1. in
Elderly People
drahmadtemimi@gmail.com

2. Learning objectives
Recognize the significance of
falls as a public health issue.
Identify the risk factors
associated with falls.
Describe the potential
consequences of falls.
Understand the components of a
comprehensive falls assessment.
Explain the principles of falls
management.

3. EPIDEMIOLOGY
● Injurious falls is a true geriatric
syndrome and serious clinical
problems facing older adults.
● Falls result in significant morbidity
and mortality and an increased rate of
nursing home placement.
● Each year, approximately 30% of
persons older than 65 years fall at
least once, and this figure rises to
more than 40% in those aged over 80.
● About 1 in 40 of older persons will be
hospitalized due to falls, nearly half of
them will die within a year.
● Within long-term care institutions,
fall rates are even higher, almost
two falls per patient per year.
● Moreover, falls in institutions more
commonly have serious
complications (10-25% are
associated with a fracture or
laceration).
● In the United States, direct medical
costs related to falls in elderly
people exceeded $19 billion in
2000.

4. The problem of falls in older persons is a
combination of:
 A high incidence of falls in this age group.
 Elderly people are high susceptibilityto
injury after falls.
 Recovery from fall injury is often delayed
in older persons.
 Falls increasing risk for subsequent falls
through deconditioning.
 Falls are frequently have serious
consequencesincluding fractures,
significant fear of falling,reduced
mobility and dependency,and need for
institutionalcare.
 Post fall anxiety syndrome can result in
loss of self-confidence,fear, depression,
social isolation, and increasedrisk of falls
from deconditioning.
Impact
of the
problem

5. Risk Factors
The multiple risk factors for falling can be
categorized as intrinsic or extrinsic.
Intrinsic risk factors include age-related
physiologic changes and diseases that
affect the risk of falling.
Extrinsic risk factors include medications
and environmental obstacles.
Key factors are those directly or indirectly
influencing balance control and gait
stability.
The chance of falling increases
significantly in people with multiple risk
factors.

6. Risk Factors
Advanced age.
Muscle weakness.
Walking and balance difficulties.
Previous fall.
Fear of falling.
Poor vision.
Malnutrition.
Vitamin D deficiency.
Medical conditions (Orthostatic
hypotension, osteoarthritis, Parkinson's
disease, brain stroke, urinary
incontinence, depression, cognitive
impairment).
Intrinsic Risk Factors

7. Risk Factors
Polypharmacy.
Psychotropic, antiarrhythmic, diuretic
medications.
Dim or glaring lighting.
Lack of stair handrails.
Poor stair design.
Tripping hazards (raised thresholds, rugs,
damaged flooring).
Lack of bathroom rails, grab bars or
slippery or uneven surfaces.
Improper use of a walking aid.
Inappropriate footwear.
Eyeglasses with multifocal lenses.
Extrinsic Risk Factors

8. Complications of Falls
Injuries:
Soft tissue injuries.
Fractures (Hip, Femur, Humerus, Wrist).
Subdural hematoma.
Hospitalization.
Disability:
Impaired mobility due to physical injury.
Impaired mobility from fear, loss of self-
confidence.
Increased rate of nursing home placement.
Increased risk of death.

9. At present, no one screening test can be
recommended to identify potential fallers.
The two best predictors of falls are a
history of falls and a reported
abnormality in gait or balance.
Once a year, ask older people routinely:
– Have you had any falls in the last year?
– Have you noticed any problems with
gait, balance, or mobility?
Answering “yes” to either screening
question warrants further assessment.
Perform a simple gait assessment.
Screening

10. FALLS ASSESSMENT
Falls assessment should include a
multifactorial evaluation beginning
with:
 the circumstances surrounding the
fall(s).
 associated symptoms.
 risk factor assessment.
 functional abilities.
 medication history.
If available, information should be
obtained from a caregiver or witness.

11. FALLS Assessment
History of fall circumstances.
Prodromal symptoms
(lightheadedness, dizziness, loss of
consciousness, palpitations).
Medication review.
Review of chronic medical problems
including alcohol misuse.
The environment in which the falls
occurred (loose mats, cords,
unstable furniture, lighting levels).
Examination of:
– vision and hearing.
– gait and balance (get up and go test).
– neurologic examination
(proprioception, muscle strength,
coordination, and cognition).
– cardiovascular system (rate and
rhythm, murmurs, orthostatic
hypotension, arrhythmias).
Investigations (FBC, Blood sugar,
ECG, Echo, Holter, CT, MRI).

13. Get up and Go Test
Observe the patient conduct:
– the needs to push off the chair to arise.
– rock back-and-forth several times to arise.
– leg strength is diminished.
– gait abnormalities (poor step height or
length, shuffling).
– poor balance (wide-based stance and slow,
multiple-point turning).
Those who are unsteady or take >15 seconds
to complete this task considered to be at
increased risk for future falls and require
referral to physical therapy for complete
evaluation.

14.  Results of the evaluation will guide
specific management.
 Most patients needing intervention
will have multiple risk factors.
 Multifactorial intervention is more
effective than single intervention in
preventing future falls.
 Ensure that trained professionals
conduct the falls prevention program.
MANAGEMENT
of highriskelderly

15. MANAGEMENT
Treat those at high risk of recurrent falls
as follows:
 Refer to physiotherapy for muscle
strengthening, gait and balance
training and advice on use of assistive
devices.
 Encourage increased exercise (such as
walking) or refer to an exercise
program with a balance component,
such as:
 Tai Chi Chuan exercise.
 Step mat exergame.

16. Step mat exergame
 It is in a training intervention, in
which participants must make
quick and accurate steps in
response to target stimuli
presented on a screen.
 Evidence indicates that it can
improve physical and cognitive
factors associated with falls in
older people.

18. Strength and balance exercises for older adults

19. MANAGEMENT
Elderly after fall
 Elicit a fall-focused history.
 Review medications and reduce
those likely to cause falls.
 Modification of home
environmental hazards.
 Review past medical history.
 Assess vision and refer if
necessary.

21. Medication classes have a
higher potential to cause falls
Antihypertensives
Antidepressants
Antiparkinsonian
Diuretics
Sedatives
Antipsychotics
Hypoglycemics
Alcohol

22. Home Environmental Hazards
 Old, unstable, and low-lying
furniture
 Beds and toilets of inappropriate
height
 Unavailability of grab bars
 Uneven or poorly demarcated stairs
and inadequate railing
 Throw rugs, frayed carpets, cords,
wires
 Slippery floors and bathtubs
 Inadequate lighting, glare
 Cracked and uneven sidewalks
 Pets that get under foot