Prevention of Falls in the Prevention of Falls in the Geriatric Patient Geriatric Patient

& & the TUG testthe TUG test

Julie SmithJulie Smith

PA Class of 2009PA Class of 2009

Advisor: Professor FahringerAdvisor: Professor Fahringer

The FactsThe Facts Falls can occur and any age, but drastically rise Falls can occur and any age, but drastically rise

after the age of 65after the age of 65

1/3 of adults over 65 years of age fall each year 1/3 of adults over 65 years of age fall each year in developed countriesin developed countries

Falls are the leading cause of fatal and nonfatal Falls are the leading cause of fatal and nonfatal injuries in people 65 and older in the United injuries in people 65 and older in the United States.States.

The most common serious injuries are head The most common serious injuries are head injuries, wrist fractures, spine fractures, and hip injuries, wrist fractures, spine fractures, and hip fractures.fractures.

60% of falls occur at home, 30% occur in the 60% of falls occur at home, 30% occur in the community and 10% occur in nursing homes or community and 10% occur in nursing homes or other institutions. other institutions.

More FactsMore Facts Tripping in the home is a cause of many fallsTripping in the home is a cause of many falls

Falls account for 80% of all injury related Falls account for 80% of all injury related admissions to the hospital of people over 65 admissions to the hospital of people over 65 years of age worldwide years of age worldwide

Fractures accounted for only 35% of non-fatal Fractures accounted for only 35% of non-fatal injuries but 61% of the total costs related to injuries but 61% of the total costs related to fallsfalls

Lower extremity injuries > Upper extremity injuries Lower extremity injuries > Upper extremity injuries

Hip Fracture StatisticsHip Fracture Statistics 90% of 352,000 hip fractures in the United States each year 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 are the result of a fall. By the year 2050, there will be an estimated 650,000 hip fractures annually. This is nearly estimated 650,000 hip fractures annually. This is nearly 1,800 hip fractures a day. 1,800 hip fractures a day.

The cost of hip fracture care averages $35,000 per The cost of hip fracture care averages $35,000 per patient. patient.

Women have two to three times as many hip fractures as Women have two to three times as many hip fractures as men. men.

White, post-menopausal women have a 1 in 7 chance of hip White, post-menopausal women have a 1 in 7 chance of hip fracture during a lifetime. The rate of hip fracture increases fracture during a lifetime. The rate of hip fracture increases at age 50, doubling every five to six years. at age 50, doubling every five to six years.

More Hip Fracture StatisticsMore Hip Fracture Statistics

The risk of hip fracture for women 5'8 The risk of hip fracture for women 5'8 " or taller is twice that of women who " or taller is twice that of women who are under 5'2. " are under 5'2. "

Nearly one half of women who reach Nearly one half of women who reach age 90 have suffered a hip fracture. age 90 have suffered a hip fracture.

The Really Scary StatisticsThe Really Scary Statistics

* ONLY 25% of hip fracture patients will * ONLY 25% of hip fracture patients will make a full recoverymake a full recovery

* 40% will require nursing home care* 40% will require nursing home care

* 50% will need a cane or walker* 50% will need a cane or walker

And ….And ….

* 24% of those over age 50 will die * 24% of those over age 50 will die within 12 months. within 12 months.

Who is Falling?Who is Falling?

Women fall 2-3 times more than menWomen fall 2-3 times more than men

Women’s healthcare costs associated Women’s healthcare costs associated with falls were 2-3 times higher than with falls were 2-3 times higher than men’s costs overallmen’s costs overall

15% of people who have fallen, fall 15% of people who have fallen, fall againagain

Why do we Fall?Why do we Fall?

Home Hazards, throw rugsHome Hazards, throw rugs #1 Reason in the home to fall….. is#1 Reason in the home to fall….. is TrippingTripping or slipping due to loss of footing or slipping due to loss of footing

or traction or traction Medication side effects, iatrogenicMedication side effects, iatrogenic Reduced muscle strength Reduced muscle strength Poor vision/Ear dysfunctions/Vertigo Poor vision/Ear dysfunctions/Vertigo Balance problemsBalance problems Osteoporosis? Fracture then fall?Osteoporosis? Fracture then fall?

Geriatric robberyGeriatric robbery

Loss of quality of lifeLoss of quality of life Loss of independenceLoss of independence Premature entrance to a nursing Premature entrance to a nursing

homehome Premature deathPremature death Extremely expensive>many can lose Extremely expensive>many can lose

house, savings, drivers license, etc…house, savings, drivers license, etc…

Risk FactorsRisk Factors Age and GenderAge and Gender HeredityHeredity> DEXA Scan to r/o osteopenia > DEXA Scan to r/o osteopenia

and osteoporosisand osteoporosis Women Women > Men> Men Home hazardsHome hazards MedicationMedication, regularly review necessary , regularly review necessary

and unnecessary medsand unnecessary meds HistoryHistory of Falls of Falls Peripheral NeuropathyPeripheral Neuropathy Ear/EyeEar/Eye dysfunctions dysfunctions

What can we do in the office?What can we do in the office?

• AskAsk about fall hx, screen in about fall hx, screen in patient hx formspatient hx forms

• ReviewReview Medication list Medication list

• AssessAssess fall risk fall risk

• Refer Refer to Physical Therapyto Physical Therapy

Assessing Fall RiskAssessing Fall Risk

Can we assess Fall risk?Can we assess Fall risk?

Is it accurate? Is it functional?Is it accurate? Is it functional?

