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STOPping FALLS

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Title: 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
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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
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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 213.740.1364
  • Email info_at_stopfalls.org
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