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Falls and Stroke

Falls and Stroke. Central South Regional Stroke Program September 2007 Funded by the Ministry of Health and Long-Term Care. Session Overview. The types of stroke. The common changes that result from stroke. The link between stroke and falls.

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Falls and Stroke

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  1. Falls and Stroke Central South Regional Stroke Program September 2007 Funded by the Ministry of Health and Long-Term Care

  2. Session Overview • The types of stroke. • The common changes that result from stroke. • The link between stroke and falls. • What factors put a resident at risk of falling • Strategies to prevent a resident from falling

  3. What is a Stroke • An interruption of the supply of blood and oxygen to an area of the brain. • This causes the brain cells in an area to die, and reduces the brain function in that area. • The area of the body controlled by the damaged area in unable to function properly. • There are two types of stroke. http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/stroke-vasculaire_e.html#ef

  4. What is a Stroke? A stroke can happen when a blood clot blocks a blood vessel in the brain. 80% of strokes are this type. A Guide to Understanding Stroke, Heart and Stroke Foundation of Canada, 1996

  5. What is a Stroke? A stroke can also happen when a blood vessel breaks and results in bleeding in the brain. 20% of strokes are this type. A Guide to Understanding Stroke, Heart and Stroke Foundation of Canada, 1996

  6. High blood pressure High blood cholesterol Heart disease Diabetes Being overweight Excessive alcohol use Physical inactivity Smoking Stress Risk factors you can do something about… Pearson et.al., (2002) AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases Circulation, 106, 388-391.

  7. What does a resident who has had a stroke look like in LTC?

  8. What are some of the losses due to stroke? • paralysis or weakness on one side of the body; • vision problems (double vision); • trouble speaking or understanding language; • Difficulty swallowing safely. http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/stroke-vasculaire_e.html#ef

  9. What are some of the losses due to stroke? • inability to recognize or use familiar objects • tiredness; • depression; http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/stroke-vasculaire_e.html#ef

  10. What are some of the losses due to stroke? • exaggerated or inappropriate emotional responses; • difficulty learning and remembering new information; and • changes in personality. http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/stroke-vasculaire_e.html#ef

  11. Stroke Statistics • There are between 40,000 and 50,000 strokes survivors in Canada each year. • 10% (4-5,000) of strokes survivors each year require long-term care. • 40% (16-20,000) of strokes survivors each year are left with a moderate to severe impairment. http://ww2.heartandstroke.ca/Page.asp?PageID=33&ArticleID=1078&Src=news&From=SubCategory

  12. Falls

  13. Falls in Canada • In Canada,falls are the sixth leading cause of death among older adults(RNAO Best Practice Guidelines, Falls and Restraints, 2002) • 33% of older adults fall each year (Campbell, Borrie & Spears, 1989). • 36% of those who fall develop serious injuries (Koski, Luukinen, Laippala & Kiveal, 1998) • 40% of admissions to nursing homes are the result of falls (Tinetti, Speechley & Ginter, 1998).

  14. Increased falls happen in LTCHs because: People tend to be more: • frail and older •  chronic illnesses •  difficulty walking •  thinking or memory, •  independence with activities of daily living, (Bedsine et al. (1996) Medical care of the nursing home resident. Philadelphia (PA): American College of Physicians. (Ejaz et al. (1994) Falls among nursing home residents: an examination of incident reports before and after restraint reduction programs. Journal of the American Geriatrics Society, 42, 9:960-4.

  15. Falls related to stroke • Poor balance • Divided attention • Impulsivity • Slowed response times • Inability to walk • Weakness • Gait problems •  spatial understanding of the world deficits •  ability to coordinate body movement • Mental dysfunction Hyndman et.al., (2004) Stops walking when talking as a predictor of falls in people with stroke living in the community Journal of Neurology Neurosurgery Psychiatry; 75:994-997 Ugar et.al., (2000) Characteristics of falling in patients with stroke. Journal of Neurology Neurosurgery Psychiatry. 69, 649-651

  16. Other causes of falls • Dizziness • Accidents • Environment factors • Wet floors • Poor lighting • Bed rails and improper bed height •  blood pressure • Sudden loss of consciousness • Acute illness • Medication side effects Rubenstein et.al., (1994) Falls in Nursing Homes Annals of Internal Medicine. 121, 6:442-451.

