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Gerontology Mod07

Falls in the Older Adult

Falls are an inevitable consequence of aging. T/F False. May be due to physical dysfunction, medications, environmental hazards
How many of those 65+ experience a fall related incident per year? >1/3. Rate is as high as 44% per year
How much greater is the risk for nursing home residents vs community dwelling older adults? 3 times greater
Falling in the past 6-12 months is a risk factor in falls. What % have falls more than once per year? 40%
Falls are the leading cause of injury, death, and disability for those over 65. Fall related injures occur how often with falls? ~15% of falls result in injury
What % of older individuals who remain on the ground after a fall for longer than 6 hours died within 6 months? 50%
What is typically observed with falls during the months preceding death? Clustering of fall occurances
What are the most common places for falls to occur at home? Stairs, to and from the bathroom, and in the bedroom. 85% of falls occur at home.
Intrinsic risk factors for falls. (11) Frail, Alzheimer's disease, Parkinson's disease, stroke, depression, RA, hip fx, LE amputation, weakness, altered vision, FOF
Extrinsic risk factors for falls. Environment (ie. dim light, floor coverings, pets, footwear). Extrinsic factors contribute to up to 37% of all falls.
Extrinsic risk factors make up what % of falls that require medical assistance? ~50%. These risk factors effect more mobile older adults.
Institutional extrinsic risk factors. (3) Time of day, staffing levels on nursing floor, and room distance form nurses' station
Other risk factors for falls. (6) Poor health status, impaired mobility from inactivity or chronic illness, postural changes or instability affecting COG, limitations in ROM or joint mobility, coordination problems, and gait deviations.
Hirase 2014 "7 Risk Factors for Falls" 1) Fall in the past year 2) Cross the street without resting 3) Walk an entire kilometer 4) Put on socks while standing on 1 leg 5) Admitted self to hospital in past year 6) Ever had a stroke &) Have a FOF or avoid going out due to FOF
Falls and near falls can generate what psychological factors? Fear, anxiety, and loss of confidence.
Tinetti's definition of FOF "Lasting concern about falling that leads to an individual avoiding activities that the person remains capable of performing"
Excessive FOF with activity limitation can lead to: Loss of mobility, decreased social stimulation, and loss of strength and function.
FOF results in what activity modifications? Limited activities or guarded during activities, altered gait habits, or inactivity.
FOF can be caused by reasons other than suffering a fall. T/F True. FOF can be caused by knowing someone that has fallen.
A use of ________ or more prescription medications is a possible risk for falling. 4
The postural control system (PCS) receives information from what systems? Receptors in propioceptive, visual, and vestibular.
3 strategies used to maintain balance. Ankle, hip, and stepping strategies.
Impairments in what 2 things are significantly related to gait speed variability? dynamic balance and upper extremity mobility
Gait speed is a strong predictor for fall risk and disability. After age 60 gait speed declines at what rate per decade? 12-16%
What is the minimum gait speed to be independent with all ADLs? 1.0 mph. Persons will be dependent on 1 or more ADLs with a gait speed < 1.0 mph.
Optimal control of balance is maintained up until what age? 60
There is a 50% increase in latency in older adults from sensory integration. Causing them to increase their usage of what strategy? Stepping strategy
Vestibular system plays a major role in control of COG position when there is a conflict between visual and somatosensory information. T/F True. It plays a minor role when somatosensory and visual information are adequate though.
The vestibular system assists in stabilizing gaze during head and body movements by _____. Generating conjugate smooth eye movements opposite in direction and ~ equal velocity to head movements.
4 basic domains of fall assessment 1) Specific patterns and injuries 2) Physical function and functional activity level 3) Psychological consequences 4) health related quality of life
Examples of screening tools for frail elderly? New patient? TGUG for frail elderly. Morse Fall Scale for new patients
Medications most commonly associated with falls by community dwelling older adults Benzodiazepines, beta-blockers, and diuretics
3 age related changes that increase adverse reactions to medications. Altered drug metabolism and absorption, changes in distribution, and elimination.
Morse Fall Scale (Location of use, time to do, scoring, limitations) Used in VA and acute care settings. Takes < 3 minutes 0-24 no risk, 25-45 moderate risk, 46-125 high risk Does not take into account medications.
