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Balance and Falls
Geriatrics
| Question | Answer |
|---|---|
| What is involved in balance? | Visual, vestibular, somatosensory and musculoskeletal. maintain balance, reaction time, postural sway, vestibular righting response. |
| How does a person typically regain balance? | ankle, knee, hup, step. |
| How many individuals 65 and older fall each year?? | 30% |
| How many people suffer moderate to severe injuries? | 20-30% including hip fractures, head tauma. |
| Does risk increase or decrease with age? | Increase steadily after 25 |
| What are common causes of falls? | Decline in sensory, slow reaction time, decreased strength, flexibility, medications,specific diseases, postural changes, incontinence, demands of the task. |
| How are medications the a cause of falls? | side-effects, more than 3/4 medications it increases your risk.... diuretics, anti-depressions, antihypertensice sedatives, alcohol |
| What diseases are a cause of fall? | Diabetes, OA, Parkinsons, hypertension, CVA Dementia. |
| What predicts fear of falling? | Contributes to fall risk, female gender, gait disorder, impaired physical function use of an AD, previous alls and depressive sympotms predict FOF |
| What is more common outdoor or indoor falls? | outdoor are almost as common as indoor |
| Who is likely to fall outdoors? | male, younger age, depressive, psychotropic medications, moderate to high alcohol consumption, gait speed, participating in leisure time/physical activity. |
| What are some of the reasons for outdoor falls? | streets and sidewalks, stairs (last step is typically higher), curbs, parking lots and garages, parks- distractions |
| Falling in the neighborhood | The built environment contributes to precieved fall risk and fear of falling |
| How can people use strategies to adapt fall risks? | avoid grates/manhole covers, ask stranger to hold arm while crossing the street, use crossing guards, ask people to hold doors, walking slowly, not using cellphone |
| What are seniors perceptions of fall risks? | recognized as important and preventable but not viewed as personally relevant. Encironmental features are percieved as likely causes of falls but not other factors. |
| Consequences of falls? | physical injures, long lies (on floor) risk for dehydration, rabdomylesis: muscle wasting, increases likelihood of increased dependency and institutionalization. social isolation |
| American and British geriatric guidelines suggest | any older person who has fallen should have an assessment of their gait and balance. if they present for an injury they should have had a fall risk assesment. |
| AGS/BGS Clinical guidelines | focused history, physical function tests, functional assessment, environmental assessment |
| Falls Efficacy Scale International (FES-I) | measures concern about falling during physical and social activity- Fear of falling |
| FES-I | a likert scale ranging from not at all concerned to very concerned. Examples include- walking on un even surface, getting p from a chair, taking a path, going shopping |
| Timed Up and Go (TUG) | Measure of physical ability |
| TUG | client stands up from chair, walks 3 meters comes back. If it takes mores than 30 seconds they need a mobility devices. will need help with ADLS, moderate fall risk. For higher functioning clients its not that great for fall risks |
| Functional Reach test | assess fall risk- if at less than or equal to 6 inches |
| Berg balance test | fourteen item assessment of balance. If score changes by 4 or 5 that there is an improvment in balance. |
| FROP-Com Screen | original version looks at medication, sensory loss, designed to be used by any health professional in home, hospital or primary care setting. |
| FROP-Com Screen Abbreviated | Assesses fall risk- looks at fall history, balance, and ADL. |
| CDC- Fall prevention checklist | in public domain, may be done by family. |
| In Home Occupational Performance Evaluation (I-HOPE) | measures the magnitude of environmental barriers on occupational preference. Shows 44 cards- asked to sort into I dont do/dont want to.. I do now with no problem or with dificulty... I dont do but like to do. |
| Prevention and Intervention? | hip protectors, exercise, home assessments, environmental adaptions assistive devices, personal assitance, medication change, life alert |
| Stepping On | community based, multi-factoral occupational therapy led 7-week program with follow-up visit & 3 month booster |
| What does stepping on consist of | groups including: balance and strength, home hazards, community saftey, footware, vision, vitamins, hip protectors, medication managment |
| How much did stepping up reduce? | 31% falls |
| Cochran Review | home evaluation effective for those with low vision and those at high risk |
| What does a multi-component exercise programs should include | at least 2 of: strength training, balance training, flexibility, and endurance training. |
| Is tai chi efffected in reducing risk of falls? | yes but not for those who are at high risk. |
Created by:
crystalfmulligan