1 / 18

Prevention of Falls in the Geriatric Patient & the TUG test

Prevention of Falls in the Geriatric Patient & the TUG test. Julie Smith PA Class of 2009 Advisor: Professor Fahringer. The Facts. Falls can occur and any age, but drastically rise after the age of 65 1/3 of adults over 65 years of age fall each year in developed countries

nat
Download Presentation

Prevention of Falls in the Geriatric Patient & the TUG test

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Prevention of Falls in the Geriatric Patient & the TUG test Julie Smith PA Class of 2009 Advisor: Professor Fahringer

  2. The Facts • Falls can occur and any age, but drastically rise after the age of 65 • 1/3 of adults over 65 years of age fall each year in developed countries • Falls are the leading cause of fatal and nonfatal injuries in people 65 and older in the United States. • The most common serious injuries are head injuries, wrist fractures, spine fractures, and hip fractures. • 60% of falls occur at home, 30% occur in the community and 10% occur in nursing homes or other institutions.

  3. More Facts • Tripping in the home is a cause of many falls • Falls account for 80% of all injury related admissions to the hospital of people over 65 years of age worldwide • Fractures accounted for only 35% of non-fatal injuries but 61% of the total costs related to falls • Lower extremity injuries > Upper extremity injuries

  4. Hip Fracture Statistics • 90% of 352,000 hip fractures in the United States each year are the result of a fall. By the year 2050, there will be an estimated 650,000 hip fractures annually. This is nearly 1,800 hip fractures a day. • The cost of hip fracture care averages $35,000 per patient. • Women have two to three times as many hip fractures as men. • White, post-menopausal women have a 1 in 7 chance of hip fracture during a lifetime. The rate of hip fracture increases at age 50, doubling every five to six years.

  5. More Hip Fracture Statistics • The risk of hip fracture for women 5'8 " or taller is twice that of women who are under 5'2. " • Nearly one half of women who reach age 90 have suffered a hip fracture.

  6. The Really Scary Statistics * ONLY 25% of hip fracture patients will make a full recovery * 40% will require nursing home care * 50% will need a cane or walker • And …. * 24% of those over age 50 will die within 12 months.

  7. Who is Falling? • Women fall 2-3 times more than men • Women’s healthcare costs associated with falls were 2-3 times higher than men’s costs overall • 15% of people who have fallen, fall again

  8. Why do we Fall? • Home Hazards, throw rugs • #1 Reason in the home to fall….. is Tripping or slipping due to loss of footing or traction • Medication side effects, iatrogenic • Reduced muscle strength • Poor vision/Ear dysfunctions/Vertigo • Balance problems • Osteoporosis? Fracture then fall?

  9. Geriatric robbery • Loss of quality of life • Loss of independence • Premature entrance to a nursing home • Premature death • Extremely expensive>many can lose house, savings, drivers license, etc…

  10. Risk Factors • Age and Gender • Heredity> DEXA Scan to r/o osteopenia and osteoporosis • Women > Men • Home hazards • Medication, regularly review necessary and unnecessary meds • History of Falls • Peripheral Neuropathy • Ear/Eye dysfunctions

  11. What can we do in the office? • Ask about fall hx, screen in patient hx forms • Review Medication list • Assess fall risk • Refer to Physical Therapy

  12. Assessing Fall Risk • Can we assess Fall risk? • Is it accurate? Is it functional? • Tinnetti Test • Berg Test -balance • Timed Up & Go

  13. The Timed Up and Go Test aka “ TUG“ Test • Quick & Easy for provider & patient Need : a chair with arms a person, and 10 feet measured out -consider hallway How to do it: Patient sits in a chair with arms, you ask them to rise from the chair, walk 10 feet, turn around, walk back to the chair and sit back down. Patient is allowed to use a walking aid and glasses if normally used. Video: www.youtube.com http://www.homehealthquality.org/hh/hha/interventionpackages/falls_prevention.aspx • Goal: Less than 12 seconds = independent • >12 seconds to complete= Risk for Falls • TUG with an obstacle

  14. Additional Test • Single Leg Stance • 30 seconds is a general goal • Try eyes open and closed • Everyone should try this!!

