Falls and older people Stepping into falls management

1. Falls and older people Stepping into falls management Working together to prevent falls • Developed by: Goulburn Valley Health • Format: Booklet and PowerPoint presentation • Availability: Download education booklet <PDF version> <Word version> • Download education presentation <PDF version> <Word version> • This staff education package (booklet and powerpoint presentation) was developed by Goulburn Valley Health for nursing and personal care staff in residential aged care facilities. It consists of a 4-hour module including training on: • the extent of the problem of falls • the definition of a fall • falls risks, and • strategies to address falls risks. • (Downloadable) • In 2009 the Department of Health funded Northern Health, in conjunction with National Ageing Research Institute, to review falls prevention resources for the Department of Health’s website. The materials used as the basis of this generic resource were developed by Goulburn Valley Health under a Service Agreement with the Department of Human Services, now the Department of Health. Other resources to maintain health and wellbeing of older people are available from www.health.vic.gov.au/agedcare

2. Working together to prevent falls Falls and older people Stepping into falls management

3. What is a fall? Kellogg, 1987 • An unintentional event that results in a person coming to rest on the ground, or another lower level, not as a result of a major intrinsic event such as stroke or epilepsy) or an overwhelming hazard (such as being pushed).

4. The extent of the problem • An estimated one in three people aged 65+ suffer a fall at least once a year, about half of those suffer multiple falls • For people aged 75+, and those in residential care the figure increases to one in two people

5. The extent of the problem • Falls are the leading cause of unintentional injury and death among people aged 65 years and over • Health care costs for Australia for falls related injuries in 2001 was estimated to be $498 million dollars • Of those admitted to hospital following a fall about 50% will die within 12 months

6. Consequences of falls • Physical injury • Emotional trauma • Psychological problems • Social consequences • Financial impact

7. Consequences of falls • 70% of falls result in an injury • One third of people who fall require medical treatment • Major injury such as dislocation or fracture occurs in 13% of falls

8. Consequences of falls • Approximately 1-2% result in a fractured femur or hip • Of those who suffer fractured femurs 50% will not fully recover, and 30% will die within 12 months

9. People at risk of falls • Advanced age • Female • Those living alone • Those with one or more diseases • People with acute illness • People on multiple medications (4 or more) • People with walking (gait) problems

10. People at risk of falls • People suffering increased postural sway • People with decreased mobility • Cognitively impaired people • Previous history of falls • Home bound • Decreased vision

11. When do falls occur? • Statistics show that most falls occur in the daytime when people are more active, around 11am and between 4pm and 6pm

12. Where do people fall? • 49% of falls take place in and around the home • 17% of falls take place in the urban environment • 14.8% occur in residential care environments

13. Areas where falls occur at home 9% 7% 4% WC Laundry Kitchen Meals Living Pantry Dining Bathroom 50% Living Entry Bedroom Garage Source: Victorian Injury Surveillance System 5% 25%

14. Causes of falls An internal cause, such as a disease or condition that affects the person individually, eg vision impairment, or muscle disease An external cause such as an unsafe environment Risk taking behaviour such as climbing an unsafe ladder Falls usually have more than one cause

15. Causes of falls • Chronic disease • Acute illness • 4 or more medications • Poor balance and gait • Impaired vision • Lack of physical activity • Hazards in the home and community • Foot disorders • Unsafe footwear

16. Falls & chronic illness Regular medical checkups, and referral to specialist services to: • Prevent worsening of the condition • Restore lost ability • Keep as well and active as possible

17. What can you do?

18. What you need to know about yourchronic illness • How your condition will affect you • What treatments are available • What assistance can be provided to you • The signs and symptoms of a flare-up • What to do if you suffer a flare-up • What can be done to reduce the risk of your condition/s causing a fall

19. Acute illnesses Examples: • Chest infections • Urinary Tract infections • Diarrhoea • Surgical procedures

20. Acute illness in the community • Seek medical treatment • Community services • Ask family, friends and neighbours to help out • Ensure adequate diet and fluids • Aids

21. Incontinence (loss of bladder or bowel control) Frequency (Needing to pass urine often) Urgency (Needing to go in a hurry) Nocturia (Needing to go to the toilet more than twice per night) Urinary Tract infections Continence & bladder problems

22. Urinary Tract Infections Symptoms • Mental confusion • Frequency • Urgency • Foul smelling urine • Incontinence • Burning or scalding when passing urine

23. Incontinence, frequency & urgency These conditions may require referral to: • Doctor • Continence Clinic (for advice, continence aids, and exercises to help bladder control) • Physiotherapist (for exercises to help bladder control) • Urologist (for a specialist opinion)

24. Postural hypotension A drop in blood pressure after standing up Causes: • Dehydration • Cardiac disease • Drug side affects • Prolonged bed rest • Dysfunction in the nervous system • Certain chronic & acute illness

