FALL IN ELDERLY

SUHAIDA BINTI ROSELIN

JURURAWAT U29
WAD GERIATRIK
 OBJECTIVE
1. Fall
2. Multifactor's can contribute fall
3. Complication
4. Assessment and prevention
• 30% of those over age 65 will fall at least once
per year

• 50% of those over age 80 will fall at least once

per year

Falls: assessment and prevention of falls in older people, NICE CG 161, 2013
 FALL
• A fall is defined as a person coming to rest on
the ground or another lower level; sometimes
a body part strikes against an object that
breaks the fall.

WHO
 FALL RISK FACTORS
1. Socio-demographic
2. Medical condition
3. Sensorimotor
4. Balance and mobility
5. Medication
6. Psychological
7. Environmental
 1.SOCIO-DEMOGRAPHIC
• Increase age
• Previous falls
• Used of walking aids
• Inactivity
 2. MEDICAL CONDITIONS
• Stroke
• Dementia / Delirium
• Parkinson’s Disease
• Depression
• Incontinence
• Arthritis
• Foot problems
• Dizziness
 3. SENSORIMOTOR
• Visual impairment
• Depth perception
• Contrast sensitivity
• Sensory impairment
• Proprioception
• Vibration sense
• Tactile sense
• Muscle weakness
• Slow reaction time
 4. BALANCE AND MOBILITY
• Difficulty with sit to stand
• Slow walking speed
• Unsteady gait
• Unsteady when standing still
• Difficulty leaning or reaching
 5. MEDICATION
• Multiple medications
• Hypnotics / anxiolytics
• Antidepressants
• Anti-psychotic
• Anti-hypertensive
 6. PSYCHOLOGICAL
• Fear of falling
• Difficulty with divided or selective attention
(dual task)
 7. ENVIRONMENTAL
• Poor footwear
• Incorrect glasses
*Home hazards are not a risk on their own but
may be so when compounded by sensori-motor
or mobility impairments.
 COMPLICATIONS
• Increase of injury.
• Hospitalization.
• Physical dysfunction:
function and quality of life may deteriorate drastically
after a fall.
• Fear of falling:
leak of confidence → avoid activity → increasing
joint stiffness and weakness → reducing mobility.
• Mortality
PREVENTION
 ASSESSMENT
1. Near fall
• A sudden loss of balance
• Does not result in a fall or other injury
• An example, a person who slips, stumbles or trips
but is able to regain control prior to falling
2. Un-witnessed fall
• When the patient is found on the floor
• No anyone else knows how she or he got there.
 Nursing interventions
1. Keep cot side rails up all the times
2. Avoid changes or make changes gradually
3. Provides meaningful their daily routine
activity
4. Provide bedside commode/offering bedpan
5. Improved lighting in room
6. Provide family members with Fall Prevention
pamphlets.
7. Tidy up around bed. Organize things at a
location reachable from bed.
8. Make sure patient use proper gait aid
9. Ensure patient wear appropriate footwear
10.Ensure floor keep dry
 RECOMMENDATION
• Take extra caution to patient with high risk of fall.
• Make sure patient is safe before leaving patient.
• Get help from other staff ; PPK or other staff nurse
to stay at patient’s cubicle while nurse in- charge
busy.
• Encourage family to accompany patient.
 PREVENTION
• Shoes: safe and appropriate
• Eye sight
• Assistive device
• Environmental management
• Physical therapy and exercise
• Medical management
ENVIRONMENTAL MANAGEMENT
BALANCE TRAINING
• Berdiri sebelah kaki
dengan tangan di depa
selama 30 saat / setakat
mampu
BALANCE TRAINING
• Berdiri memegang
kerusi, kaki kanan
melangkah setapak
kedepan , kemudian
keposisi asal . Ulang
dengan kaki kiri
 SIT TO STAND EXERCISE
• Sit on chair
• Place your feet slightly
behind your knees
• Lean slightly forward
• Stand up (using your hands
as support if needed)
• Progress to no hands after
time
• Step back until your legs
touch the chair, bend your
knees and slowly lower your
bottom back into the chair
• Repeat 10 times
TIMED UP AND GO TEST
 Low fall risk; clients are freely mobile;
< 10 sec
encourage regular exercise

Moderate fall risk; clients are independent

with basic transfers; most go outside alone
< 20 sec and climb stairs, many are independence
with tub and shower transfers. PT referral
may be appropriate.

High fall risk; “Gray zone”; functional

20-29 sec abilities vary. Physician or multidisciplinary
team assessment recommended.

Very high fall risk; Many are dependent

with chair and toilet transfers; most are
dependent with tub and shower transfers;
>30 sec most cannot go outside alone; few, if any,
can climb stairs independently. Physician
or multidisciplinary team assessment
recommended.
 SUMMARY
• Assess the RISK OF FALLS from patients background
and observation of patients behaviors. Share the
information among the staff and carer.
• Actions that can be taken against the occurrence
factor of patient falls.