Don't Fall For It!

Reduce the rate of ED visits due to falls among older adults

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Objective

  • Hip Fractures (Lower trunk) are the leading cause in fall related ED visits amongst the elderly for both genders.
  • "1.64 million older adults were treated in hospital emergency departments (EDs) for unintentional fall-related injuries in the USA" (BMJ)
  • Not all falls lead to major injury, but 5% lead to fractures
  • Most instances are unintentional
  • Increase in falls over the past 10 years
  • "a recent study using data from the National Health and Nutritional Examination Survey demonstrated an increased prevalence of self-reported disability over time among older Americans in basic activities of daily living, instrumental activities of daily living and mobility" (bmjopen)
  • Women are more commonly admitted to the ER for low trunk fractures d/t falls

Assessment

  • why lower trunk injuries are predominant
  • age groups affected most (85+ greater chance of fracture)
  • Although fractures seem rare, they are the leading cause of hospitalization r/t falls in older adults
  • prior leg fractures lead to increased probability of hip fracture occurrence in the future
  • assess weakness in lower extremities (weight bearing exercises)
  • visiting a health professional may be more beneficial than standard or group delivered programs
  • proportion of older americans with physical limitations has increased over time according to the Medicare Current Beneficiary Survey
  • decrease in grip strength leads to increased chance of fall d/t lack of support when walking

Overcome Barriers

  • Adequate diet do prevent fragility in bones i.e. consuming enough calcium on a daily basis
  • Group-delivered exercise interventions (9 trials, 1387 participants)
  • Individual lower limb strength training (1 trial, 222 participants)
  • Nutritional supplementation (1 trial, 46 participants)
  • Vitamin D supplementation, with or without calcium (3 trials, 461 participants)
  • Home hazard modification in association with advice on optimizing medication (1 trial, 658 participants), or in association with an education package on exercise and reducing fall risk (1 trial, 3182 participants)
  • Pharmacological therapy (raubasine-dihydroergocristine, 1 trial, 95 participants)
  • Interventions using a cognitive/behavioral approach alone (2 trials, 145 participants)
  • Home hazard modification for older people without a history of falling (1 trial, 530 participants)
  • Hormone replacement therapy (1 trial, 116 participants)
  • Correction of visual deficiency (1 trial, 276 participants). (online library.wiley.com)
  • Tai Chi

Motivators

  • Provide a goal for them to strive towards
  • Strengthened muslces
  • Improved balance
  • improved bone minieral density
  • improved reaction time
  • ability to maintain mobility and function properly
  • Tai Chi intervention reduced the risk of multiple falls by 47.5%

Action Step


  • participate in physical activity
  • join a gym
  • Ask a family member/friend to assist in ambulation/ADLs PRN
  • Multidisciplinary, multifactorial, health/environmental risk factor screening/intervention programs in the community both for an unselected population of older people (4 trials, 1651 participants)
  • A program of muscle strengthening and balance retraining, individually prescribed at home by a trained health professional (3 trials, 566 participants, pooled relative risk (RR) 0.80, 95% confidence interval (95%CI) 0.66 to 0.98)
  • Home hazard assessment and modification that is professionally prescribed for older people with a history of falling (3 trials, 374 participants, RR 0.66, 95% CI 0.54 to 0.81)
  • Withdrawal of psychotropic medication (1 trial, 93 participants, relative hazard 0.34, 95%CI 0.16 to 0.74)
  • Cardiac pacing for fallers with cardioinhibitory carotid sinus hypersensitivity (1 trial, 175 participants, WMD -5.20, 95%CI -9.40 to -1.00)
  • A 15 week Tai Chi group exercise intervention (1 trial, 200 participants, risk ratio 0.51, 95%CI 0.36 to 0.73).

Community Resources

  • Healthcare provider/healthcare professional
  • Family members for assistance
  • Physical therapist
  • Personal Trainer at home or local gym

Sources of Information