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Tuesday, 5 July 2011

Falls Prevention

v     A fall is an event which results in a person coming to rest inadvertently on the ground or other lower level
v     An injurious fall is one which is reported to the primary health care team. There may be falls which cause substantial injury and still go unreported, but understandably there is little known about the incidence of unreported injurious falls.
v     75-80% non injurious falls are never reported to health professionals
v     Aged 65 and over- 1 in 3 women fall each year
  1 in 5 men fall each year
v     Aged 85 and over- 1 in 2 men and women fall each year
v     40% of falls in over 65’s occur in the home
v     85% of falls in the over 85’s occur in the home
v     aged 65, the most common fall in the home might be in the garden, on stairs or in the kitchen
v     85 year olds, falls tend to occur in the bedroom or bathroom
v     Frequent fallers- more than 3 times in a year
v     There is a wrist # every 9 minutes and hip # every 10 minutes in the UK

The injuries that may occur after a fall are:
ü      Fractures (approximately 96% of fractures follow a fall)
ü      Dislocations
ü      Lacerations (Cuts)
ü      Sprains
ü      Deep bruises
ü      Joint pain-leading to asymmetry
v     Six months after hip surgery only 20% regain full pre –fracture mobility
v     Fear of falling and loss of confidence in balance capabilities predict:
ü      Deterioration in functional ability
ü      Falls
ü      Fractures
ü      Admission into institutional care
v     Long lie-A lie more than one hour is associated with an increased risk of dehydration, hypothermia, pneumonia, kidney failure and pressure sores
v     Risk factors: - Intrinsic risk factors, traits of an individual that increase their risk of falling; Extrinsic risk factors are social and physical factors that relate to the external environment.

Non modifiable risk factors for falls
v     Age                                              
v     Female
v     Dementia, cognitive impairment, Alzheimer’s disease
v     Number of medical conditions
v     Foot deformities/ Poor condition of feet
v     Recent discharge from hospital
v     Impaired hearing (Menieres Disease, Tinnitus)
v     Impaired vision (macular degeneration, acuity, contrast sensitivity, adaptations to the dark)
v     Stroke
v     Transient Ischemic attacks
v     Peripheral Neuropathy
v     Malignancy
v     Heart disease
v     Parkinson’s disease

Modifiable risk Factors for Falls

  • Low strength
  • Low power
  • Poor gait/ Leg Muscles weakness
  • Poor functional ability
  • Poor balance
  • Arthritis
  • Poor coordination and reactions
  • Postural hypotension
  • Cognitive impairment
  • Urinary urgency
  • Fear of falling/ Loss of confidence
  • Need for medication review
  • Poor nutritional status; Vitamin D and calcium deficiency
Other risk factors
  • Cognitive impairment (confusion, delirium, dementia), memory loss
  • Loss of confidence, fear of falling
  • Somatosensory loss; poor skin, cuts or bruises on feet, ulcers
  • Previous history of falls
  • Depression,
  • Environmental factors; loose carpets; bathtub without handles; poor lighting; unsafe stairways; ill fitting shoes
Role of Exercise

  • Improve older people stability during standing, transferring, walking and other functional movement
  • Balance training     
  • Strengthening the muscles around the hip, knee and ankle
  • Increase the flexibility of the trunk and lower limbs
  • Relearning skills of everyday living and maintenance of upright posture during balance challenge
  • Floor coping strategies, to get up from the floor or to prevent complications associated with staying on the floor for long time
Specificity of exercise
  • To improve health and modify certain risk factors for falling, moderate physical activity is appropriate
  • To reduce injurious falls, exercise should include training in balance, strength, co-ordination and reaction times
  • To reduce fracture, exercise should include bone loading in addition to the elements outlined for reducing falls
By Amit Gupta

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