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Falls: Low Vision and Falls

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Falls: Low Vision and Falls Jag Mallya 1-09-2010 Definition: A fall is an event which results in a person inadvertently coming to rest on the ground, the floor or ... – PowerPoint PPT presentation

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Title: Falls: Low Vision and Falls


1
Falls Low Vision and Falls
  • Jag Mallya
  • 1-09-2010

2
Definition
  • A fall is an event which results in a person
    inadvertently coming to rest on the ground, the
    floor or other lower level.
  • No evidence of
  • sudden onset of paralysis,
  • epileptic seizure, or Loss of consciousness
  • overwhelming external force

3
Epidemiology of Falls
  • gt 65 years 30
  • gt 75 years 40
  • 50 of falls in people who fall twice
  • or more in a year.

4
Consequences of Falls
  • Commonest cause of Accidental injury in older
    people.
  • Commonest cause of Accidental Death in gt 75
    years of age.
  • 6 falls gt 65 years result in a fracture.
  • Commonest cause for older people to attend A E
    gt 75 years hip fractures predominate.
  • Fragility fracture also costs 1.7 billion per
    year (In-patient long term provision.)

5
Table 10 Cost of an individual hip
fracture Category Cost Hospital care

4,760 Ambulance
171 Long stay residential
care 20,010 GP
use
164 Outpatient use
319 Total Cost

25,424
6
Cost of Hip Fracture in Elderly in UK.
  • Hospital Costs 430,407,013
  • Social Care Costs 933,420,670
  • Other 18,000,000
  • Approx Total Cost 1,382,932,183
  • Ref The Economic cost of hip fracture in the
    UK.

7
Social Costs of Falls
  • By 2051 Falls (Population of Australia
    22,403,920)
  • Direct health cost attributed to falls related
    injury will increase 3 fold.
  • 2500 additional hospital beds will need to be
    permanently allocated to falls.
  • 3320 additional Nursing Home places.
  • Ref Health Service impacts and costs of falls
    in older age (WHO) Dongbu Fu

8
(No Transcript)
9
Falls are Multifactorial
Intrinsic Factors
Extrinsic Factors
Medical conditions Impaired vision and
hearing Age related changes
Medications Improper use of assistive
devices Environment
FALLS
10
Falls in the Community
  • Accidents/environment 37
  • Weakness, balance, gait 12
  • Drop attack 11
  • Dizziness or vertigo 8
  • Orthostatic hypotension 5
  • Acute illness, confusion, drugs,




    decreased vision 18
  • Unknown 8

Rubenstein JAGS 1988
11
Causes of Falls Summary of 12 Studies
  • Accident/environment
  • Gait/balance disorder
  • Dizziness/vertigo
  • Drop attack
  • Confusion
  • Postural hypotension
  • Vision problem
  • Other specified
  • Unknown
  • 31
  • 17
  • 13
  • 10
  • 4
  • 3
  • 3
  • 15
  • 5

Rubenstein LZ, Josephson KR. Clin Geriatr Med.
2002(May)18(2)141-158
12
Age related changes affecting balance
13
Normal Changes with Aging
  • Neurologic
  • Increased reaction time
  • Decreased righting reflexes
  • Decreased Proprioception
  • Vision Changes
  • Decreased accommodation dark adaptation
  • Decreased muscle mass
  • Strength

14
Periodic case finding in Primary Care Ask all
patients about falls in past year
Assessment and Management of Falls
No intervention
No falls
Recurrent
Single fall falls
No problems
Gait/balance problems
Check for gait/balance problem
Fall Evaluation
Assessment History Medications Vision Gait and
balance Lower limb joints Neurological Cardiovascu
lar
Multifactorial intervention (as
appropriate) Gait, balance, exercise -
programs Medication - modification Postural
hypotension - treatment Environmental hazards -
modification Cardiovascular disorders - treatment
15
(No Transcript)
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