What causes a fall? - NARI National Ageing Research Institute · Balance . Visual Impairment...
Transcript of What causes a fall? - NARI National Ageing Research Institute · Balance . Visual Impairment...
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What causes a
fall?
Medical, physical, cognitive and
environmental considerations
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True
False
Falls are an inevitable part of ageing.
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True
False
Falls are an inevitable part of ageing.
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True
False
The elderly fall more than any
other age group?
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True
False
The elderly fall more than any
other age group?
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Older people speaking about falling over
LISTEN CAREFULLY
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Fever
Myalgia
Arthralgia
Headache
Sore throat
Influenza Medical
syndrome
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Falls
syndrome
Medications
Poor vision
Arthritis
Dementia
Fear of falling
Geriatric
syndrome
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What causes a fall?
vs
How to prevent future falls?
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Intrinsic factors
Extrinsic factors
Behavioural factors
All of the above
Most falls in the elderly are due to
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Intrinsic factors
Extrinsic factors
Behavioural factors
All of the above
Most falls in the elderly are due to
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Falls risk factors
Modifiable vs
non-modifiable
Stable vs
changing
Intrinsic vs
extrinsic
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Falls risk factors
e.g. Age
e.g. Environment
e.g. Medications
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History of Falls
• More than one fall in the last 12 months
• A fall with an injury in the previous year
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Which medication is most
likely to cause a fall?
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Medication (as a falls risk factor)
• use of > 4 medications ***
• psychoactive medication ***
• benzodiazepines ***
• antidepressants ***
• anti-psychotics ***
• anti-arhythymics *
• antihypertensive *
• anti-inflammatory -
• analgesics - Lord et al, 2007
*** strong evidence
** moderate evidence
* weak evidence
- no evidence
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Medical Conditions • impaired cognition ***
• stroke ***
• Parkinson’s disease ***
• multiple chronic illnesses ***
• depression **
• neurological signs **
• incontinence **
• acute illness **
• arthritis **
• foot problems **
• dizziness *
• orthostatic hypotension *
• vestibular disorders -
Lord et al, 2007
*** strong
evidence
** moderate
evidence
* weak evidence
- no evidence
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Falls in Clinical Groups
Lord et al., 1993; Forster & Young, 1995; Hill, 1998; Hill & Stinson, 2004
???
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Vitamin D Deficiency
• Vitamin D important for bone mineralisation,
and general muscle and bone health
Older adults at risk of deficiency -
• Exposed to less sunshine
• Reduced ability to synthesise vitamin D
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Central integration
SENSORY MOTOR
vision
vestibular
somato-sensory
coordination
strength
range of motion
reaction time
Balance
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Visual Impairment
Source: Vision 2020
www.vision2020australia.org.au
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Vision (as a falls risk factor)
• People with a vision impairment have:
– twice as many falls
– three times the risk of depression and
– the risk of hip fractures increases eight fold.
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Macular Degeneration
Source: Vision 2020
www.vision2020australia.org.au
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Cataract
Source: Vision 2020
www.vision2020australia.org.au
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Diabetic Eye Disease
Source: Vision 2020
www.vision2020australia.org.au
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Glaucoma
Source: Vision 2020
www.vision2020australia.org.au
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Vestibular dysfunction
• Common cause of
dizziness
• Difficult to
diagnose
• Vestibular
rehabilitation can
be used to treat
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The Lower Limb
Age related changes
Muscle weakness
Decreased joint
range of motion
Somatosensory
changes
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Foot Problems
• Painful feet including painful corns, arthritis
• bunions
• gout
• swollen ankles / feet
• toe deformities (hammer, mallet and claw
toes)
• fallen arches
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Footwear
• Desirable characteristics:
– Shoes with fastening mechanism (laces /
velcro etc)
– Shoes with thin, hard soles
– High shoe collar (boots)
– Slip resistant soles and good tread on
soles
– Low or no heels
– Posterior (back) bevel on heel
Shoes that are too small can result
in foot pain and deformity
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Cognition
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Epidemiology of Falls in Dementia
60-90% of older people with dementia (twice the rate
of older people without cognitive impairment)
Approx. 3 times increased fracture risk
Fallers with dementia are 5 times more likely to be
institutionalized
Shaw, 2003; Shaw, et al., 2003; Van Dijk, et al., 1993; Tinnetti, et
al., 1988; Morris et al., 1987, Allen et al 2009
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Continence
• Risk factor for falls in 2 ways:
– Episode of incontinence and subsequent
potential for slipping
– Urge incontinence may cause a person to
hurry
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Continence (as a falls risk factor)
• Relationship between incontinence and
falls is likely to be confounded by mobility
and cognition
• Urinary frequency or need for frequent
assistance with toileting
• Desire to avoid an incontinent episode
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Nutrition
• Low Body Mass Index (BMI)
VS
• High Body Mass Index (BMI)
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Behavioural factors
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Physical Activity
Inactive
Falls Fear or injury or
functional decline
Inactive Moderately active Active
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Now add to that…
…The environment
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What is the environment?
…the physical, social and attitudinal environment in which people live and conduct their lives (WHO, 2001)
…comprises cultural,
physical, social and
institutional elements (CAOT, 1997)
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The environment and person
centred care
comfort safety
preferences
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True
False
Nothing can be done to stop
falls
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True
False
Nothing can be done to stop
falls
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Falls Prevention Tip:
Falls occur because of an
interaction of factors.