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Prevention of Falls in the Geriatric Patient & the TUG test Julie Smith PA Class of 2009 Advisor: Professor Fahringer
The Facts n Falls can occur and any age, but drastically rise after the age of 65 n 1/3 of adults over 65 years of age fall each year in developed countries n n n Falls are the leading cause of fatal and nonfatal injuries in people 65 and older in the United States. The most common serious injuries are head injuries, wrist fractures, spine fractures, and hip fractures. 60% of falls occur at home, 30% occur in the community and 10% occur in nursing homes or other institutions.
More Facts n n Tripping in the home is a cause of many falls Falls account for 80% of all injury related admissions to the hospital of people over 65 years of age worldwide Fractures accounted for only 35% of non-fatal injuries but 61% of the total costs related to falls Lower extremity injuries > Upper extremity injuries
Hip Fracture Statistics n 90% of 352, 000 hip fractures in the United States each year are the result of a fall. By the year 2050, there will be an estimated 650, 000 hip fractures annually. This is nearly 1, 800 hip fractures a day. The cost of hip fracture care averages $35, 000 per patient. n n n Women have two to three times as many hip fractures as men. White, post-menopausal women have a 1 in 7 chance of hip fracture during a lifetime. The rate of hip fracture increases at age 50, doubling every five to six years.
More Hip Fracture Statistics n n The risk of hip fracture for women 5'8 " or taller is twice that of women who are under 5'2. " Nearly one half of women who reach age 90 have suffered a hip fracture.
The Really Scary Statistics * ONLY 25% of hip fracture patients will make a full recovery * 40% will require nursing home care * 50% will need a cane or walker And …. * 24% of those over age 50 will die within 12 months.
Who is Falling? n n n Women fall 2 -3 times more than men Women’s healthcare costs associated with falls were 2 -3 times higher than men’s costs overall 15% of people who have fallen, fall again
Why do we Fall? Home Hazards, throw rugs n #1 Reason in the home to fall…. . is Tripping or slipping due to loss of footing or traction n Medication side effects, iatrogenic n Reduced muscle strength n Poor vision/Ear dysfunctions/Vertigo n Balance problems n Osteoporosis? Fracture then fall? n
Geriatric robbery n n n Loss of quality of life Loss of independence Premature entrance to a nursing home Premature death Extremely expensive>many can lose house, savings, drivers license, etc…
Risk Factors n n n n Age and Gender Heredity> DEXA Scan to r/o osteopenia and osteoporosis Women > Men Home hazards Medication, regularly review necessary and unnecessary meds History of Falls Peripheral Neuropathy Ear/Eye dysfunctions
What can we do in the office? • Ask about fall hx, screen in patient hx forms • Review Medication list • Assess fall risk • Refer to Physical Therapy
Assessing Fall Risk n Can we assess Fall risk? n Is it accurate? Is it functional? n n n Tinnetti Test Berg Test -balance Timed Up & Go
The Timed Up and Go Test aka “ TUG“ Test n Quick & Easy for provider & patient Need : How to do it: a chair with arms a person, and 10 feet measured out -consider hallway Patient sits in a chair with arms, you ask them to rise from the chair, walk 10 feet, turn around, walk back to the chair and sit back down. Patient is allowed to use a walking aid and glasses if normally used. Video: www. youtube. com http: //www. homehealthquality. org/hh/hha/interventionpackages/falls_prevention. aspx n Goal: Less than 12 seconds = independent n >12 seconds to complete= Risk for Falls n TUG with an obstacle
Additional Test n Single Leg Stance • 30 seconds is a general goal • Try eyes open and closed • Everyone should try this!!