Tinnetti TestTinnetti Test Berg Test -balance Berg Test -balance Timed Up & GoTimed Up & Go

The Timed Up and Go TestThe Timed Up and Go Test aka “ TUG“ Test aka “ TUG“ Test

Quick & Easy for provider & patientQuick & Easy for provider & patient

Need : Need : a chair with armsa chair with arms a person, and a person, and 10 feet measured out10 feet measured out

-consider hallway-consider hallwayHow to do it: How to do it:

Patient sits in a chair with arms, you ask them to rise from the chair, walk 10 feet, 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.turn around, walk back to the chair and sit back down.Patient is allowed to use a walking aid and glasses if normally used.Patient is allowed to use a walking aid and glasses if normally used.

Video: Video: www.youwww.youtube.comtube.com

http://www.homehealthquality.org/hh/hha/interventionpackages/falls_prevention.aspx http://www.homehealthquality.org/hh/hha/interventionpackages/falls_prevention.aspx

Goal: Less than 12 seconds = independentGoal: Less than 12 seconds = independent

>12 seconds to complete= Risk for Falls>12 seconds to complete= Risk for Falls

TUG with an obstacleTUG with an obstacle

Additional TestAdditional Test

Single Leg StanceSingle Leg Stance

• 30 seconds is a general goal30 seconds is a general goal

• Try eyes open and closedTry eyes open and closed

• Everyone should try this!!Everyone should try this!!

Fall Prevention TipsFall Prevention Tips1. Take a 1. Take a Fall HistoryFall History

2. 2. Medication reviewMedication review: : • benzodiazepinesbenzodiazepines• sleeping aidssleeping aids• neurolepticsneuroleptics• antidepressantsantidepressants• seizure medsseizure meds

3. 3. TUG TESTTUG TEST – shoot for <12 sec – shoot for <12 sec If >12 sec, walking aid, PT, If >12 sec, walking aid, PT,

patient educationpatient education

4. 4. Visual acuity Visual acuity <20/60 puts at <20/60 puts at risk for depth perception risk for depth perception deficits. Refer if neededdeficits. Refer if neededEar checksEar checks- ear infections, - ear infections, vertigo symptomsvertigo symptoms

5. 5. Bone densityBone density: Family hx, : Family hx, Dexa scans and Treat:Dexa scans and Treat:Calcium, Vit D, FosamaxCalcium, Vit D, Fosamax

6. 6. Home hazard safetyHome hazard safety - - communication with patient and communication with patient and family to eliminate hazardsfamily to eliminate hazards

7.7.Gait dysfunctionsGait dysfunctions: Abnormal : Abnormal gait, improper use of walking aids gait, improper use of walking aids lead to falls, Refer to PTlead to falls, Refer to PT

88.. MusculoskeletalMusculoskeletal

abnormalities/weaknessabnormalities/weakness,, Refer to PT for strengtheningRefer to PT for strengthening

9. 9. Impaired neurological Impaired neurological examexam, , DM patients with DM patients with peripheral neuropathies,peripheral neuropathies,

- Refer for EMG, PT- Refer for EMG, PT

10. 10. Medic AlertsMedic Alerts especially for especially for those living alonethose living alone

Patient EducationPatient Education Eliminate or secure all throw rugs Eliminate or secure all throw rugs

with non-slip padswith non-slip pads

Assess lighting, and have Assess lighting, and have nightlights for evening bathroom nightlights for evening bathroom tripstrips

Install hand rails in bathrooms Install hand rails in bathrooms and stairwaysand stairways

Remove clutter on floors and Remove clutter on floors and stairways, cords especiallystairways, cords especially

Always wear shoes or slippers Always wear shoes or slippers with rubber soleswith rubber soles

Non-skid surface in bathtubs and Non-skid surface in bathtubs and showersshowers

Evaluate thresholds for potential Evaluate thresholds for potential tripping dangerstripping dangers

Shower chairs and bedside Shower chairs and bedside commodes are helpfulcommodes are helpful

Easy access to contact and Easy access to contact and emergency numbersemergency numbers

Slow changes in positions from Slow changes in positions from lying to sitting to standinglying to sitting to standing

Sit in chairs with armsSit in chairs with arms

No high heels ladies!No high heels ladies!

Proper use of walking aids include Proper use of walking aids include actually using themactually using them

Ear infections and eye problems Ear infections and eye problems can lead to fallscan lead to falls

Report any side effects from Report any side effects from medications involving dizzinesmedications involving dizzines

Stay active and practice a good Stay active and practice a good nutritional dietnutritional diet

Take medicine as instructed Take medicine as instructed

The Bottom LineThe Bottom Line IT’S A BAD THING!!IT’S A BAD THING!!

BUT, YOU CAN MAKE BUT, YOU CAN MAKE A DIFFERENCEA DIFFERENCE

GIVE OUR ELDERS A GIVE OUR ELDERS A CHANCE TO TAKE CHANCE TO TAKE THE RIGHT STEPSTHE RIGHT STEPS

ReferencesReferences 1. Demura S, Uchiyama M. Proper assessment of the falling risk in the elderly by a physical mobility 2. Elley CR, Robertson MC, Kerse 1. Demura S, Uchiyama M. Proper assessment of the falling risk in the elderly by a physical mobility 2. Elley CR, Robertson MC, Kerse

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http://orthoinfo.aaos.org/topic.cfm?topic=A00121http://orthoinfo.aaos.org/topic.cfm?topic=A00121 VIDEO http://www.youtube.com/watch?v=xx1XCpglOcVIDEO http://www.youtube.com/watch?v=xx1XCpglOc