Study Of Falls In The Elderly

Aging is a normal phenomenon in all over the world so that the necessity of old age care is very important. WHO states that world countries have accepted the chronological age of 65 years as a definition of elderly. Nowadays, world is developing too fast I all the sectors especially in medical science and technology. It makes great differences in the life span and the quality of life of the people.

The fastest population increase has been in the number of those aged 85 and over, the “oldest old”. In 1984, there were around 660,000 people in the UK aged 85 and over. Since then the numbers have more than doubled reaching 1.4 million in 2009. By 2034 the number of people aged 85 and over is projected to be 2.5 times larger than in 2009, reaching 3.5 million and accounting for 5 per cent of the total population. (Office of national statics 2010).

Falls is one of the most common problems in old age. Elder people falls frequently and it can cause serious injuries such as fracture, dislocation and head injuries (Dr.Roberts A 1995). Falls represent the most frequent and serious type of accident in the over 65s. “While improvements have been made in the care of hip fractures, the report reveals 37 per cent of people still aren’t receiving a ‘falls assessment” (AgeUK 2010).

The work experiences in care home helped me to know about common problems of old age. I understand, falls is one of the common problems in old age. However, this study will helps me to explore about what are the causes of falls in the old age and how we can reduce and prevent the frequency of falls.

Office of national statistics.

http://www.statistics.gov.uk/cci/nugget.asp?id=949

WHO

http://www.who.int/healthinfo/survey/ageingdefnolder/en/index.html

AgeUK

http://www.ageuk.org.uk/latest-press/archive/age-uk-responds-to-national-hip-fracture-database-national-report-2010/

SEARCH STRATEGY

To find information about my independent study topic, I came across with much verity of articles and literature such as books, journals, eBooks, internet, databases etc. A plenty of databases I were searched, for example, EBSCO, PUBMEB,BMJ,CINHAL,BNI and Google web search and Google books also. University website helped me to locate and use the relevant databases more effortlessly. These databases helped me to search and study about my topic falls in the old age care.

When I start searching about my topic, I found a huge amount of literature in my screen. To sort out the relevant information from the many articles I used the inclusion and exclusion methods and some keywords, that is the literature is not more than ten is years old and research nature, then I used some key words related to my topic such as falls in the old age, causes of falls, risk factors of falls and prevention of falls. When I start search in EBSCO, The search exposed few results with relevance to falls among the aged, some results on fractures, three on domestic injuries and deaths and review article on approach to falls and one on urgent situation management of falls. As a part of my study I visited many websites also they are AGE.UK, World Health Organisation (WHO) and office of national statistics.

DEFINITION OF FALLS IN THE OLD AGE

‘An event, which results in a person come to rest inadvertently on the ground or other lower level’. Globally, an estimated 391 000 people died due to falls in 2002.World Health Organisation.

World Health Organisation.

http://www.who.int/violence_injury_prevention/other_injury/falls/en/index.html

CLASSIFICATIONS OF FALL

Rein Tideiksaar cited the work of Luckinen, et.al (1994). Falls is classified into mainly four groups.

Extrinsic or environmental factors:

It includes. Slips, trips or externally included displacements.

Intrinsic factors

Mobility or balance disorder or loss of consciousness

Non-bipedal

It includes person falls from the bed, chair or device.

Non- identified or non classifiable.

It includes fall cannot be identified or described by either a person or collateral damage.

Reference

Falling in old age : prevention and management (1997)

By Rein Tideiksaar

http://books.google.co.uk/books?id=426l9wOdfyAC&pg=PA140&dq=classification+of+falls.lach+et+al&hl=en&ei=-o3BTLWdDs2Usway-uDpCA&sa=X&oi=book_result&ct=result&resnum=3&ved=0CDoQ6AEwAg#v=onepage&q&f=false

R.B. Shukla, D. Brooks(1996) a guide to care of the Elderly.

CAUSES OF FALLS IN THE OLD AGE

Falls and unsteadiness of gait are major problems faced by the elderly. Accidental injuries and fatalities due to fall indicate substantial morbidity and mortality in the elderly. (B. Everett Gray,1990).Among all negative outcomes derived from elderly health conditions, falling is considered one of the main causes of functional impairment.( Arlete Maria Valente Coimbra and et al, 2009).

Physical causes:

Arthritis

Parkinson’s disease

Foot problems

Strokes

Cardiac failure

Mental causes :

Depression

Dementia

Alzheimer’s disease

Drugs and Medication:

Sedatives

Diuretics

Hypotensive age

Environmental factors:

Hazards in the home (rugs, mats, loose carpets, poor lightings)

weather conditions

Age- related changes:

Balance/gait

General frailty

Poor vision

Poor mobility

Non Accidental:

Elderly abuse

Criminal injury

BOOK referred

R.B. Shukla, D. Brooks(1996) A guide to care of the Elderly.

