fall prevention in the home setting, hcs420, current issues in hcs
TRANSCRIPT
HOW BIG IS THE PROBLEM?
• One in three adults aged 65 and older fall each year.
• Of those who fall 20% out of 30% suffer moderate to severe injuries which makes it harder for them to get around, or live independently, and increase the risk of an earlier death.
• Older adults are hospitalized for fall related injuries five times more often than they are for injuries in other cases.
HOW ARE COSTS CALCULATED?
• Direct costs is what the patient and insurance companies pay for treating fall-related injuries. These costs include fees for hospital and nursing home care, doctors and other professional services, rehabilitation centers, community-based services, use of medical equipment, prescription medication, changes made to the home, and insurance processing.
• Direct costs do not account for the long-term care effects of these injuries, such as disability, dependence on others, lost time from work and household duties, and reduce quality of life.
HOW COSTLY ARE FALL-RELATED INJURIES AMONG OLDER ADULTS
• In 2012 , the total direct medical costs of fall injuries for people 65 and older was $30 billion.
• By 2020 the direct and indirect cost of fall injuries is expected to be $67.7 billion.
• Among older adults fall-related injuries is one of the 20 most expensive medical conditions.
• Among seniors treated for fall injuries, 65% of direct medical costs were for inpatient hospitalizations, 10% for medical office visits and home health care, 8% for hospital outpatient visits, 7% for emergency room visits, and 1% for prescription drugs and dental visits.
• About 78% were reimbursed by Medicare.
HOW DO THESE COSTS BREAK DOWN?
• The cost of fall injuries increase rapidly with age.
• Costs of both fatal and nonfatal falls are higher for women than in men.
• In 2000, medical costs for women who were 58%, of older adults, were two to three times higher than the cost for men.
TYPE OF INJURY AND TREATMENT SETTING
• In 2000, 78% of fall deaths and 79% of total costs were due to traumatic brain injuries and injuries to the lower extremities.
• Injuries to internal organs were responsible for 28% fall deaths and accounted for 29% of costs.
• On average, the hospitalization cost for a fall injury is $34,294. (2012)
DID YOU KNOW?
Falls are the most common cause of injury and the 6th leading cause of deaths for seniors.
Canadians spend about $3 billion a year on seniors' fall injuries.
Almost half of admissions in a long term care facility are fall-related.
Half of the people who have a hip fracture never regain their pre-fall level of functioning.
Falls usually happen because of the combined effects of a number of factors, such as a loss of balance, side effects of a curtain medicine, impaired mobility or vision, and environmental hazards.
DID YOU KNOW? CONTINUED
• Most falls occur in seniors; homes, while doing usual daily activities.
• 40% of falls that require hospitalization involve hip fractures.
• Woman are 3 times more likely than men to be hospitalized for a fall.
• Seniors may develop a "fear of falling," causing them to restrict their activities which can increase their risk of falling due to weak muscles, stiff joints and poor balance.
INDOOR RISKS
• Poorly lit stairs, ramps or doorways
• Stairs that are not uniform form top to bottom or those with narrow steps
• Stairs without handrails or marking on the edges of the steps
• Lack of, or incorrectly installed grab bars in bathrooms
• Slippery floors, throw rugs, loose carpets
• Walking surfaces cluttered with objects like cords, pets, or newspapers
• Toilet seats are too low or too high
• Poorly maintained or improper use of mobility aids and equipment
OUTDOOR RISKS
• Uneven or cracked sidewalks
• Stairs without handrails
• Stairs without clear edge markings on all steps
• Poor lighting; either not enough or too much glare
• Snow, ice, wet leaves on stairs or walkways
• Unmarked curb edges or corners without curb ramps
• Long crosswalks without pedestrian islands
• Objects on sidewalks such as bikes or garbage cans
• Controlled crosswalks with times too short for a safe walking place
RISKY BEHAVIORS
• Wearing loose fitting or worn out shoes, or shoes with thick soles
• Taking medication without a regular review for fall risk by a physician, or pharmacist
• Consuming alcohol to the point of impaired judgement and balance
• Trying to get objects that are out of reach rather than asking for assistance
• Carrying heavy, or awkward handbags that can affect balance
• Not using assistive devices such as walkers or canes when needed or using them incorrectly
SOCIAL AND ECONOMIC RISKS
• Living alone without a way to access help
• Lack of social networks that lead to isolation and depression
• Lack of knowledge or access on how to acquire needed health care services or health promotion information
• Poor eating habits, with low protein or low fluids
STAIRS AND STEPS
• Make sure you have light switches at the top and bottom of the stairs and that the stairs are well lit
• Make sure your stairs are in good repair and free of clutter and have a non-skid surface
• Make sure runner mats, carpeting or other floor covering on your stairs are well fastened or secure
• Make sure there are solid handrails or banisters on both side of the stairway
• Remove your reading glasses when going up and down the steps
• Never rush up and down the stairs, it is a major cause for a fall
KITCHEN
• Place frequently used items in an easy-to-reach location with heavy items closer to the floor
• If you have a good balance, use a stable step stool with a safety rail for reaching high places, otherwise ask for help. Do not stand on chairs or other unstable furniture
• Always wipe up any spills immediately to avoid slipping
• Avoid use of floor wax, or use a non slip kind
• Ask for help with tasks that you feel you can't do safely
OUTSIDE
• Keep front steps and walkways in good repair and free of snow, ice, and leaves
• Keep your front entrance well lit, consider motion-sensitive lighting
• Put away all gardening supplies such as hoses, rakes, etc. when not in use
LIVING ROOMS
• Remove all throw rugs or scatter mats or use a non slip backing with flat edges and make sure they are not in high traffic areas, or at the top or bottom of steps
• Watch that your pets are not under your feet, put a bell in their collar so you know where they are
• Make sure all walking areas are clear of clutter, telephone or electrical cords and other obstacles are out of the way
• Make sure all rooms, stairs, and balconies are well lit with non glare lighting
• Make sure you have a non slip surface on stairs, balconies, porches, patios, etc.
• Consider getting a personal alarm device that you wear around your neck or wrist to call immediate help by just pressing a button
BEDROOM
• A light switch near your bedroom entrance is ideal. If this is not available try a motion sensitive or clapper device that automatically turns on the light
• Make sure there is a clear path from your bed to the bathroom or the door
• Have a cordless phone near your bed
• Have a lamp beside your bed, there are lamps that you just touch the base to turn on
• Place night lights in the halls and bathroom in case you get up in the middle of the night
• Sit on the edge of your bed for a minute before getting up after from sleeping all night
BATHROOM
• Use a rubber bath or shower mat, or a non slip surface in your tub or shower
• Install a grab bar by the toilet, bathtub, and shower. Obtain the advise of an occupational or physical therapist on the correct type and placement of the devices
• Use a bath seat so you can take a shower or bath sitting down
• Keep an absorbent towel available to wipe up moisture or spills immediately.
ANSWERS:
• Maintain an active and healthy lifestyle through appropriate exercises, good nutrition, regular physical checkups, and eye and ear exams
• For those who are active outside of the home, exercises to promote balance, and strength are best for reducing falls
• Avoid carrying too much
• Wear footwear that provide good support, that have non slip treads and that are not too thick
• Be socially active, join a community group and get together with family or with friends.
REFERENCES
• www.cdc.gov/homeandrecreationalsafety/falls/fallcost.html
• Article called "Seniors' falls can be prevented." from BC INJURY research and prevention unit. Authors, Dr. Vicky Scott PhD and Fahra Rajabai, MSc