FALLS IN ELDERLY

• Falls in older adults are not brief interruption in

the activity as they are younger persons but
potentially life-threatening events and may be
simply the first sign of single problem
• Moreover it lead to hospitalization, increase cost ,
burden on society and even lead to death.
Definition of Falls
• Falls is an event which
results in a person
coming to rest in the
ground or another
lower level with or
without loss of
consciousness or
injury
Incidence of Falls
• Falls are the sixth leading cause of death in older
adults.
• About 25% of person aged 70 years. It increase
to 35% for people aged 75 years and older.
• Between one-half and two thirds of
institutionalized elderly people experienced fall
every year.
• Falls occur approximately 25-33% of community
dwelling older adult.
• 50-67% of nursing home resident experience falls
Risk factors of Falls
A- INTRINSIC RISK FACTORS
• Age related changes
• Diseases (medical problem)
• Female sex

B- EXTRINSIC RISK FACTORS

• Drugs
• Environmental
• Improper assistive device
I HATE FALLING
I: Inflammation of joints (or joint deformity)
H: Hypotension (orthostatic blood pressure changes)
A: Auditory and visual abnormalities
T: Tremor (Parkinson’s disease or other causes of tremor)
E: Equilibrium (balance) problem
F: Foot problems
A: Arrhythmia, heart block or valvular disease
L: Leg-length discrepancy
L: Lack of conditioning (generalized weakness)
I: Illness
N: Nutrition ( poor, weight loss)
G: Gait disturbance
Consequences of Falls
Physical Psychological

• Skin tearing • Fear of falling

• Internal bleeding • Increased dependency
• Subdural hematoma • Depression
• Hip fracture • Anxiety
• Immobilization • Loss of confidence
• Hospitalization • Social withdrawal
The American Geriatrics Society and
British Geriatrics Society
recommend that all adults older than
65 years be screened annually for a
history of falls or balance
impairment.
Circle “Yes” or “No” for each statement below
Yes (2) No (0) I have fallen in the past year
Yes (2) No (0) I have or have been advised to use a cane or walker to get
around safely
Yes (2) No (0) Sometimes I feel unsteady when I am walking
Yes (2) No (0) I steady myself by holding onto furniture when walking at home

Yes (2) No (0) I am worried about walking

Yes (2) No (0) I need to push with my hands to stand up from a chair
Yes (2) No (0) I have some troublesome stepping onto a curb
Yes (2) No (0) I often have to rush to the toilet
Yes (2) No (0) I have lost some feeling in my feet
Yes (2) No (0) I take medicines that sometimes makes me feel
lightheadedness and more tired than usual
Yes (2) No (0) I take medicines to help me sleep or improve my mood
Yes (2) No (0) I often feel sad or depressed
TOTAL If you scored 4 points or more, you may be at risk for
falling
• ASSESSMENTS
1. History of Falls “SPLATT”
• Symptoms “dizziness or vertigo, palpitation, chest pain”
• Previous fall “during past year”
• Location
• Activity at time of fall
• Time of fall
• Trauma or injury with fall
• PHYSICAL EXAMINATION
• Sensory examination (visual acuity fields, cataract,
glaucoma, hearing loss)
• Cardiovascular examinations (arrhythmias, heart failure)
• Neurological examination (mental status, mood and
behavior)
• Musculoskeletal examination ( muscle weakness, severe
arthritis, limited range of motion)
• Mobility evaluation
• Balance
• Gait transfer(wheel chair patient)
Evaluate gait, strength and balance
• Recommended test:
• Timed Up and Go
Evaluate gait, strength and balance
• Optional test:
• 30- second chair stand
Evaluate gait, strength and balance
• Optional test:
• 4-stage balance test
• ENVIRONMENTAL ASSESSMENT
• Lighting, walking surface, furniture, clothing and
equipment

• MENTAL AND AFFECTIVE TESTING

• As indicated formal cognitive and affective functions
should be evaluated

• LABORATORY/DIAGNOSTICS TESTING
• Any laboratory or diagnostic tests should be tailored to the
suspected underlying cause
Prevention
• PHYSICAL THERAPY APPROACH
• Must consider individual risk factors, such as functional
limitations or reduced bone strength and environmental
hazards.
• Multi-component exercise beneficial for bone health and
maintaining functional ability in older community-dwelling
adults.
• Whole-body vibration training has shown potential to
improve muscle performance, balance and bone strength
• Home hazard assessment and modification and use of hip
protectors are efficient for frail older adults at the highest
risk of falling.
Prevention
• INTERVENTION FOR PREDISPOSING FACTORS
• Educate patient how to use assistive device
• Educate patient about arising slowly
• Maintain adequate hydration and provide small frequent
meal rest periods after meal, give antihypertensive
medications after meals
• Educate patient about signs and symptoms of
hypoglycemia and need to carry concentrated sugar
• Regular eye examination
Prevention
• ENVIRONMENTAL MODIFICATION
• Provide adequate lighting in rooms and hallways with
switches located at room entrance
• Keep flashlight beside the table in case of power failure
• Arrange furniture so that pathway are not obstructed
• Provide stable furniture along pathway for balance and
support
• Provide nonskid rugs and carpets runners on slippery
floors, use non-skid floor wax, wipe up spills immediately
• Use elevated toilet seat or install safety frame
• Apply nonskid mat on tub floors
• Provide handrails on both sides of bathroom
Rehabilitation
• Adequate rehabilitation physically, socially and
psychologically of injured person is very important post
fall.