STOPping FALLS

1
STOPping FALLS
one step at a time

• Fall Prevention Center of Excellence GOALS
• Make fall prevention a key public health
  priority
• Create, test and evaluate effective and
  sustainable fall prevention programs
• Build a comprehensive fall prevention system in
  California

2
Table of Contents

• Prevalence
• Awareness
• Falls outside the Home
• Falls in Home
• Prevention
• Medical Management / Risk Assessment
• Balance and Mobility
• Home Modification
• Tips to Take Home

3
Are you at risk of Falling?

• Do you take 4 or more medications daily?
• Have you fallen 2 or more times in the past 6
  months?
• Do you wear floppy slippers or a long bathrobe?
• Do you have trouble getting in and out of the
  bathtub?
• Do you have trouble walking without holding on to
  something?
• Do you have trouble getting in and out of a
  chair?
• Do you have throw rugs?
• Do you have stairs without rails?
• Do you have clutter in your walking space?
• Do you have trouble seeing pathways or pets?
• Provided by the San Diego County Office of Public
  Health,
• A Division of the Health Human Services Agency

4
How many did you answer yes to?

• Falls are a serious health risk.
• In the United States, ONE OF EVERY THREE persons
  age 65 and older falls each year.
• Among older adults, falls are the leading cause
  of injury deaths and the most common cause of
  injuries and hospital admissions for trauma.
• In 2002, nearly 13,000 people ages 65 and older
  died of fall-related injuries.

http//www.cdc.gov/ncipc/pub-res/toolkit/toolkit.h
tm
5
Falls Heard Around the World

• Pope falls down, cuts head. Sandomierz,
  Poland June 6, 1999
• Queen Mother recovering after two falls in a
  week. November 6, 2000

6
Famous Fallers
fell in a bathtub hospitalized
never recovered
7
Dr. Robert Atkins April 17, 2003

• Diet guru of low-carb, high-protein fame, died
  Thursday at Cornell University Medical Center
  from injuries received earlier this month when he
  fell.
• Atkins, 72, was on his daily walk to work when he
  fell on an icy sidewalk outside his New York City
  office and suffered injuries to his head.

8
Billy Graham Falls, Breaks Hip January 7, 2004

• Billy Graham was recovering.. after falling
  and breaking his hip. Graham, 85. He received a
  partial hip replacement"He's in good
  spirits,will need extensive physical
  therapyailments in recent years, including
  Parkinson's Disease.

9
Castro broke his left knee and right arm in a
fall after giving a graduation speech in the
central Cuban city of Santa Clara.
Fidel Castro October 21, 2004
10
Risk Factors for Falling

• Being female. 
• Being white.
• Having had a previous fall.
• Having lower body weakness or gait or balance
  problems.
• Having physical limitations, wearing glasses, or
  having other visual problems.
• Having more than one chronic disease, history of
  stroke, Parkinsons Disease, neuromuscular
  disease, urinary incontinence, or postural
  hypotension.
• Being cognitively impaired
• Taking more than four medications or using
  psychoactive medications
• Wearing shoes with thick, soft soles (e.g.,
  jogging shoes)

http//www.cdc.gov/ncipc/pub-res/toolkit/SummaryOf
Falls.htm
11
Facts about Senior Falls

• For people ages 65 and older, falls are the
  leading cause of injury death (CDC 2001). 
• Among seniors, falls are the underlying cause of
  a large proportion of fatal traumatic brain
  injuries (TBI). From 1989 to 1998, the
  fall-induced TBI death rate among people ages 80
  and older increased 60 (Stevens 2001).
• The risk of falling increases exponentially with
  age (Samelson 2002). 
• Courtesy of CDC website

12
More Facts

• Older adults who have fallen previously or who
  stumble frequently are two to three times more
  likely to fall within the next year (Tinetti
  1988 Teno 1990).
• For people ages 65 and older, two-thirds to
  one-half of falls occur in or around the home
  (Nevitt 1989 Wilkins 1999). 
• At least 95 of hip fractures among older adults
  are caused by falls (Nyberg 1996).
• Fall-related death rates and hip fracture
  hospitalization rates have been increasing
  (Stevens 1999).

Courtesy of CDC Website
13
Where People Fall
Source National Health Interview Survey,
1997-1998 (Kochera, 2002)
14
Awareness

• Falls outside the Home
• Falls in the Home
• For people ages 65 and older, two-thirds to
  one-half of falls occur in or around the home
  (Nevitt 1989 Wilkins 1999).

