Falls Elderly Population Running head: FALLS IN THE ELDERLY POPULATION


Literature review paper Falls in the Elderly Population

They range from non-compliance due to the difficulties of scheduling the program to the communities convenience to not being flexible to any variances in their programs. and adherence to different fall prevention programs. 2). The approach should include a wide range of organizations and individuals including family members. A national approach to reduce elder falls. that focuses on the daily life of senior citizens is needed within our residential. institutional. The Federal government recognizes this as a community problem. social workers. Sixty percent of fall-related deaths occur among persons 75 and older (Committee on Energy and Commerce. Community health nursing needs to recognize the increase in falls in the elderly and to start prevention programs that the elders will adhere to. Risks for falls are separated into extrinsic factors involving the environment and intrinsic factors that are age and or psychosocial related. Community health nurses need to assess their population to assist in the development of a program that fits the community. The costs of falls are becoming a burden to society and to our elders. and falls among our elderly are increasing at an alarming rate. mcGee &. employers and others (Committee on Energy and Commerce. . Community health nurses need to implement educational programs that address falls and recruit community members to assist them. Campbell site one of the reasons that people withdrew from a fall prevention program was ill health. and communities. architects. Robertson.Falls in the Elderly Population As America ages so do the number of elderly people in our population. fall prevention programs. There are many factors that determine whether a fall prevention program will be successful in a community. 1). Gardner. 2002. health care providers. This literature review looked at the risk factors for falls.

The risk factors responsible for a fall can be either intrinsic or extrinsic (Fuller. An elderly person experiencing one or more injurious falls is three times more likely to receive hospital care. 1). Galindo-Ciocon. and – sometimes. which are self-generated or due to failure of physical supports such as a cane. 85). 1007). 28). the number of Americans over the age of 85 years will reach 13 million. Peak &. Falls can be defined as: a sudden unintentional change in position causing an individual to land at a lower level. 84). Donovan &. 2000. drug regimen. four times more likely to visit the emergency room. and . seven times more likely to receive home health service.It has been projected that. The complications and injuries from falls have detrimental consequences for elderly people. and the psychosocial aspects of falls such as family support or lack of it. Intrinsic or host factors which are related to the health status of the elderly: non-bipedal fall risk factors. and those over 65 will number 66. Sterbenz. gait patterns in relationship to ground surfaces and shoes. on an object. A major focus is on the risks of falls and methods to decrease them. or the ground. Zarrinkhameh &. Womack.fatal (Brown-Commodore. Studies show that certain factors place an older person at risk for fall (Mosley. or overwhelming external force (Feder. Cryer. psychological. by the year 2040. physical. the floor. There are various reasons documented on why falls occur in the elderly. epileptic seizure. nutritional status. Carter. 1998. for example (Brown-Commodore. 1995. 2000. Newton. declining cognitive status. Falls are the leading cause of death in people over the age of 65 (Committee on Energy and Commerce. 38). 2159).6 million. West. 2001. The risk of sustaining an injury from a fall depends on the individual patient’s susceptibility and environmental hazards. walker. 1995. or chair. The consequences of falls are social. other than as a consequence of sudden onset of paralysis. 2002. and sixteen times more likely to receive nursing home care than an elderly person who has not fallen (Lambert. and economical.

Outdoor hazards that have been reported include steps and sidewalks in poor repair (Rawsky. high beds. particularly when drugs are combined with other drugs and/or alcohol. so does the risk of polypharmacy to treat multiple ailments. Peak &. worn stair treads. chronic illness medication/polypharmacy. Depression and social isolation may result in unintentional-or possibly. Extrinsic factors (environmental) that were identified were slippery floors.marital status (Mosley. Campbell. 1998. Devlin. or four or more drugs are used concurrently (Rawsky. 38). high steps. which contributes to an increased risk for falls (Rawsky. 1995. 1). precipitates further functional decline. Galindo-Ciocon. lack of armrests. 2000. 161). gait/balance impairment. but there were difficulties in recruiting participants to the trial and a high dropout rate (Robertson. incorrect dosages are taken. elimination problems. nonlocking bed wheels. Gardner &. As development of the number of chronic disease increases with age. orthostasis. and bathtubs. a lack of grab bars. 85). This would also include sensory deficits (hearing. Psychosocial factors can also increase the risk of falling. inadequate lighting. . Withdrawing psychotropic drugs reduced the risk of falls by 66%. glare on floors. in turn. high cabinets. West. low toilet seats. 2000. 85). sliding carpets. 162). Between 50% and 90% of elders who report a fall admit to restricting their activities for fear of another fall. 162). and objects on the floor (Brown-Commodore. this restriction. inappropriate chair heights. 162). 2001. Polypharmacy can greatly increase fall risk. psychological issues (includes the fear of falling) and previous falls (Rawsky. ill-fitting walking aids or footwear. Families of the elderly also become over protective and restrict the autonomy of the elderly person after a fall (Brown-Commodore. intentional-falls as mechanisms to gain attention or end one’s life (Rawsky. wheelchair transfers. 5). Fear of falling can result in self-imposed reductions in mobility and social interaction. vision.

