Falls Among the Elderly

Lovely Abankwa, Ngwe Njiwah, Nathan Roth, Stephanie Swanson, and Nathan Todd

An elderly American is admitted to an emergency room every 18 seconds for fall-related injuries

An elderly American dies every 35 minutes due to fall-related injuries

Healthy People 2010 aimed to reduce fatality rates associated with falling among those over the age of 65 to 2003 levels

Unfortunately, these rates have only increased

What is the problem?

In 2010, fatal injuries from falling were the #1 cause of injury death for Americans over the age of 65

Fall injuries are the #1 cause of nonfatal injury-related hospital admissions for persons older than 65

82 percent of fall-related deaths are of individuals 65 and older

The extent of the problem

In 2005, 76 fall events were recorded per 1,000 persons aged 65 and older

Only 36 fall events were recorder per 1,000 persons under the age of 65

1/3 of persons 65 and older will experience a fall in a given year

Of persons 65 and older living in senior community centers, 30-40 percent will experience a fall

Specifics

In 2007, the total number of deaths attributed to unintentional falls was 692

375 among males and 317 among females

Total hospitalizations for fall-related injuries were 17,105

6,248 among males and 10,857 among females

Falls in Illinois

Hospitalizations for hip fractures incurred as a result of a fall for persons over the age of 65 were 10,099

2,694 among males and 7,405 among females

Falls and the Elderly in Illinois

Treatment of fatal and nonfatal falls in 2000 was $19 billion

The average cost for a fall-related hospitalization is $17,500

Approximately 15 percent of all rehospitalizations within the first month of discharge are related to falls

Economic Costs of Falls Among the Elderly

Increased healthcare costs, incidences of falling, and inflation will only create more stress on the healthcare system and overall economy

Fatal and nonfatal falls have increased dramatically among American seniors since 2000

By 2020, costs due to fall-related injuries are projected to reach $54.9 billion

Economic Costs Continued

Hawaii – Fall prevention and early detection coordinator

Maryland – Last week in September is Fall Prevention Awareness Week

Minnesota – risk management plans for adult foster homes

Illinois – long-term care hospitals must report data on elderly falls to the Department of Healthcare and Family Services

Recent Legislation

Age: the older an individual is, the greater the likelihood of experiencing a fall

Most falls occur in or around the home, and are the result of slipping, tripping, or stumbling

Risk Factors for Falls Among the Elderly

Chronic health conditions such as heart disease, diabetes, obesity, arthritis, and osteoporosis

Psychological conditions: agitation, anxiety, depression, cognitive impairment, impulsivity, short-term memory loss

Risk Factors

Physical conditions: diabetes, Alzheimer’s, a history of falling, fatigue, gait problems, impaired muscle strength, impaired physical functioning, visual impairment, Vitamin D deficiency, and stroke

Pharmaceuticals: anticoagulants, antiepileptics, chemotherapeutics, laxatives, psychotropics, sedatives, and hypnotics

Risk Factors

Physical activity, especially that which incorporates strength, balance, and gait training

Use of canes and walkers

Home safety: better lighting, grab rails, handrails, and safer shoes

Regulation of pharmaceuticals

Chronic disease control

Fall prevention education

Evidence-based Prevention

Survey Results

Survey Results

20 Questions Ages 72-94 13 Females/7 Males

Survey Questions/Responses Do you live by yourself, with family, caregiver, or group living facility?

- 2 participants responded living by themselves

- 9 participants responded with Family

- 2 participants responded with Caregiver

- 7 participants responded with Facility

How many times have you fallen in the last six months?

- 5 participants responded Never

- 7 participants responded Once

- 4 participants responded Twice

- 4 participants responded Four and more

Survey Questions/Responses How did you fall?

- 6 participants responded Loss of balance

- 7 participants responded Slip

- 1 participant responded Muscle weakness

- 1 participant responded Dizziness/fainting

What type of injury resulted from your fall?

- 4 participants responded Bruises

- 3 participants responded Fracture

- 5 participants responded Other

Survey Questions/Responses Who did you report to when you fell?

- 1 participant responded Caregiver

- 8 participants responded Family

- 1 participant responded Doctor

- 1 participant responded Nurse

Have you installed safety bars in your bathroom?

- 12 participants responded Yes

- 8 participants responded No

Survey Questions/Responses

Do you think that public areas have adequate railing or wide enough space?

- 4 participants responded Very much

- 5 participants responded Mostly

- 4 participants responded Somewhat

- 3 participants responded Not at all

Do you currently own any life alert/monitoring device at home?

- 6 participants responded Yes

- 14 participants responded No

BALANCE AND FLEXIBILITY IN THE ELDERLY

BALANCE

One can reduce risk of falls with an exercise program that includes balance training, resistance exercises, walking, and also weight transfer.

BALANCE: HOW IT WORKS Our bodies can do this by way of three

systems.

Visual cues Internal spatial orientation The inner ear

Here are some things that may be involved with balance problems; Your vision may decrease which can lead to falls due to

not seeing clearly. Your hips and legs can become weaker making it

harder to walk. We can develop poor posture or have spinal

degeneration making it harder to stand erect. Our ability to lift our feet decreases and we can

stumble.

