FALLS IN THE ELDERLY:

WHO? WHY? WHAT HAPPENS NEXT?

Rhonda Bugbee, RN, CEN

Trauma Consultant

HELP! I’VE FALLEN AND I CAN’T GET UP!

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 >65 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

LEADING CAUSES OF DEATH

Age Group First Leading Cause of Trauma Death

Second Leading Cause of Trauma Death

35 – 64 Motor Vehicle36.8%

Falls29.6%

65+ Falls43.3%

Motor Vehicle10.2%

DEATH BY INJURY SEVERITY SCORES

Age Group

1 – 8 9 -15 16 -24 >24

35 - 64 0.66% 1.4% 4.5% 28%

65+ 2.2% 4.3% 11.8% 43%

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.

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.

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

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) Alzheimer’s or dementia Arthritis Parkinson’s disease Foot problems

Toenail length, callouses, bunions, deformities

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

RISK FACTORS FOR FALLS

Medications Some antidepressants Sedatives Some antihypertensive and cardiac medications Hypoglycemic drugs

Alcohol

PREVENTING FALLS

Exercise Physical Therapy assessment Review all medications by the health care

provider Vision exam Podiatrist exam

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

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.

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

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.

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

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

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