R.B. Shukla(1999) Care of the elderly.

Falls in the elderly of the Family Health Program (2009)

Arlete Maria Valente Coimbra, Natalia Aquaroni Ricci, Ibsen Bellini Coimbro, LÄ±lian Tereza Lavras Costallat,

http://www.sciencedirect.com.ezproxy.uwe.ac.uk/science?_ob=MImg&_imagekey=B6T4H-4YCGKNF-1-1&_cdi=4975&_user=122883&_pii=S0167494310000245&_origin=search&_coverDate=12%2F31%2F2010&_sk=999489996&view=c&wchp=dGLbVlb-zSkWA&md5=bb481983dd92110f0721752512e8a78f&ie=/sdarticle.pdf

Slips, stumbles and falls: pedestrian footwear and surfaces

By B. Everett Gray, ASTM Committee F13 on Safety and Traction for Footwear.

http://books.google.co.uk/books?id=1LMK0x-eZiIC&pg=PA7&dq=falls+in+the+elderly&hl=en&ei=YxbITMerK4qOjAeH_ehy&sa=X&oi=book_result&ct=result&resnum=6&ved=0CEQQ6AEwBQ#v=onepage&q=falls%20in%20the%20elderly&f=false

RISK FACTORS OF FALLS IN THE ELDERLY

In 2007, 81% of fall deaths were among people 65 and older. Men are more likely to die from a fall. After adjusting for age, the fall fatality rate in 2007 was 46% higher for men than for women. (CDC). Risk factors for fall are categorized according to their origin as follows, age related changes, common pathologic changes and functional impairment, medication effects and environmental factors. (Miller.C, 2008). According to the 2007, WHO report on falls prevention in the old age, classified into four risk factors can cause fall,

Behavioural risk factors

Environmental risk factors

Biological risk factors

Socioeconomic risk factors

Behavioural risk factors:

Behavioural risk factors include human actions, emotions or daily choices. The main Behavioural risk factors are:

Multiple medications Use

Excess alcohol intake

Lack of Exercise

Inappropriate Footwear

Environmental risk factors

Environmental factors encapsulate the interplay of individuals’ physical conditions and the surrounding environment, including home hazards and hazardous features in public environment. It includes:

Poor building design

Slippery floors and stairs

Looser rugs

Insufficient lighting

Cracked or uneven sidewalks

Biological risk factors

Biological factors embrace characteristics of individuals that are pertaining to the human body. For instance, age, gender and race are non-modifiable biological factors. The risk factors are:

Age

Genter

Race

Chronic illness

Reduced physical, cognitive and affective funct

Socioeconomic risk factors

Socioeconomic risk factors are those related to influence social conditions and economic status of individuals as well as the capacity of the community to challenge them. It includes,

Low income

Inadequate housing

Lack of social interactions

Limited access to health and social service

Lack of community resources

Reference

WHO, Global report on prevention of falls in the old age, (2007)

http://www.who.int/ageing/publications/Falls_prevention7March.pdf

http://books.google.co.uk/books?id=ms9o2dvfaQkC&printsec=frontcover&dq=WHo+Global+report+on+falls+Prevention+in+older+Age&hl=en&ei=_rLKTPiRFMuNjAeZ5c3LDw&sa=X&oi=book_result&ct=result&resnum=1&ved=0CCwQ6AEwAA#v=onepage&q&f=false

CDC, Falls among Older Adults: An Overview

http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

Nursing for wellness in older adults.

Carol A. Miller(2008) p 465

http://books.google.co.uk/books?id=yUx01gmNLboC&pg=PA465&dq=risk+factors+of+falls&hl=en&ei=M7zOTPr_C9jPjAfmjdXXBw&sa=X&oi=book_result&ct=result&resnum=2&ved=0CDMQ6AEwAQ#v=onepage&q=risk%20factors%20of%20falls&f=false

COMPLICATIONS OF FALLS

Complications results from falls are the leading cause of death from the injuries in men and women aged over sixty five years and older, with men older eighty five years and older having the highest death rate, more than 180 death in per 100000 population.(john.c.beck, 2004). Falls related mortality is a critical problem in the old population. While the majority of falls among old persons do not result death, falls experienced by this age group are a leading cause of mortality.(Tidekasaar,1997). Fractures of hip and lower extremities are more common and lead to prolonged disability because of impaired mobility. (Robert. K, 2004). The common complications of falls are:

Painful soft tissue injuries

Fractures

: Hip Fractures

: Femur Fractures

: Humerus Fractures

: Wrist Fractures

: Ribs Fractures

– Subdural hematoma

– Hospitalization

– Complications of immobilisation

– Risk of iatrogenic diseases

– Infections and Inflammations

– Disabilities

– Impaired mobility because of physical injury

– Impaired mobility from fear, loss of self confidence and restriction

Of ambulation.

