seat
• Keep drawers closed

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Preventing Falls Outside the Home

• Repair cracked sidewalks
• Install handrails on stairs and steps
• Trim shrubbery along the pathway to the home
• Install adequate lighting by doorways and along
  walkways leading to doors.

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Preventing FallsFrom the Medical Standpoint

• Test for balance Get Up and Go Test
• Refer to PT for gait assessment
• Postural hypotension
• Taking 3 or 4 prescription medications
• Treat osteoporosis

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What Happens After the Hip Fracture?

• One in four people that have a hip fracture that
  lived independently before the fracture had to
  live in a nursing home for a year afterward,
  according to the CDC
• Some never recover their balance and strength
• This can lead to depression and dementia and a
  downhill spiral.
• Unfortunately 1/4 of the elderly people who
  fracture their hips die within 6 months of the
  injury

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So What TO Do?

• Do safety checks of the home inside and out
• Test for gait and balance
• Encourage exercise and movement
• Check the medications
• Dress right
• Get your feet checked and cared for
• If you drink, do so moderately