  15. Fall Prevention Tips 1. Take a Fall History 2. Medication review: • benzodiazepines • sleeping aids • neuroleptics • antidepressants • seizure meds 3. TUG TEST – shoot for <12 sec If >12 sec, walking aid, PT, patient education 4. Visual acuity <20/60 puts at risk for depth perception deficits. Refer if needed Ear checks- ear infections, vertigo symptoms 5. Bone density: Family hx, Dexa scans and Treat: Calcium, Vit D, Fosamax • 6. Home hazard safety - communication with patient and family to eliminate hazards • 7.Gait dysfunctions: Abnormal gait, improper use of walking aids lead to falls, Refer to PT • 8.Musculoskeletal abnormalities/weakness, Refer to PT for strengthening • 9. Impaired neurological exam, DM patients with peripheral neuropathies, - Refer for EMG, PT • 10. Medic Alerts especially for those living alone

  16. Eliminate or secure all throw rugs with non-slip pads Assess lighting, and have nightlights for evening bathroom trips Install hand rails in bathrooms and stairways Remove clutter on floors and stairways, cords especially Always wear shoes or slippers with rubber soles Non-skid surface in bathtubs and showers Evaluate thresholds for potential tripping dangers Shower chairs and bedside commodes are helpful Easy access to contact and emergency numbers Slow changes in positions from lying to sitting to standing Sit in chairs with arms No high heels ladies! Proper use of walking aids include actually using them Ear infections and eye problems can lead to falls Report any side effects from medications involving dizzines Stay active and practice a good nutritional diet Take medicine as instructed Patient Education

  17. The Bottom Line • IT’S A BAD THING!! • BUT, YOU CAN MAKE A DIFFERENCE • GIVE OUR ELDERS A CHANCE TO TAKE THE RIGHT STEPS

  18. References • 1. Demura S, Uchiyama M. Proper assessment of the falling risk in the elderly by a physical mobility 2. Elley CR, Robertson MC, Kerse NM, Garrett S, McKinlay E, Lawton B, et al. Falls assessment clinical trial (FACT):design, interventions, recruitment strategies, and participant characteristics. BMC Public Health 2007, 7:185. available from:http://www.biomedcentral.com/1471-2458-7-185. • 3. Fatalities and injuries from falls among older adults---United States, 1993-2003 and 2001-2005. MMWR Weekly Report Nov. 17, 206/55(45);1221-1224. • 4. Healey F, Monro A, Cockram A, Adams V, Heseltine D. Using targeted risk factor reduction to prevent falls in older in-patients:a randomized controlled trial. Age and Ageing 2004;33:390-395. • 5. Kannus P, Khan KM, Lord SR. Preventing falls among elderly people in the hospital environment. MJA 2006;184 (8):371-373. • 6. Laessoe U, Hoeck GC, Simonsen O, Sinkjaer T, Voigt M. Fall risk in an active elderly population-Can it be assessed? Journal of Negative Results in BioMed 2007, 6:2. • 7. Lord SR, Menz HB, Sherrington C. Home environment risk factors for falls in older people and the efficacy of home modifications. Age and Ageing 2006; 35-S2 ii55-ii59. • 8. Mansfield A, Peters A, LLiu B, Maki B. A perturbation-based balance training program for older adults:study protocol for a randomized controlled trial. BMC Geriatrics 2007, 7:12. available from :http:/www.biomedcentral.com/1471-2318/7/12. • 9. Melzer I, Benjuya N, Kaplanski J. Postural stability in the elderly:a comparison between fallers and non-fallers. Age and Ageing 2004;33;602-607. • 10. Nordvall H, Gunhild Glanberg-Persson, Lysholm J. Are distal radius fractures due to fragility or falls? Acta Orthopaedica 2007;78:(2):271-277. • 11. Ozcan A, Donat H, Gelecedk N, Ozdirenc M, Karadibak D. The relationship between risk factors for falling and the quality of life in older adults. BMC Public Health 2005, 5:90. available from:http://www.biomedcentral.com/1471-2458//5/90 • 12. Peeters GE, deVries OJ, Elders PJ, Pluijm SM, Bouter LM, Lips P. Prevention of fall incidents in patients with a high risk of falling:design of a randomized controlled trial with an economic evaluation of the effect of multidisciplinary transmural care. BMC Ger. 2007, 7:15. available from :http://www.biomedcentral.com/1471-2318/7/15. • Shinichi Demura and Masanobu Uchiyama “Proper Assessment of the Falling Risk in the Elderly by a Physical Mobility Test with an Obstacle”. Tohoku J. Exp. Med., Vol. 212, 13-20 (2007) . • 13. Stenvall M, Olofsson B, Lundstrom M, Englund U, Borssen B, Svensson O, et al. A multidisciplinary, multifactorial intervention program reduceds postoperative falls and injuries after femoral neck fracture. Osteoprorosis Int. 2007, 18:167-175. • 14. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj. Prev. 2006;12;290-295. • 15. van Schoor NM, Smit JH, Twisk JR, Bouter LM, Lips P. Prevention of Hip fractures by external hip protectors. JAMA, April 16, 2003-vol289, No. 15, p1957-1962. • 16. Vassallo M, Sharma JC, Briggs RSJ, Allen SC. Characteristics of early fallers on elderly patient rehabilitation wards. Age and Ageing 2003;32:338-342. • http://orthoinfo.aaos.org/topic.cfm?topic=A00121 • VIDEO http://www.youtube.com/watch?v=xx1XCpglOc

More Related