– Risk of institutionalisation

– Death

Essentials for clinical geriatrics, (Robert Kane, 2004)

http://books.google.co.uk/books?id=zYgxA_XAM7QC&printsec=frontcover&dq=essentials+for+clinical+geriatrics,robert.l.+kane&hl=en&ei=sgjITInvC4vQjAfkyuRo&sa=X&oi=book_result&ct=result&resnum=1&ved=0CDUQ6AEwAA#v=onepage&q=complications%20of%20falls&f=false

G R S, (Geriatric Review Syllabus), john.c.beck.

http://books.google.co.uk/books?id=zjPf6bJt9RYC&pg=PA149&dq=complications+of+falling+in+the+elderly&hl=en&ei=kqDKTOXWIMWOjAeZvZDnDw&sa=X&oi=book_result&ct=result&resnum=9&ved=0CF4Q6AEwCA#v=onepage&q=complications%20of%20falling%20in%20the%20elderly&f=false

PREVENTION OF FALLS IN THE ELDERLY

Prevention of falls is crucial to the health of all older persons, including those without a history of falling, even older persons with no history of falls expresses fearful anticipation of falling. Such persons usually have an underlying gait dysfunction or imbalance problem that may lead to self imposed restriction of activities and mobility and may result in them being house bound or chair bound. Falls cannot be prevented unless the risk factors are identified

(National guideline for prevention falls in older persons, 2000)

Stephan.R (2007) cited the work of The Kellogg International working group (1987) on the prevention of falls in the elderly as defined as’ unintentionally coming to the ground or some lower level and other than as a consequences of sustain a violent blow, loss of consciousness, sudden onset of paralysis as in the stroke or an epileptic seizure’. Considerable evidence now exists that most falls among older persons are associated with identifiable and modifiable risk factors and that targeted prevention efforts are shown to be cost-effective. Most falls and resulting injuries among older persons are shown to result from a combination of age and disease-related conditions and the individual’s interaction with their social and physical environment (WHO,2008). Ebrahim S and A Kalache (1996) describes the causes and prevention of falls:

Causes

Prevention

Uses of drugs

Psychological factors

Extrinsic factors

Alcohol use

Assistive devices

Cognitive/behavioural/

Social programme

Clinical assessment of risk

.(Rai G 2006)

Warn older person against self medication

Rational prescribing of medication

Assist disoriented person to take medication

Use CNS drugs very carefully and cautiously.

Counselling of older people with stress related disorders

Provide divertional therapy

Environmental factors must be accessed and corrected

Ensure obstacles free environment

Ensure adequate light and contrast

Ensure No loose mat or slipping surface

Provide night light

Hand rails

Advice on safe drinking pattern

Review combination of alcohol with other drugs

Provide appropriate walking aids

Minimise restraint devices

Balance and gait training

Restore confidence

Provide social contact

Teach avoidance of risk taking behaviour to person or care giver.

History and circumstances of falls

Any loss of consciousness

Any loss of movement or involuntary movement

Any incontinence

All prescribed and the over the counter medications

Any recent acute and/or ongoing chronic medical problems

Any previous problems with gait and balance

Chest pain

Palpitation

Hearing problems

Eye sight problems

Memory loss

Depression

Habits relating to alcohol or recreational drugs.(Rai G 2006)

The Global report of prevention of falls in the elderly (WHO, 2007) states that multi factorial approach is helpful to prevent falls in the community and elderly. The approaches are

Balance and gait training with appropriate use of assistive devices;

Environmental risk assessment and modification;

Medication review and modification

Managing visual problems

Providing education and training

Addressing foot and shoe problems

Addressing orthostatic hypotension and other cardiovascular problems

Multi factorial approaches are shown to be the most effect prevention strategy in residential settings. Components of successful multi factorial interventions include: staff training and guidance, changes in medication, resident education, environmental assessment and modification, supply and repair of aids, exercise, and use of hip protectors (WHO, 2007).

Hip protectors (a plastic shield sewn into special underwear so that it lies over the greater trochanter) are known to absorb energy when a patient falls, thus reducing the incidence of hip fractures. They are especially beneficial in patients who live in nursing homes and residencial homes, who are very frail and hence have thin bones and prone to recurrent falls and fractures.( Shukla.R, 1999).

References

Falls in the older people: risk and strategies for prevention (2007).