  17. What is balance? Balance is the ability of a person not to fall. Gustavsen, Marit, Aamodt, Geir and Mengshoel, Anne Marit (2006),'Measuring balance in sub-acute stroke rehabilitation', Advances in Physiotherapy, 8:1, 15 - 22

  18. Balance is important because it is involved in day-to-dayactivities, such as getting up from a chair, walking and bending over to pick up something. Gustavsen, Marit, Aamodt, Geir and Mengshoel, Anne Marit (2006) 'Measuring balance in sub-acute stroke rehabilitation', Advances in Physiotherapy, 8:1, 15 - 22

  19. Balance can be improved. Significant improvement in balance, mobility, and gait can be made after a stroke. Garland SJ. Willems DA. Ivanova TD. Miller KJ. Recovery of standing balance and functional mobility after stroke. Archives of Physical Medicine and Rehabilitation. 2003 Dec; 84(12): 1753-9.

  20. Early signs of fatigue • Foot dragging • Increased leaning to one side • Walking hunched over on the walker or leaning heavily on the walker • Decreased balance – wobbly Michael et.al., (2006) Fatigue After Stroke: Relationship to Mobility, Fitness, Ambulatory Activity,... Rehabilitation Nursing; Sep/Oct 2006; 31, 5; ProQuest Nursing & Allied Health Source pg. 210

  21. Strategies • Note on medical chart or resident’s door that there is a high risk of falls • Move high-risk residents to rooms close to the nursing station to increase observation • Reassess after new episodes of illness or, change in meds. • Lower side rails for those that climb out of bed. Rubenstein et.al., (1994) Falls in Nursing Homes Annals of Internal Medicine. 121, 6:442-451.

  22. Strategies • Increase staff to resident ratio. • Attend falls prevention education. • Use alarm systems when residents move unassisted • Use protective hip pads Rubenstein et.al., (1994) Falls in Nursing Homes Annals of Internal Medicine. 121, 6:442-451.

  23. Always remember that you can request an OT/PT referral from CCAC if you need assistance with finding the right strategy.

  24. Remember to encourage the residents to ask for assistance.

  25. CASE STUDY

  26. Sue Sue has just arrived to Cozy Acres long term care home from hospital. Sue was recently admitted for management of stroke. What are some of the concerns you might have regarding Sue’s ability to remain safe upon arrival at the long-term care home?

  27. Sue Later when you are able to review Sue’s transfer information, you are aware that Sue had fallen 3 times prior to her transfer to Cozy Acres. Sue walks with a four wheel walker and requires some hands on assistance to keep her balance. Sue is impulsive and is not aware that her lack of balance may cause her to fall and possibly hurt herself. Sue’s family is very concerned about her falls and the potential to hurt herself. What is your plan to maximize Sue’s safety?

  28. Next Steps… • You are the eyes and ears of your facility • Be aware of the diagnosis of your residents • Take this information and use it with the residents that you work with. • Share this information with other staff.

  29. More Information • Acute Changes and Stroke • Continence and Stroke • Dementia and Stroke • Falls and Stroke • Pain and Stroke Please contact: Rebecca Fleck or Kim Young Community and Long Term Care Specialist Central South Regional Stroke Program 905-521-2100 x 44127

  30. Acknowledgements • Best Practices Long-term Care Advisory Group • Best Practices Long-term Care Evaluation Group • Best Practice Falls Working Group, Waterloo • Mary-Lou van der Horst, Regional Best Practice Coordinator Long-Term Care Central South Region • Wendy MacDougal, Regional Best Practice Coordinator Long-Term Care Central West. • Beverley Morgan, Project Coordinator, RNAO Best Practice Guidelines, Hamilton Health Sciences • Central South Regional Stroke Program • Maryann Watts, Hamilton Health Sciences, Clinical Manager Neuro-ambulatory Centre • Melanie Fall Stratton, Regional Stroke Program, Program Manager, • Kim Young, Regional Stroke Program, Community and Long-term Care Specialist • Lisa Colizza, Regional Stroke Program, Regional Stroke Development Specialist • Nancy van Essen, Regional Stroke Program, Stroke Rehabilitation Coordinator • Carol Pereira, Regional Stroke Program, LTC Project Coordinator

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