Falls


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Defination Of Falls:

Falls is an event which result in a person coming to rest on the ground or another lower level with or without loss of consciousness or injury.

Incidance Of Falls In Elderly:

•                Falls are the sixth leading cause of death in older adults.
• About 25% of person aged 70 years .It increase to 35% for people aged 75 years and older .
• Between one –half and two third of institutionalized elderly people experience fall every years .
• Falls occur approximately 25 to 33% of community dwelling older adult 50 to 67% of nursing home resident experience falls.
  

Epidemiology of Falls in the Elderly

From 1992 through 1995, 147 million injury-related visits were made to emergency departments in the United States.1 Falls were the leading cause of external injury, accounting for 24 percent of these visits. Emergency department visits related to falls are more common in children less than five years of age and adults 65 years of age and older. Compared with children, elderly persons who fall are 10 times more likely to be hospitalized and eight times more likely to die as the result of a fall.

Annually, 1,800 falls directly result in death.Approximately 9,500 deaths in older Americans are associated with falls each year.

Elderly persons who survive a fall experience significant morbidity. Hospital stays are almost twice as long in elderly patients who are hospitalized after a fall than in elderly patients who are admitted for another reason.Compared with elderly persons who do not fall, those who fall experience greater functional decline in activities of daily living (ADLs) and in physical and social activities,and they are at greater risk for subsequent institutionalization.

Risk Factors Of Falls:

Falls are often caused by a number of factors. The faller may live with many risk factors for falling and only have problems when another factor appears. As such, management is often tailored to treating the factor that caused the fall, rather than all of the risk factors a patient has for falling. Risk factors may be grouped into intrinsic factors and extrinci factors.

Intrinsic risk factors:

• Age Related changes                                                    

                         Visual  deficts

                          Neurological function

                         Musculoskeletal function

• Diseases (medical problems).

                         Sensory
                         Neurological
                       Musculoskeletal system
                       Cardiovascular disease
                       Gastrointestinal system
                       Metabolic
                       Psychological
                       

• Female sex .

Extrinsic factors:

• Drugs:

      (Such as cardiac medication, CNS depressant, laxative, antihypertensive, Narcotic, Chemotherapy drugs, narcotic and oral hypoglycemic) 

• Environmental
• Improper assistive devices

Preventions Of Falls:

The scope for prevention can be appreciated by considering some of the common conditions and risk factors predisposing to falls in the elderly. From this, the wide range of preventative measures and treatment possibilities can be appreciated. Falls should be considered a symptom rather than a diagnosis, so that when a patient, usually an elderly person, presents with a history of falls, effort should be made to find the cause or causes.

1. Exercise regularly. It is important that the exercises focus on increasing leg strength and improving balance, and that they get more challenging over time. Tai Chi programs are especially good.
2. Ask their doctor or pharmacist to review their medicines—both prescription and over-the counter—to identify medicines that may cause side effects or interactions such as dizziness or drowsiness.
3. Have their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision. Consider getting a pair with single vision distance lenses for some activities such as walking outside.
4. Make their homes safer by reducing tripping hazards, adding grab bars inside and outside the tub or shower and next to the toilet, adding railings on both sides of stairways, and improving the lighting in their homes.

Mangement Of Falls In Elderly:

Assement:

The strongest predictors of risk are previous falls, with injurious falls and a walking or balance difficulty increasing risk even further.Screening balance tests can help identify those with deficits who will benefit from an exercise program.

Key components of a multifactorial assessment include:

a detailed falls history, medication review, risk factor assessment including osteoporosis, urinary incontinence and cardiovascular disease
physical examination including gait and balance, neurological and cognitive function, lower limb strength, visual acuity, feet and footwear
functional assessment such as activities of daily living, perceived functional ability and fear of falling.

Physical examination

• Sensory examination ' visual acuity , fields , cataracts, glaucoma , hearing loss
• Cardiovascular examinations 'arrhythmias , heart failure .
• Neurological examination 'mental status, mood and behavior.
• Musculoskeletal; examinations muscle weakness severe arthritis, limited range of motion
• Mobility evaluation .
• Balance
• Gait transfer (wheel chair patient

 Environmental assessment

                                 Lighting, walking surface, furniture, clothing, and equipment

Mental and Affective testing

                                 As indicated formal cognitive and affective function should be evaluated .

Laboratory /diagnostics testing:

                                 Any laboratory or diagnostics tests should be tailored to be the suspected underlying cause of the falls for example anemia, electrolyte imbalance, dehydration, arrhythmia, screening for osteoporosis using bone mineral density techniques , complete blood count , X-ray , ECG

Recent Related Research (from Pubmed)


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