Question | Answer |
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 |