Falls in Elderly Presented by Dr. Soad H. Abd El Hamid El Tantawy

1. Falls in Elderly Presented by Dr. Soad H. Abd El Hamid El Tantawy Lecturer of Gerontological Nursing Faculty of Nursing Mansoura University

2. Out lines: • Introduction • Definition of falls • Incidence of falls • Risk factors of falls • Consequences of falls • Management • Prevention

3. Falls in Elderly • Falls in older adult are not brief interruption in activity as they are younger persons but potentially life- threatening events and may be simply the first signs of single problem. • Moreover it lead to hospitalization and increase cost and burden on society and even lead to death .

4. Definition of Falls • Falls is an event which result in a person coming to rest on the ground or another lower level with or without loss of consciousness or injury.

5. Incidence of falls • Falls are the sixth leading cause of death in older adults. • About 25% of person aged 70 years .It increase to 35% for people aged 75 years and older . • Between one –half and two third of institutionalized elderly people experience fall every years . • Falls occur approximately 25 to 33% of community dwelling older adult • 50 to 67% of nursing home resident experience falls.

6. Risk factors of falls A-Intrinsic risk factors: • Age Related changes • Diseases (medical problems). • Female sex .

7. 1-Age related change • Visual function • Neurological function • Musculoskeletal function

8. 2-Disease • Sensory • Neurological • Musculoskeletal system • Cardiovascular disease • Gastrointestinal system • Metabolic • Psychological

9. B- Extrinsic risk factors • Drugs: • Such as cardiac medication, CNS depressant, laxative, antihypertensive, Narcotic, Chemotherapy drugs, narcotic and oral hypoglycemic . • Environmental • Improper assistive devices

10. Consequence of falls • Physical consequences: • Skin tear and internal bleeding, subdural hematoma. • Falls result in physical injures, disability and death • Sever injures that require hospitalization. • Hypothermia, dehydration, bronchial pneumonia and pressure damage to the skin . • Hip fracture one of the most serious injures resulting annually more than 233,000 hip fracture . • Immobilization

11. Psychological consequences • Fear of falling can itself be debilitating. It can lead to restricted activity, decreased exercise, eventually to increased dependency, depression, anxiety, loss of confidence, social withdrawal and institutionalization. Older adults who fall may or may not experience psychological trauma post fall (falls phobia syndrome) one significant consequences of falling may be fear of falling aging . • Economic consequences

12. Managements • Assessment : 1-History of falls''SPLATT" • Symptoms ' dizziness or vertigo, palpitation, chest pain '' • Previous fall '' during past year '' • Location . • Activity at time of falls . • Time of fall. • Trauma or injury with fall

13. 2-Physical examination • Sensory examination ' visual acuity , fields , cataracts, glaucoma , hearing loss • Cardiovascular examinations 'arrhythmias , heart failure . • Neurological examination 'mental status, mood and behavior. • Musculoskeletal; examinations muscle weakness severe arthritis, limited range of motion • Mobility evaluation . • Balance • Gait transfer (wheel chair patient )

14. 3- Environmental assessment: Lighting, walking surface, furniture, clothing, and equipment 4-Mental and Affective testing: As indicated formal cognitive and affective function should be evaluated . 5- Laboratory /diagnostics testing: Any laboratory or diagnostics tests should be tailored to be the suspected underlying cause of the falls for example anemia, electrolyte imbalance, dehydration, arrhythmia, screening for osteoporosis using bone mineral density techniques , complete blood count , X-ray , ECG .

15. Prevention 1-Intervention for predisposing factors: • Educate patient how to use assistive devices • Educate patient about arising slowly (count 30 , changing position • Maintain adequate hydration and provide small frequent meals rest periods after meal , give antihypertensive medications after meals • Educate patient about signs and symptoms of hypoglycemia and need to carry concentrated sugar , • Regular eye examination

16. 2-Enviromental modification: • Provide adequate lighting in rooms and hallways with switches located at room entrance • Use nights keep flashlights, keep flashlight in beside table in case o9f power failure • Arrange furniture so that pathway are not obstructed • Provide stable furniture along pathway for balance and support • Provide nonskid rugs and carpets runners on slippery floors , use non –skids floor wax , wipe up spills immediately

17. Use elevated toilet seat or install toilet safety frame • Apply nonskid mat on tub floors • Provide handrails on both sides of bathroom

18. 3-Rehabilitation: • Adequate rehabilitation physically, socially, and psychologically of injured person is very important post fall.

19. Thank you