Risk Factors for Falls (and injuries)

1
Risk Factors for Falls (and injuries)

• - intrinsic
• - extrinsic
• - modifiable with exercise

2
A Risk continuum ?

• Over 200 risk factors documented in the literature

D Drugs and alcohol A Age related
physiological changes M Medical E Environment
3
Intrinsic vs Extrinsic - we are all trippers

• Over HALF the falls experienced in the home are
  due to environmental hazards - trips, slips,
  unsafe or unlit stairways
• A decline in a persons intrinsic risk factors
  (declining function and balance) mean that the
  extrinsic risk factors (loose mats, slippery
  floors) no longer just cause a correctable trip -
  they cause an injurious fall

4
D - Drugs and Alcohol

• Cumulative effect of medication / time of day
• Prescribed medications / multiple drug regimes
• Analgesics - Antidepressants
• Sedatives - Antipscyhotics
• Diuretics - ANY 4 OR MORE MEDICATIONS
• Heavy drinkers (gt7 units per week) (Campbell et
  al., 1989, OLoughlin et al., 1993)
• Mixing medications with alcohol

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A - Age related physiological changes

• Deterioration in physical functions and systems
  (strength, power, endurance, coordination,
  reaction, balance, proprioception and neural
  control, asymmetry)
• Decrease in functional capacity, mobility and
  activity
• Deterioration in feet (bunions, corns,
  circulation, neuropathies)
• Increase in cognitive impairment and depression

6
Psychological risk factors

• Fear of falling
• Avoidance of activity
• Reduced quality of life
• Increased anxiety

7
M - Medical

• Acute Infections
• Cardiovascular control - postural hypotension,
  drop attacks, heart disease, stroke, tias
• Dementia, Alzheimers Disease
• Parkinsons Disease
• Thyroid dysfunction
• Peripheral Neuropathies or myopathies
• Malignancies
• Impaired hearing or vestibular function (Menieres
  Disease, Tinnitus)
• Impaired vision (macular degeneration, glaucoma,
  cataracts, visual acuity, contrast sensitivity,
  adaptation to dark)

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M - Medical 2

• Foot deformities - bunions, corns, hard skin,
  arthritis, oedema
• Urinary incontinence or urgency
• Receiving community health or social services
• Recent discharge from hospital
• Use of assistive walking aids - cane, zimmer
• Malnutrition / Anaemia - Nutritional
  recommendations are 10-20?g rda Vitamin D and
  1,000mg rda calcium, Vit B12 deficiency leads to
  sensory abnormalities

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E - Environment

• Personal risk factors
• glasses (bifocals and varifocals)
• footwear and clothing

• Outdoors
• Poorly lit pathways
• Uneven pavements
• Slippery leaves
• Rubbish, building materials,
  obstacles
• Bus drivers!

• Indoors
• Loose carpets
• Wires and cables
• Unstable furniture
• Change of level
• Poor lighting
• Cold rooms

Sentimentality or never been a problem before
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Not modifiable with tailored exercise

• vision problems gender
• multiple medications social class
• chronic medical conditions poor housing
• hypothermia poor heating
• malnutrition poor footwear
• age
• exercise may not have a major effect

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Modifiable with tailored exercise

• low strength depression
• low power postural hypotension
• poor gait cognitive impairment
• poor mobility urinary urgency
• poor balance fear of falling
• arthritis
• exercise is likely to have
• a major positive effect

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How can we identify older people at high risk of
falling?

• AGS/BGS guidelines - get up and go test as a
  filter for a full assessment by a specialist
  clinician for people who have fallen at least
  once. J Am Geriatr Soc 2001 49 664 672.
• Falls Risk Assessment Tool (FRAT)
• 5 questions to assess risk. J Public Health
  2004 26138-143.

?? Usefulness in residential/nursing settings
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FRAT - Assessment of falls risk in older people
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PROFET targeting risk factors (Close et al.
Lancet 1999)

• Referral / intervention
• Day hospital
• GP
• O/P
• Optician
• Social services
• Supply minor equipment

• Medical assessment
• General medical
• Postural hypotension
• Visual acuity
• Balance
• Cognition and affect
• Corotid sinus syndrome
• Occupational Therapy
• Function
• Physical handicap
• Psychological handicap
• Environmental hazards

The rate of falls was reduced by 60
15
Tinetti (1994) - Multifactorial
The rate of falls was reduced by 30