25. How to get up safely • Sit on the edge of the bed or chair with feet on the floor for a few minutes before getting up • Stand up slowly using both arms to push up for support • Make sure you have good balance and do not move off if you feel lightheaded or dizzy • Use support when bending down and stand back up slowly

26. Reducing falls from postural hypotension • Regular medication reviews • Inform doctor of any side affects from medications (prescribed or other) • Ensure adequate fluid intake • Treatment and control of associated diseases

27. DizzinessDizziness needs to be properly investigated by a doctor or specialist Causes: • Medications • Chronic disease • Acute illness • Psychological disorders If you are dizzy you need to get up safely

28. Strategies for preventing falls due to impaired vision • Annual check ups with optometrist • Specialist referral for eye problems • Ensure the environment is safe • Occupational therapy home assessment • Vision Australia referral • Colour contrasting • Adequate lighting • Glare reduction

29. Color contrasting

30. Color contrasting

31. Seeing well • Keep your glasses in reach • Remember to wear your glasses • Turn your light on at night before you get up so that you can see where you are going • Bifocals are not recommended

32. Hearing problems • Medical examination • Audiology referral • Hearing aids (Wear them!!!) • Specialist referral • Raise awareness of the problem amongst carers/family and friends

33. Medications • 80-90% of people over 65 use medications • Some medication can cause or contribute to falls • Older people can have altered sensitivity to medications • Side effects from drugs are greater when multiple medications are used

34. Medication risks • Multiple medications (4 or more) • Medication side affects • Use of medications associated with an increased risk for falls (eg sleeping tablets) • Difficulty taking medications/incorrect use • Lack of information or instructions

35. Falls management & medications • Regular review of medications • Keep a medication list • Use of Webster packs or dosettes • Use the same doctor if possible • Assistance with medications e.g. District Nurse • Obtain information on side effects • Inform doctor of any side effects suffered • Inform doctor about herbal medications being taken • Discuss any medication changes with your doctor

36. Balance and gait disorders • Medical assessment • Physiotherapy • Prescribed walking aids • Ensure safe environment • Occupational therapy home assessment • Exercise

37. Walking aids • If you have a walking aid, remember to use it (Correctly!!!!!) • Only used prescribed walking aids • Make sure you know how to use your walking aid • Have your walking aid within reach at all times

38. Lack of physical exercise Reduced activity leads to: • Reduced muscle tone and bone density • Loss of strength • Poor balance and coordination • Reduce mobility • Increased frailty • Reduced quality of life

39. Staying activeexercise & training • Strength and Balance training • Hydrotherapy/water exercise • Exercise programs • Tai Chi • Walking for 30 minutes most days of the week • Dancing • Ask you doctor or physiotherapist for an exercise program that is suitable for you

40. Reducing falls from foot disorders • Purchase of properly fitting shoes • Referral to podiatrist for treatment of foot disorders • Referral to podiatrist for advice on purchasing of shoes • Referral to a specialist for treatment of foot disorders

41. Reducing falls from unsafe shoes Purchase safe footwear: • Flat sole • Broad rounded heel • Flexible sole • Good grip • Lace ups if possible or velcro fasteners • Shoes that are enclosed at the front and back • Avoid scuffs, thongs, high heels, and sling backs • Don’t wear socks without shoes

42. Shoe sole to ground contact Flat Shoe Court Shoe Shoes with greater ground contact help to reduce the risk of falls

43. Nutrition and falls Optimal nutrition is important to reduce the risk of falling and to enhance recovery if a fall occurs. The incidence of falls has been linked to: • Vitamin deficiencies • Protein-calorie deficiencies

44. Nutrition and falls Effects from under-nutrition include: • Reduced muscle mass • Weight loss • Iron deficiency (aenemia) • Balance and gait abnormalities • Vision disorders • Hypotension • Decrease in folic acid can lead to confusion

45. Eating and drinking • It is important to have enough diet and fluids, especially in hot weather • Make sure that you eat and drink enough according to your doctor’s or dietitian’s advice • If you are having problems with chewing, swallowing, or with your appetite, tell your doctor or dietitian

46. Strategies to reduce nutrition related falls • Referral to dietician • Medical review • Assistance with shopping • Assistance with meals eg Meals on Wheels

47. Vitamin D and calcium • Vitamin D and calcium deficiencies are common in nursing home, hostel and house bound older people • Vitamin D and calcium are essential for healthy bones

48. Vitamin D and calcium • A diet with 1200-1500mg of calcium per day is recommended • 20 minutes of direct sun exposure 4-6 times per week to the face and hands is required to absorb adequate vitamin D (Vitamin D cannot be absorbed through a window). Avoid peak heat times (10.00am-3.00pm) • Supplements are advised for people not receiving adequate amounts

49. Fear of falling • 50% of people who fall will suffer fear of further falls • Fear of falling causes people to restrict their activities Strategies for fear of falling • Seek help from doctor, social worker or physiotherapist

50. Treatment of fear for falling • Assessment of medical condition • Identification of fears • Counseling and education • Physiotherapy • Behaviour modification and treatment of fears and phobias