15
Outdoor Community Hazards

1. Uneven pavement or surfaces
   and/or pavement cracks
2. Tree roots
3. Obstacles in walkways
4. Obstacles in walkways
5. Uneven steps
6. Unsafe stair design
7. Poor lighting

16
Problems in the Community

• Lack of features related to the built
  environment
• Poor enforcement of safety codes or regulations,
  and/or inadequate building codes, are related to
  problems in the community

17
Possible Community Modifications

• Identifying and eliminating hazardous conditions
  that interfere with mobility and increase fall
  risk
• Adding supportive features

18
Preventing Outdoor Falls

• Be cautious about the surface and setting in
  which you walk
• Walk on a prescribed track
• Walk for exercise in newer, well maintained
  areas, even malls and civic spaces

19
Preventing Outdoor Falls

• Be aware of your surroundings
• Cracks in sidewalks, tree roots, holes, and
  changes in elevation
• Look for tree roots as hazards as well as fallen
  leaves, blossoms, seed pods, and other debris
• Note curbs and changes in elevation
• Walk in good lighting
• Wear footwear with firm soles and low heels

20
Fall Prevention

• Medical Management
• Physical Activity
• Home Modification

21
Medical Management

• Understanding the Problem
• People age 65 and over buy more than 25 percent
  of all prescription medicines and 30 percent of
  all nonprescription (over-the-counter) medicines
  sold in this country.
• Older people more likely than younger people to
  have long-term illnesses such as arthritis,
  diabetes, high blood pressure, and heart disease
  that require taking medicines on a regular basis
• Common for older people to take several different
  medicines

http//www.healthinaging.org/public_education/elde
rcare/23.xml
22
Medication Management Is Confusing
23
Older Individuals tend to be more sensitive to
drug effects

• THIS SLIDE POSSIBLY NOT NEEDED?
• For example, a drug such as Valium(TM)(diazepam)
  may stay in an 80-year-old body four times as
  long as it does in a 40-year-old body.
• The liver and the kidneys break down and remove
  most drugs from the body. As people age, these
  organs may not work as rapidly as they once did
  and some drugs may leave the body more slowly,
  sometimes causing side effects

http//www.healthinaging.org/public_education/elde
rcare/23.xml
24
Different doctors possibility of one or more
medicines

• At least one doctor should keep track of all the
  medicines a person is taking to minimize
  drug-drug interaction and other risks associated
  with taking many medicines
• If the (primary care) doctor is unaware of the
  medicine already prescribed by other doctors and
  health care providers, this can cause problems.

http//www.healthinaging.org/public_education/elde
rcare/23.xml
25
Inform your doctor or pharmacist

• All prescription drugs from any doctor, including
  eye drops, creams, and ointments.
• Nonprescription medicines, including vitamins,
  minerals, antihistamines, sleeping pills,
  laxatives, cold medicines, and antacids.
• Folk remedies, nontraditional products, or
  "alternative medicines," such as plant compounds,
  herbs, special teas, or nutritional supplements.
• "Social" drugs such as alcohol, tobacco, or
  caffeine.

http//www.healthinaging.org/public_education/elde
rcare/23.xml
26
Physical Activity
27
Physical Activity

• Engage in Regular Physical Activity
• Ask your physician what types of activities would
  be best for you.
• Determine a plan for regular physical activity
  that fits with your interests and abilities.
• Consider targeted balance and mobility exercises
  that are most effective at reducing fall risk.

http//nihseniorhealth.gov/exercise/benefitsofexer
cise/06.html
28
Benefits of Exercise

• People of all ages and physical conditions
  benefit from exercise and physical activity
  because it helps prevent or delay many diseases
  and disabilities
• Moderate exercise and physical activity can even
  improve the health of people who are frail or who
  have diseases that accompany aging
• Exercise and physical activity can help older
  people maintain or partly restore
• strength, balance, flexibility, and endurance

http//nihseniorhealth.gov/exercise/benefitsofexer
cise/06.html
29
Benefits of Exercise

• Increasing strength and endurance make it easier
  to climb stairs and carry groceries.
• Improving balance helps prevent falls.
• Being more flexible may speed recovery from
  injuries.

http//nihseniorhealth.gov/exercise/benefitsofexer
cise/06.html
30
Exercises to Try

• Four types of exercise are important for staying
  healthy and independent
• strength exercises
• balance exercises
• stretching exercises
• endurance exercises

http//nihseniorhealth.gov/exercise/benefitsofexe
rcise/06.html
31
Strength Exercises

• Strength exercises build muscle as well as
  increase your metabolism, which helps keep your
  weight and blood sugar in check.

http//nihseniorhealth.gov/exercise/benefitsofexer
cise/06.html
32
Lets try a Strength Exercise

• Knee Flexion strengthens muscles in the back of
  the thigh.
• Stand straight, holding onto table or chair for
  balance.
• Slowly bend one knee as far as possible, so foot
  lifts up behind you. Don't move your upper leg at
  all bend your knee only.
• Hold position.

http//nihseniorhealth.gov/exercise/benefitsofexe
rcise/06.html
33
Knee Flexion

• 4. Slowly lower foot all the way back down.
• 5. Repeat with other leg.
• 6. Alternate legs until you have 8 to 15
  repetitions with each leg.
• 7. Rest. Then do another set of 8 to 15
  alternating repetitions.

http//nihseniorhealth.gov/exercise/benefitsofexe
rcise/06.html
34
Balance Exercises

• Balance exercises build leg muscles and help
  prevent falls.
• Each year, U.S. hospitals have 300,000 admissions
  for broken hips, and falling is often the cause
  of those fractures.
• Balance exercises can help
• you stay independent by helping
• you avoid disabilities that may
• result from falling.

