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Balance and Falls

Geriatrics

QuestionAnswer
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