Sunday, February 26, 2012

At risk for falls - aren't we all?

Did you know…?

Need to Bring Frailty into focus Care

  • One-third of people aged 65 and over will fall at least once each year.
  • Falls are the most common cause of injury and the sixth leading cause of death for seniors.
  • Canadians spend about $3 billion a year on medical care for fall-related injuries to seniors.
  • Women are three times more likely than men to be hospitalized for a fall-related injury.
  • 40 per cent of falls that require hospitalization involve hip fractures.
  • Half of the people who have a hip fracture never regain their pre-fall level of functioning.
  • Almost half of admissions to long-term care facilities are fall-related.
  • Most falls occur in seniors' own homes, while doing their usual daily activities. However, up to 40 per cent happen outdoors and in public places.
  • Falls usually happen because of the combined effects of a number of factors, such as a loss of balance, side effects of medicine, impaired vision or mobility, and environmental hazards.
  • Many seniors are afraid of falling and restrict their activities. This can increase their risk of falling because of muscle weakness, joint stiffness and poor balance.

As some one in her 50s, I've been noticing that I have been more susceptible to slipping than in the past. I hurry down the stairs for the phone. Rush in floppy slippers. Glasses askew, I misstep.

Here is one post that tells us what happens when seniors fall:
Mr. CD, 88, took a little tumble (you must read this ER Charge Nurse Blog!)

  • a scalp laceration the length of Q-tip on his temple, 
  • bled like a stuck pig, 
  • transported by EMS, triaged, assessed by both MD and RN, x-rayed, CT’d, 
  • deblooded, stapled, tetanus’d, acquired a head dressing worthy of a maharajah, and finally sent back to the nursing via a private ambulance and their ill-paid yet (hopefully) competent attendants.

As seniors age they take themselves for granted. Age brings a decrease in flexibility, reflexes, poor eyesight, poor hearing, a reduced sense of touch and proprioception, which is the ability to know the position or movement of a body part without looking.

Most of us are not debilitated by a fall. 

Sometimes chronic falls indicate frailty and should mean that the senior needs to do more exercise to build muscles. Unfortunately, it is hard to convince seniors that they are at risk and should take steps to rectify the situation.

How do you convince someone they are engaging in risky behaviour?
A hard call, this one. I usually use myself as an example, rushing, talking about a misstep, or a near-accident.
We can prevent falls, using environmental actions: loose rugs, and the like.
Ensuring that the senior has enough calcium in their diet to decrease frailty.
Regular exercise, which is a great social activity, as well!
Checking their medications, using Medscheck in Ontario.

Falls are the leading cause of death due to injury for those over 80.
In the case of seniors, falling leads to hospitalisation and there is an impact on all of us from this institutionalisation: physically, socially, emotionally for family and friends. I have written about the dangers of this previously, both hospitalization and readmission risks.

Factors known to increase the risk of falls
and fall-related injuries in seniors include:

  • Advanced age
  • Gender (females are at higher risk)
  • Chronic and acute illnesses, such as the effects of a stroke, Parkinson's disease, arthritis, heart disease, incontinence or acute infection
  • Mobility problems, including slower reflexes, muscle weakness, poor balance and poor posture
  • Changes in mental alertness caused by cognitive impairments, depression, delirium, side effects of medications, alcohol use, poor nutrition, dehydration or lack of sleep
  • Taking multiple medications, particularly those known to increase your risk of falling such as antidepressants, tranquilizers and antihypertensives.
Other risks can predict dangers: the Dalhousie Frailty Scale is a good assessment tool (PDF). Also,
  • living alone, climbing ladders alone, too much alcohol, refusing to use walkers, misuse of canes or walkers, poor diet, lack of access to healthcare.
The environment adds to the situation:
  • stairs without handrails, poor lighting indoors and out, inattention to curbs, crosswalks. 
Falls are not the only risks, obviously, but they are highly preventable.

Risk taking – can mean climbing up on unstable furniture, climbing up too high, or reaching for something out of your reach, lifting things that are too heavy, not paying attention or underestimating your surroundings. Know your limitations and think before taking that risk.

Footwear – non slip soles, and shoes that fit properly are important.

Blood pressure – Have your doctor check you for postural hypotension (an excessive drop in blood pressure that occurs when a person stands up or is in an upright position). This causes dizziness, light-headedness and loss of consciousness.  You need to rise slowly from a seated or laying down position. If you get up in the middle of the night to use the bathroom take your time.

MedicationsPolypharmacy - four or more, puts you at risk for a fall. Ask your pharmacist for a Medscheck, a comprehensive review of all your medications including over-the-counter drugs. This service is covered by OHIP. The pharmacist will check the dosages, and drug interactions. The pharmacist may make some recommendations to reduce your risk.

Vision – have your eyes checked every 2 years. If you need glasses, get them. Poor vision has been blamed for many falls. If you wear bifocals consider changing your prescription and using reading glasses. Bifocals cause problems when walking and trying to look at the ground.

Home Safety – The most common are scatter rugs, clutter on the stairs, extension cords (even pets) underfoot also can become trip hazards. Clear snow and ice from your walkways, or ask a neighbour to help. Many local community home support offices will help with this. Check out in Ontario

Bathroom – put a night light in the bathroom and hall. Installing grab bars in the bathroom gives you more independence. You want them there when you are slipping or dizzy so you can prevent a fall. Put a non-slip mat in your shower stall, and be careful in the bathroom.

Leg Strength – Regular walking will keep your legs strong. Stairs are a great way to exercise. Put on some music, and do step-ups. Do a series of ten leading with your right leg, another ten leading with your right. Stand up firmly on the step, placing both feet together.

Bones – Osteoporosis leads to weak bones, which break very easily. Ensure get get enough calcium. Know your bones: ask your doctor for a bone density test.

Nutrition – Drink water throughout the day, as dehydration makes you dizzy. Make sure you take in enough vitamin D to maintain bone health.

Incontinence – There is help. Ask your doctor to refer you to the appropriate services.

~ Alberta Centre for Injury Control & Research. Edmonton: Alberta Centre for Injury Control & Research; 2010. (PDF) 

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