Timed Single Legged Stance (Location of use, time to do, scoring, limitations) Community dwellers ~30 seconds Norm 10 sec with EO Sensitive to clinical interventions
Berg Balance Scale (Location of use, time to do, scoring) Community dwelling adults and institutionalized adults 15 min to administer 0-20 w/c bound, 21-40 walking with assistance, 41-56 independent
Functional Reach Test (Scoring) < 25.4 cm 2x as likely to fall < 15.2 cm 4x as likely to fall 0 cm 8x as likely to fall
Modified Clinical Test of Sensory Interaction on Balance mCTSIB (Use, test, limitations) Assesses how well an individual can balance when 1 or more of their sensory inputs are compromised 1) solid, level surface EO 2) EC 3) Foam EO 4) Foam EC Limitations: can't discern patterns of sensory dysfunction, doesn't predict in community-dwellers
Physical Performance Test (Use, Time, Scoring) Screen for falls, frailty, and ADLs. Predict need for institutionalization and likelihood of death 10 min to administer 32-36 not frail, 25-32 mild, 17-24 moderate, <17 unlikely to function in community
Dynamic Gait Index (Use, Scoring) Effectiveness of intervention for community dwelling adults and vestibular disorders 8 aspects of gait scored 0-3 (3 normal) < 20 is a high risk for falls
Functional Gait Assessment (Use, Scoring) Reduces ceiling effect of DGI Good validity for PD Predicts falls within next 6 months 10 items scored fro 0-3 with higher total representing better balance and gait ability
5 Times Sit-to-Stand Test (Use, Scoring) Measures functional LE strength and dynamic balance Times > then norms are associated with increased disability and morbidity 12 sec 60-69; 13 seconds 70-79; 15 seconds 80-90
Timed Up and Go (Use, Scoring) Designed for frail adults > 14 sec in community dwelling adults associated with a high fall risk > 30 in frail older adults = require assistive device for ambulation and dependent in ADLs
Performance-Oriented Mobility Assessment POMA (Scoring) Observe gait and balance Balance scale 9 items total score out of 16 Gait scale 8 items total score out of 12 Risk of falls >24 Low 19-24 Medium <19 High
Psychosocial screenings for fall risk FOF, depression, and cognitive impairment
Falls Efficacy Scale (FES) Elderly in long-term care Self reported scores for 10 ADLs (1 - totally confident to 10 - no confidence) Average > 6 indicative of FOF
Modified Falls Efficacy Scale (MFES) 4 outdoor activities added to FES Use visual analog scale 0 = not confident 10 = completely confident Average < 8 indicates FOF
Survey of Activities and Fear of Falling in the Elderly (SAFE) 11 items representing ADLs and IADLs Activity level scale 0 = no 1 = yes FOF scale 0 = not worried 3 = very worried Higher scores = > FOF
Activities specific Balance Confidence Scale (ABC) Self-report measure of balance confidence 16 items rated from 0% - no confidence to 100% - complete confidence < 50 low level of functioning 51-80 medium level of functioning > 80 high level of functioning Better than FES on high vs low mobility pts.
Depression and falls Can be a contributor to and a result of falls
Center for Epidemiological Studies Depression Scale (CES-D) self-report scale to assess depression not used to make a diagnosis 20 statements to reflect pt's feelings in previous week Max score 60 >21 major depression 15-21 mild to moderate depression < 15 absence of depression
Geriatric Depression Scale (GDS) Long form: 30 item questionnaire 5-7 min to complete Short form: 15 questions 0-4 normal 5-8 mild depression 9-11 moderate 12-15 severe
Mini Mental State Exam (MMSE) < 24 indicates cognitive decline
Cornerstone of management of balance disorders Balance re-organization strategies
Fall interventions should promote orientation, gaze stabilization, postural realignment, muscle strength, and joint mobility
Fall prevention program and safety education 1) Identify fall risks 2) Safety in the home and environmental adaptations 3) Allow plenty of time for functional activities 4) Test for postural hypotension
Flexibility exercises for fall prevention Ankle flexibility important for proprioceptive efficiency of ankle joint receptors
Balance exercises 1) Postural control or response to perturbations 2) Weight shifting 3)Anticipatory adjustments to limb movements
1st Motor Response (<50 ms) Spinal cord = automatic reflexes Impulse Technique Isometric Stabilization (ITIS) - medicine ball, perturbations Oscillating Technique Isometric Stabilization (OTIS) - band resistance, body blade
Impulse Technique Isometric Stabilization (ITIS) Quick and repetitive loading and unloading Facilitates mechanoreceptors which stimulate joint proprioceptors and reflex adaptation
Oscillating Technique Isometric Stabilization (OTIS) Stimulates mechanoreceptors and muscle spindle activity Leg is stabilized it reacts to weight shifting generated by the arms increasing proprioception
2nd Motor Response (70 -120 ms) Brainstem = facilitates co-contraction Bilateral > SLS > EO > EC Stable > unstable > Head turning
Placing band around the forefoot for monster walks has what action? Selective enhancement of gluteal muscles vs TFL by adding ER to the hips
Tai Chi Participants >70 3x/week for 6 months significantly decreased # of falls, reduced FOF, and improved functional balance and physical performance
Created by: jpwittman