Fall Prevention & Management

Falls

Situation in which the older adult falls to the ground or

is found lying on the ground

Unintended contact with nearby surface to recover

balance

Unplanned, unexpected contact with a supporting

surface
Types of Fall

Accidental vs non accidental

Syncope vs non syncope
Intrinsic vs extrinsic
Falls with injury vs without injury
Single fall vs recurrent fall
Incidence of Fall
Traditional Risk Factors Categories
Intrinsic Modifiable
medical conditions risk factors YOU CAN
lifestyle choices change
cognition Non-modifiable
Extrinsic risk factors YOU CAN’T
Environment change
Risk Factors—Age-Related
Medical Conditions
Poor general health Stroke
Diabetes Musculoskeletal
Arthritis stiffness
Osteoporosis Weak muscles
Risk Factors—Lifestyle & Behavior
Exercise
Footwear
Alcohol use
Nutrition
Hydration
Fear of falling
Fear of Falling—Warning Signs
Need to touch or hold onto things or people
Walks very slowly
Takes small steps
Limited movement
Expresses a fear of falling
Risk Factors—Environmental:
Where Do People Fall?

60% fall in the home

30% fall in public areas
10% fall in healthcare facilities
Risk Factors—Environmental cont’d:
The Home & Yard

Poor lighting
Lack of handrails
Items that are hard to reach
Obstacles in paths
Fall Prevention
Resistance training
 Generate force
 Resistance training principal

 Overload
 Specificity
 Reversibility

 RM ……….Endurance ……Strength…..

The American College of Sports Medicine recommends that healthy sedentary

adults undertake a strength training programme involving one set of 8–12RM
of 8–10 different exercises twice weekly.
 Endurance training

Role of Endurance training in fall prevention ????

Shoes
Evidence to support the suggestion that shoes may
influence postural stability
50% of falls

Advantages of high heel ???

Advantages of flat shoes??
Disadvantages of high heel ???
Disadvantages of flat shoes??
Which one is best ??
Heel elevation
Research into the effects of heel elevation

 Increased loading on the forefoot

 Alterations in the function of the big toe joint during the propulsive
phase of gait
 Decreased stride length
 Increased energy consumption
 Increased arch height
Advantages
However, further research needs to be undertaken to
ascertain the optimum heel elevation for women’s
shoes, as many older women report that they feel safer
in a ‘slight’ heel,

Heel elevation may have some beneficial effects in

older people with Parkinson’s disease to facilitate
forward propulsion.
Low heel less than 2.5inches (6cm)

Mid heel 2.5 -3.5 inches (8cm)

High heel above it

Shoes
The Four C’s
Fall Prevention must be:
Consistent
Cross Disciplines
Coordinated
Culture
 Risk factor and solution
Risk factor Solution
Lightening ???
Slippery floor surface ???
Loose rugs ???
Upended carpet edges ???
Wet surface ???
Low chairs ???
Stairs ???
Toilet seat ???
Toilet safety ???
 Intervention strategies
RISK FACTOR INTERVENTION

• Muscle weakness • Resistance training

• Impaired balance • Training, assistive devices

• Impaired gait • Training, environment

• Transfer skills • Training, grab rails

 Intervention strategies
RISK FACTOR INTERVENTION

• >4 prescribed • Review

drugs
• Educate, withdraw
• Sedative use
 Intervention strategies
 RISK FACTOR  INTERVENTION

Environmental hazards Give Advice

Handrails
Remove items
Secure rugs/carpets

Footwear New shoes

 Intervention strategies
INTERVENTION
RISK FACTOR

• Visual impairment • Glasses

• Cognitive impairment • Minimise

• Depression • treat
Hip protectors
Intervention & Prevention—Lifestyle &
Behavioral Risk Factors
Mental activity & focus training
Exercise—Tai Chi classes, strength training
Education to improve home environment
Intervention & Prevention—Assistive
Devices
Walkers:
improve balance
relieve or reduce weight bearing
provide 4-way stability
Canes:
improve balance
provide support for one side of the body
Intervention & Prevention—Assistive
Devices cont’d…
Reachers
Portable seat lift
Special step stools
Intervention & Prevention—Environment: Home
Kitchen—keep items within easy reach
Bathroom—grab bars for toilet and bathtub
Bedroom
nightlights
bed and nightstand at proper height
Intervention & Prevention—
Environment: Home & Yard
Living room
Remove extra things
Porch
railings
clear pathways
Throughout
clear paths
good lighting
Intervention & Prevention—Community:
Referral System
Physical Therapy
Occupational Therapy Home Health Nurse
Dieticians Community Programs
Social Workers exercise, etc.
Support Groups
Balance Retraining
Strength Training
Aerobic Training
Balance training
Flexibility training
Combined Exercise Programs
Sensory Orientation Training

Balance board
Balance circuit
Frenkel's Exercises
Tai Chai exercise
Common features of effective exercise programmes for falls
reduction
(1) Type of exercise to include

(a) balance exercises

(b) exercises conducted in weight-bearing positions
(c) exercises with the aim of reducing the amount of support provided by the arms
(d) functional activity practice (i.e. stair climbing/sit-to-stand)
(e) an additional component of endurance exercise to increase general fitness (but
not a walking programme on its own)
(f) an additional component of moderate-intensity resistance training

(2) Exercise prescription

(a) progressive in intensity

(b) individually prescribed intensity
(c) exercises chosen to address the key risk factors of that individual or population
group
(3) Nature of programme

(a) sessions with a duration of 60 minutes (may need to build up to this level)
(b) undertaken by participants at least three times a week
(c) conducted for a minimum of six weeks (but long term exercise is probably
required for sustained benefits)
(d) either delivered in a group setting or on an individual basis
(e) contain support mechanisms to motivate participants to maintain adherence
(i.e. group camaraderie or telephone follow-up for home based programmes)

(4) Design and delivery

(a) programmes designed by a trained professional (a physiotherapist in most

cases)
(b) exercises delivered by a trained instructor (to ensure exercises are challenging
yet safe)
 Fall
Evaluation

Mutifactorial intervention
Assessment
as appropriate

History Gait, balance and exercise programs

Medications Medication modification
Vision Postural hypotension
Gait and balance modification
Neurological Environmental hazard modification
Cardiovascular Cardiovascular disorder treatment
Conclusion
Importance of fall prevention education
Fall risk assessment
Identification of risk factors
Interventions & prevention
Healthcare providers, communities, and seniors work
together