Falls in home-dwelling elderly

1. Falls in home-dwelling elderly Mieke Deschodt Center for Health Services and Nursing Sciences Katholiek Universiteit Leuven

2. Falls incidence In home-dwelling elderly 28% - 35% of people aged 65 or older fall at least ones a year 32% - 42% of people aged 75 or older 15% - 50% with two or more fall incidents per year (Masud & Morris, Age Ageing 2001; Tinetti, NEJM 2003; Milisen et al., Tijdschr Gerontol Geriatr 2004)

3. Falls incidence In institutionalized elderly (e.g. nursing home) 30-70% at least one fall incident a year 15-40% with 2 or more fall incidents Average number of falls per bed 1,4 in somatic institutions 2,2 in psychogeriatric institutions (NVKG & CBO richtlijn, 2004)

4. Fall incidents per season

5. Fall incidents per daily period

6. Indoor versus outdoor

7. At home versus not at home

8. Locations indoor

9. Impact on the older person • Physical impact (40% - 60%) • Minor injury: 30% - 50% • Bruises, cuts, tissue damage • Major injury: 10% - 15% • Fracture: 5% - 10%; • Hip fracture: 1% - 2%; • Soft tissue injury and head injury: 5% (AGS panel on falls prevention et al., JAGS 2001; Masud & Morris, Age Ageing 2001; Milisen et al., Tijdschr Gerontol Geriatr 2004; Tinetti, NEJM 2003)

10. Impact on the older person • Psychological impact: • Fear of falling again: 32% - 63% • Loss of self-confidence, loss of independency, social isolation, depression,… causes an increased risk of falling and a longer hospitalisation (AGS panel on falls prevention et al., JAGS 2001; Masud & Morris, Age Ageing 2001; Milisen et al., Tijdschr Gerontol Geriatr 2004; Tinetti, NEJM 2003)

11. Impact on the older person • Increased risk of mortalilty • Involuntary injury = 5th cause of death in people aged 70 years or older • Fall accidents = most important cause of involuntary injuries • Most important risk factor in older persons with osteoporosis for having a hip fracture • Hip fracture • 20% becomes immobile • only 14% - 21% regains full ADL-independency • 25% - 33% mortality risk in the first year (AGS panel on falls prevention et al., JAGS 2001; Masud & Morris, Age Ageing 2001; NVKG richtlijn & CBO, 2004)

12. Financial consequences • Increases use of sources • Institutionalisation = 3 x more ofter in fallers • Hospital admission as a result of falling increases 6 times from the age of 65 • Fall injury = most expensive category of all traumata in elderly (Englander et al., J Forensic Sciences 1996; Masud & Morris, Age Ageing 2001)

13. (Kneuzing, schaafwonde, …) €10.528 Increased age and institutionalisation before the fracture are the most important decisive factors for the additional cost (Haentjens et al. Disabil Rehabil 2005)

14. Falls Fall incident = result of a combination of Intrinsic risk factors Extrinsic risk factors Multifactorial problem multidisciplinary solution

15. Effectivity • Multifactorial evaluation followed by multifactorial interventions targeting on identified risk factors • In older persons with increased risk • = most effective • 25% to 39% reduction of fall incidents • Little/no proven effect on incidence of severe injuries • the risk profile of the older person has no influence on the effectivity • cave older persons with severe cognitive problems (e.g. dementia) • (Gillespie et al., Cochrane 2003; Tinetti, NEJM 2003; Chang et al., BMJ 2004; Kannus et al., Lancet 2005)

16. Inability to get up after a fall incident • 1 year follow-up of 90 women en 20 men (90+) at home and in an institution • 60% fell at least 1x/year • 82% of falls occured when the person was alone • 80% were unable to get up without help • > 95% has a personal alarm system, +/- 80% does not use the alarm system • 30% had lain on the floor for an hour or more • Pressure ulcers, dehydration, hypothermia, pneumonia, hospital admission, moving into long term care, death • Older persons need training in strategies to get up from the floor after a fall incident (Fleming et al. BMJ 2008)

17. Inability to get up after a fall incident • Cognitive impairment is the only characteristic that predicted lying on the floor for a long time • Need for developing an automatic fall detection system that is not depending on the (cognitive) capacities of the older person • (Fleming et al. BMJ 2008) • Building and validating a camera system for fall detection in home-dwelling elderly

18. Camera system • Alarm can be generated independently • No action needed of the person in contrast to the personal alarm system • In cases where the person is not fully conscious after the fall, there will still be an alarm • Because of the alarm a care provider can quickly come to help • Preventing that the faller lies on the floor for a long time • The system can reduce the fear of falling and enables for older people to live longer independently at home.

19. Camera system • Unlike accelerometers, gyroscopes, or alarm buttons, a camera system is fully contactless • elderly people do not have to take along or wear the alarm button and so they can't forget it • The system is not battery-operated • After a fall incident the circumstances can be studied carefully with the camera images, so that preventive steps could be taken to prevent similar falls