BALANCE

FLEXIBILITY TRAINING Little research exists to allow for the design

of programs to improve flexibility  in older adults. The American College of Sports and Medicine recommends exercises that improve joint range i.e. walking, aerobics, a stretching program.

FLEXIBILITY Stretching is an important part of elderly

and seniors flexibility. It is known to help offset the effects of normal decline in the flexibility of your joints, and help you remain active and independent.

FLEXIBILITY

Benefits to stretching;

Stretching can greatly help back pain. Stretching can improve your posture. Stretching is beneficial for arthritis.

5 Flexibility movements

Ankle stretch Chest stretch Neck stretch Shoulder stretch Upper body stretch

FLEXIBILITY

FLEXIBILITY

General flexibility guidelines;

Warm up before stretching Don't bounce during stretching Don't hold your breath during a stretch Stretching should not cause pain, be gentle Don't combine turning and bending back

exercises at the same time.

FLEXIBILITY Generally elderly and seniors stretching

should be done 2 to 3 days per week, performing each stretch 3 to 5 times with a 20 to 30 second hold.

For increased flexibility, stretches should be performed 4 to 5 days per week.

Activity Break

Weight Training for

65+

“Exercises have been shown to increase the strength of your muscles, maintain the integrity of your bones, and improve your balance, coordination, and mobility” (CDC)

Benefits of weight training outweigh risks of…

1. Injury2. Sudden heart attack

Check with your doctor if you…

1. Have a chronic disease2. Have arthritis3. Have diabetes4. Have high blood

pressure

Fall reduction with weight training

1. Maintain bone strength2. Balance3. Coordination4. Mobility5. Flexibility

Quick Question

What percent of bone mass could you lose in 25 years?

50 percent!!!This means from age 50-75

The average woman loses 1-2 percent bone mass annually

Results of studies

Tufts University concluded strength training increases bone density and decreases risk of falling.

12 month study done at Tufts University showed..

1. 1% increase in bone density in hip and spine

2. 75% increase in strength3. 13% increase in balance*Only 2 times per week*Control group had losses in each category

Bone Density

What is Bone Density/Osteoporosis Bone Density- A quantitative

measurement of the mineral content of bone, used as an indicator of the structural strength of the bone and as a screen for osteoporosis.

Osteoporosis- A serious condition that can result in tremendous pain with fractures. Also known as thinning of the bones.

Ways to Build Strong Bones Eating healthy foods Taking medications to build strong bones or

to help with osteoporosis Physical activity (yoga)

Healthy Foods for Strong Bones

Vitamin D

Tuna fish Salmon Orange juice fortified

with vitamin D Milk, nonfat, reduced fat

and whole Liver, beef Cheese, Swiss Egg Cod liver oil Swordfish

Calcium

Collard greens Spinach Soy beans Almonds White beans Whole-grain tortillas Mozzarella Ricotta Fruit Frozen yogurt Fat free milk

Calcium and Vitamin D By Age

Age Recommended calcium intake (milligrams a day)

Recommended vitamin D intake (international units a day)

1–3 years 700 600

4–8 years 1,000 600

9–18 years 1,300 600

19–50 years 1,000 600

Males 51–70 years 1,000 600

Females 51–70 years 1,200 600

71 and older 1,200 800

Activity Break!!!

Collard greens Spinach Soy beans Almonds White beans Whole-grain tortillas Mozzarella Ricotta Liver, beef Cheese, Swiss Egg Cod liver oil

Tuna fish Salmon Orange juice fortified with

vitamin D Fruit Frozen yogurt Fat free milk Milk, nonfat, reduced fat

and whole Swordfish

Healthy Foods for Strong Bones

Medications Forteo Evista (raloxifene) Fosamax

(bisphosphonates) Zometa

Bone Density Test A bone mineral density (BMD)

test measures how much calcium and other types of minerals are in an area of your bone

This test is also known as a dual-energy x-ray absorptiometry (DEXA) scan

The purpose is to: Diagnose bone loss and

osteoporosis See how well osteoporosis

medicine is working Predict your risk of future bone

fractures There are two different types of a

BMD/DEXA tests: Central DEXA and the Peripheral DEXA (p-DEXA)

Bone Density Test Cont…

Central DEXA

You lay on a soft table, and the scanner passes over your lower spine and hip. Usually, you do not need to undress. This scan is the best test to predict your risk of fractures.

Peripheral DEXA

These smaller machines measure the bone density in your wrist, fingers, leg, or heel. You may find these machines in doctor's offices, pharmacies, shopping centers, and health fairs

5 Healthy Living Steps Step 1:Meet with your physician to assess

your risk for osteoporosis. Step 2:Eat sufficient calcium in your diet. Step 3:Eat sufficient amounts of vitamin

D in your diet. Step 4:

Exercise, using weight-bearing exercises.

Step 5:Avoid smoking, heavy drinking

and a sedentary lifestyle.

Activity Break!!!