Fall Prevention Tips 1. Take a Fall History n communication with patient and family to eliminate hazards 2. Medication review: • • • benzodiazepines sleeping aids neuroleptics antidepressants seizure meds 3. TUG TEST – shoot for <12 sec If >12 sec, walking aid, PT, patient education 4. Visual acuity <20/60 puts at risk for depth perception deficits. Refer if needed Ear checks- ear infections, vertigo symptoms 5. Bone density: Family hx, Dexa scans and Treat: Calcium, Vit D, Fosamax 6. Home hazard safety - n 7. Gait dysfunctions: Abnormal gait, improper use of walking aids lead to falls, Refer to PT n 8. Musculoskeletal abnormalities/weakness, Refer to PT for strengthening n 9. Impaired neurological exam, DM patients with peripheral neuropathies, - Refer for EMG, PT n 10. Medic Alerts especially for those living alone
Patient Education n Eliminate or secure all throw rugs with non-slip pads Assess lighting, and have nightlights for evening bathroom trips Install hand rails in bathrooms and stairways n Easy access to contact and emergency numbers n Slow changes in positions from lying to sitting to standing n Sit in chairs with arms n No high heels ladies! n Remove clutter on floors and stairways, cords especially n Proper use of walking aids include actually using them n Always wear shoes or slippers with rubber soles n Ear infections and eye problems can lead to falls n Non-skid surface in bathtubs and showers n Report any side effects from medications involving dizzines n Evaluate thresholds for potential tripping dangers n Stay active and practice a good nutritional diet n Shower chairs and bedside commodes are helpful n Take medicine as instructed
The Bottom Line n n n IT’S A BAD THING!! BUT, YOU CAN MAKE A DIFFERENCE GIVE OUR ELDERS A CHANCE TO TAKE THE RIGHT STEPS
References n n n n n 1. Demura S, Uchiyama M. Proper assessment of the falling risk in the elderly by a physical mobility 2. Elley CR, Robertson MC, Kerse NM, Garrett S, Mc. Kinlay E, Lawton B, et al. Falls assessment clinical trial (FACT): design, interventions, recruitment strategies, and participant characteristics. BMC Public Health 2007, 7: 185. available from: http: //www. biomedcentral. com/1471 -2458 -7 -185. 3. Fatalities and injuries from falls among older adults---United States, 1993 -2003 and 2001 -2005. MMWR Weekly Report Nov. 17, 206/55(45); 1221 -1224. 4. Healey F, Monro A, Cockram A, Adams V, Heseltine D. Using targeted risk factor reduction to prevent falls in older in- patients: a randomized controlled trial. Age and Ageing 2004; 33: 390 -395. 5. Kannus P, Khan KM, Lord SR. Preventing falls among elderly people in the hospital environment. MJA 2006; 184 (8): 371 -373. 6. Laessoe U, Hoeck GC, Simonsen O, Sinkjaer T, Voigt M. Fall risk in an active elderly population-Can it be assessed? Journal of Negative Results in Bio. Med 2007, 6: 2. 7. Lord SR, Menz HB, Sherrington C. Home environment risk factors for falls in older people and the efficacy of home modifications. Age and Ageing 2006; 35 -S 2 ii 55 -ii 59. 8. Mansfield A, Peters A, LLiu B, Maki B. A perturbation-based balance training program for older adults: study protocol for a randomized controlled trial. BMC Geriatrics 2007, 7: 12. available from : http: /www. biomedcentral. com/1471 -2318/7/12. 9. Melzer I, Benjuya N, Kaplanski J. Postural stability in the elderly: a comparison between fallers and non-fallers. Age and Ageing 2004; 33; 602 -607. 10. Nordvall H, Gunhild Glanberg-Persson, Lysholm J. Are distal radius fractures due to fragility or falls? Acta Orthopaedica 2007; 78: (2): 271 -277. 11. Ozcan A, Donat H, Gelecedk N, Ozdirenc M, Karadibak D. The relationship between risk factors for falling and the quality of life in older adults. BMC Public Health 2005, 5: 90. available from: http: //www. biomedcentral. com/1471 -2458//5/90 12. Peeters GE, de. Vries OJ, Elders PJ, Pluijm SM, Bouter LM, Lips P. Prevention of fall incidents in patients with a high risk of falling: design of a randomized controlled trial with an economic evaluation of the effect of multidisciplinary transmural care. BMC Ger. 2007, 7: 15. available from : http: //www. biomedcentral. com/1471 -2318/7/15. Shinichi Demura and Masanobu Uchiyama “Proper Assessment of the Falling Risk in the Elderly by a Physical Mobility Test with an Obstacle”. Tohoku J. Exp. Med. , Vol. 212, 13 -20 (2007). Obstacle”. Tohoku Med. , Vol. 212, 13 -20 (2007). 13. Stenvall M, Olofsson B, Lundstrom M, Englund U, Borssen B, Svensson O, et al. A multidisciplinary, multifactorial intervention program reduceds postoperative falls and injuries after femoral neck fracture. Osteoprorosis Int. 2007, 18: 167 -175. 14. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj. Prev. 2006; 12; 290 -295. 15. van Schoor NM, Smit JH, Twisk JR, Bouter LM, Lips P. Prevention of Hip fractures by external hip protectors. JAMA, April 16, 2003 -vol 289, No. 15, p 1957 -1962. 16. Vassallo M, Sharma JC, Briggs RSJ, Allen SC. Characteristics of early fallers on elderly patient rehabilitation wards. Age and Ageing 2003; 32: 338 -342. http: //orthoinfo. aaos. org/topic. cfm? topic =A 00121 http: //orthoinfo. aaos. org/topic. cfm? topic VIDEO http: //www. youtube. com/watch? v=xx 1 XCpgl. Oc