Karate black belt Eleanor Hyndman, 90
http//nihseniorhealth.gov/exercise/benefitsofexe
rcise/06.html
35
Anytime Anywhere Balance Exercises

• Walk heel-to-toe. Position your heel just in
  front of the toes of the opposite foot each time
  you take a step. Your heel and toes should touch
  or almost touch.
• Stand on one foot (for example, while waiting in
  line at the grocery store or at the bus stop).
  Alternate feet.
• Stand up and sit down without using your hands.

http//nihseniorhealth.gov/exercise/benefitsofexe
rcise/06.html
36
Stretching Exercises

• Stretching exercises are thought to give you
  more freedom of movement to do the things you
  need and like to do.
• Stretching exercises alone will not improve your
  endurance or strength.

http//nihseniorhealth.gov/exercise/benefitsofexe
rcise/06.html
37
Endurance Exercises

• Endurance exercises are any activity -- walking,
  jogging, swimming, raking -- that increases your
  heart rate and breathing for an extended period
  of time.
• Build up your endurance gradually, starting with
  as little as 5 minutes of endurance activities at
  a time, if you need to.

http//nihseniorhealth.gov/exercise/benefitsofexe
rcise/06.html
38
Examples of Moderate Endurance Activities

• Older adults who have been inactive for a
• long time will need to work up to these
• activities gradually.
• walking briskly on a level surface
• swimming
• gardening, mowing, raking
• cycling on a stationary bicycle
• bicycling.

http//nihseniorhealth.gov/exercise/benefitsofexe
rcise/06.html
39
How much, how often?

• GOAL work your way up to a moderate-to-vigorous
  level that increases your breathing and heart
  rate.
• It should feel somewhat difficult to you.
• Once you reach your goal, you can divide your
  exercise into sessions of no less than 10 minutes
  at a time, if you want to, as long as they add up
  to a total of at least 30 minutes on most or all
  days of the week.

http//nihseniorhealth.gov/exercise/benefitsofexe
rcise/06.html
40
Home Modification

• The home environment is implicated in 35 to 40
  of falls (Josephson, Febacher, Rubeinstein,
  1991)
• The majority (55) of fall injuries occur inside
  the house (National Health Interview Survey,
  1997-1998)

41
Hazards and Safety Risksin the Home

• Outside Steps To The Entrance
• Inside Stairs To A Second Floor
• Unsafe Bathrooms

42
Everyday Situations Possible Solutions

• 1. Lack of support in the bathroom/shower.
• Solution Install grab bars and use non-slip mats
  or non-skid strips.
• 2. Lack of support in the toilet.
• Solution Install grab bars or use raised toilet
  seat.
• 3. Climbing stairs.
• Solution Installs handrails on both sides of the
  stairs.
• 4. Dark passage or stairway.
• Solution Install brighter lights, and have
  switches at both ends.

43
(No Transcript)
44
Everyday Situations Possible Solutions

• 5. Objects in the way books, clothes,
  newspapers, and shoes.
• Remove them from the pathway.
• 6. Slippery Rugs.
• Remove or use double-sided tape to secure them to
  the floor.
• 7. Items out of reach.
• Keep ones most often used at levels that can be
  reached easily.

45
Unmet Needs for Features

• 1.14 million elderly households have an unmet
  need for home modifications (HUD, 1999)
• 1) Handrails/grab bars
• 2) Ramps
• 3) Easy access bathrooms

46
A Home in Need of Improvements
Front Entry
Back Entry
47
Back Entry
Back Entry Lacks Handrails
Back Entry Slope is Steep
48
Bathroom
Shower is Dark and Grab Bar Not Useful
High Step in Shower
49
Universal Design

• Adaptable Housing and Neighborhoods Accessible to
  Persons of All Ages and Abilities
• The Design of All Products and Environments
  Should Be Useable by All Persons to the Greatest
  Extent Possible

50
(No Transcript)
51
Home Safety Summary Checklist
52
Tips to take Home

• Educate yourself know where falls occur and be
  aware of risk factors
• Prepare yourself to prevent falls before they
  happen with exercise, proper footwear, etc.
• Be an advocate to stop falls Educate Service
  Providers, Business Owners, Local Politicians
• Play an active role in preventing falls for
  yourself and others in your community Report
  outdoor hazards such as broken sidewalks and
  unmarked curbs to city officials.

53
Questions?

• Fall Prevention Center of Excellence Program
  Office
• University of Southern California
• Andrus Gerontology Center
• Los Angeles, California 90089-0191
• Tel [phone]
• Email info_at_stopfalls.org