Stephen R. Lord, Catherine Sherrington, Hylton B. Menz

http://books.google.co.uk/books?id=1enrvVe81YgC&pg=PA21&dq=prevention+of+falls+in+the+old+age&hl=en&ei=XNXKTL7hH5SSjAeWqIjIDw&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEEQ6AEwAw#v=onepage&q=prevention%20of%20falls%20in%20the%20old%20age&f=false

WHO, Global report on prevention of falls in the old age, (2007)

http://www.who.int/ageing/publications/Falls_prevention7March.pdf

Ebrahim S and A Kalache (1996), Epidemiology in old age. P.364, BMJ group.

Gurucharan Rai, Joe reosethal, Jacqueline morris Steave iliffe (2006) shared care of older people.

R.B. Shukla(1999) Care of the elderly.

National guideline for prevention falls in older persons, 2000

MANAGEMENT OF FALLS

Multi factorial factors had an influence in the falls in the elderly and causes falls so a multi factorial approach management is helpful to prevent falls in the elderly. Multi disciplinary management includes Medical assessment, nursing, physiotherapy, education, occupational therapy, social worker, the dietician, Chiropodist, orthodist and specialist Nurses. (Shukla. R 1996)

Rai. G, 2006 states that management of any patients with falls with clearly guided by the findings from history, examination and investigation, such that any identified risk factors or causes of falling can be specifically addressed. Much of the management focuses on prevention of further falls. This will always include careful review of the risk and benefits of any medication which the patient is currently taking. Physiotherapy and occupational therapy can be helpful in identifying and reducing environmental risk for falling. Strength and balance exercise can help individuals learn to get up after a fall. Multi disciplinary management have an important role in the prevention of falls, improving health, risk assessment, health education.

References

Gurucharan Rai, Joe reosethal, Jacqueline morris Steave iliffe (2006) shared care of older people.

R.B. Shukla, D. Brooks(1996) A guide to care of the Elderly.

Summery

The most important goal of this study was to expand more information about two sets of possible risk factors for falls, causes, prevention and management of falls. The main aetiology of falls is recognized as intrinsic and extrinsic factors.

Most of the falls in the older people can be prevented or reduced in frequency if clinicians first begin to view the falls as symptomatic or an underlying problem and , second perform comprehensive assessment to uncover a magnitude of medical, psychological and environmental factors that may cause falls. (R Tideiksaar, 1988).

References

Falls in the elderly.

R Tideiksaar

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1629317/?page=16

Conclusion

Fall and fall related injuries are major public health challenges that call for global attention.

This problem will increase in magnitude as the numbers of older adults increase in many

nations throughout the world( WHO)

Every old age person was classified as having an intrinsic or extrinsic fall using the information obtained at the fall assessment. Extrinsic falls were related to environmental hazards (slip, trip or externally induced displacement), whereas intrinsic falls were related to mobility or balance disorder, muscle weakness, orthopaedic problems, loss of consciousness, neurally mediated cardiovascular disorder or sensory impairment.

IN my point of view, Prevention is better than cure it an old proverb. It is perfectly applicable in the case of falls in the elderly. As a part of this I understand early detection of risk factors and cause of falls is the most relevant method to prevent injuries, haemorrhage, disabilities, etc in old age. Provide comfortable house and ensure the nursing homes or residential homes are hazards less It can prevent extrinsic factors of fall and environmental hazards.

References

WHO, Globel report of prevention of falls in the elderly.

http://www.who.int/ageing/projects/1.Epidemiology%20of%20falls%20in%20older%20age.pdf

RECOMMANDATIONS

Center for disease control and prevention (CDC) states that older adults can take several steps to protect their independence and reduce their chances of falling. They can:

Exercise regularly. It’s important that the exercises focus on increasing leg strength and improving balance. Tai Chi programs are especially good.

Ask their doctor or pharmacist to review their medicines-both prescription and over-the counter-to reduce side effects and interactions that may cause dizziness or drowsiness.

Have their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision.

Make their homes safer by reducing tripping hazards, adding grab bars and railings, and improving the lighting in their homes.

Additional ways to lower hip fracture risk include:

Getting adequate calcium and vitamin D in your diet.

Undertaking a program of weight bearing exercise.

Getting screened and treated for osteoporosis.

Center for disease control and prevention (CDC), Falls among Older Adults: An Overview.

http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

REFLECTION

Reflective practice is” a process of review an experience of practice in order to describe analyses and evaluate and so inform learn from practice” (Sarah B, P 161). WHO has done a study on falls in the elderly and reflected it and states that by building on the three pillars of falls prevention, the model proposes specific strategies for:

Building awareness of the importance of falls prevention and treatment;

Improving the assessment of individual, environmental, and societal factors that increase the likelihood of falls.

For facilitating the design and implementation of culturally-appropriate, evidence-based interventions that will significantly reduce the number of falls among older persons.

As a part of my independent study I came across with the topic of falls in the elderly. It gives a huge knowledge about elderly care and how to prevent falls in the elderly.

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