2001. 2002. endurance. on the basis of this and the results of a t’ai chi trial. range of motion. Gardner &. exercise programs with a balance improvement component could be considered for wider implementation among unselected older people living at home (Day et al. 2160). 5). Another states that the exercise group had the same number of moderate injuries but fewer serious injuries as a result of a fall than the control group (Robertson. . For balance training T’ai chi classes with individual tuition can reduce the number of falls in older people. Most exercise programs without other interventions do not reduce the incidence of falls in unselected older people living in the community. Using measurement tools was only seen by the author in physical therapy journal articles and rehabilitation nursing journals. That individually tailored exercise programs (women over 80) administered by a qualified professional reduce the incidence of falls in a selected high-risk group living in the community. 6). 2160). In the articles that the author reviewed the most widely used intervention for fall prevention was exercise. sensation and strength (Fuller. Postural control is a complex task that involves balance. 2000. The frequency of falling is related to the accumulated effect of multiple disorders superimposed on age-related changes (Fuller. A study reviewing eight trails of exercise interventions by Feder et al that used falls as an outcome measure showed the following information. Information on the effectiveness of exercise programs to reduce falls is conflicting. ambulation capability. In a selected group (mild deficits in strength and balance) exercise programs reduce the risk of falls in a selected group of older people living in the community. Devlin. There are different risk factor assessment tools available to measure the postural control of an individual.The risk of sustaining an injury from a fall depends on the individual patient’s susceptibility and environmental hazards. Campbell. One study stated that the exercise programme made the major contribution..

2001.. 49%) (Gardner. . The authors recommended (in one study) the following element for community-based fall prevention programs: six weeks in length. 2002..In reading the literature there was a high rate of participants withdrawing from fall prevention programs. Programs for older people should be able to be modified as health status changes (Gardner et al. 2001. 39). 41). 551). Robertson. Most people wanted to take part in the falls prevention program because they considered that exercise was beneficial or because they wished to improve walking. balance training. compatible scheduling with the center's activities. conditioning. became ill. 88). Home hazard management and vision screening and referral are not markedly effective in reducing falls when used alone but add value when combined with the exercise programme (Day et al. de Klerk. Bennett &. Custom-designed programs could enhance the success of the program whose ultimate goal is to reduce falls and increase safety awareness (Lambert et al.... safety practices. Fall prevention programs involving occupational therapy for training related to activities of daily living. balance. 551).. Knowing participants’ stage of change can guide selection of more effective fall prevention programs (Lambert et al. An important part of a fall prevention program is to determine the financial costs for the recommended change and the necessary support mechanisms to assist with the costs of the personal or home environment changes (Lambert et al. 2002. 1450). assertiveness training. or died (Stevens. 2002. 6). 27). 549).. A study by Stevens et al stated that the main reasons that subjects left the study were that they moved. The most common reason given for stopping the exercise program or withdrawing from the trial was a health problem (48 of 98. Holman. Campbell. 39). occurring on the same day of the week. 1995. and use of resources must be implemented (Brown-Commodore. or muscle strength (Gardner et al. and group discussions to facilitate adherence (Lambert et al. mcGee &.

Included are studies to identify the role of exercise and optimum levels of activity to reduce falls and enhance functional ability (Rawsky. The author has noted that physical therapist studies have found assessment tools that could be utilized by the nursing discipline. she has found that a multi-disciplinary approach to falls is needed. Several of the researchers have outlined future research targeting areas where more information is needed. 7).. Assessment and monitoring tools related to risks for falls can be researched. In community health nursing. This is detrimental to adherence to a fall prevention program as the needs of the community are not being met. but there is no research that attempted that approach with any effectiveness. The author personally sees a gap in any assessment tools that will pinpoint whether or not an elder is at high risk for falls. the community will have to be involved to help design a program that will work for them. The studies have shown that there has not been any input from the community in their studies. There are deficits that are noted with trying to use a universal assessment tool with the elderly. and the one most appropriate for a specific patient population can be implemented (Brown-Commodore. The author would like to see fall prevention programs that are tailored to a specific community. the author has found.. The association between home hazards and falls needs to be better understood. Cost effectiveness studies of exercise and other successful interventions would provide important information on which to base resource allocation for the prevention of falls among older people living at home (Day et al. 2002. 87). 6). 2000. The healthcare system can be involved in reducing the problem of falls that occurring in . 1995. 1454). In the author review of the studies. The knowledge base that underpins interventions for hazard reduction is limited. to elucidate the biomechanics of falls on hazards and the characteristics of hazards that cause falls (Stevens et al.There is a need for further research noted in all of the studies. 2001.

and the list could go on. All of the studies target the elder population but the author feels that education should occur at a younger age. community health nurse. implemented to reduce falls. According to the Elder Fall Prevention Act of 2002 there is a need to develop effective public education strategies in a national initiative to reduce elder falls in order to educate the elders themselves. employers. People who are responsible for formulating exercise programs for our elderly must be aware that individual needs differ. caregivers. family members. social workers. physical therapist.the United States. occupational therapist. employers. These programs would involve doctors. and others who touch the lives of senior citizens. Fall prevention programs need to have three levels of health addressed primary. secondary and tertiary care. public health nurses. We need to look at the fact that falls contribute to significant morbidity and mortality in the elderly. People could design their home for a decrease in functional limitations when they get older. thereby making it a safer environment for their later years. .

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D. & De Klerk. British Medical Journal. Gardner. & Campbell. 49(11). November). N. M. 1-6. M. C. N. A. Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. (2001. 322. 1: Randomised controlled trial. March 24). Stevens. N. (2001.. Holman. 1448-1455. Journal of the American Geriatrics Society. Preventing falls in older people: outcome evaluation of a randomized controlled trial..Robertson.. M. Devlin. M. Bennett. . J. C.