Falls in Elderly

Dr. Satheeskumar Durairaj

Ms. Sivapriya

www.gmu.ac.ae COLLEGE OF HEALTH SCIENCES

Introduction
• Fall means sudden, uncontrolled and unintentional downward
displacement of body to the ground
• WHO report
• > 80 age – 50 % / year with multiple fall

• 40% of death caused by fall or Approximately 30-50% of people living

in long-term care institutions fall each year
• Women > men
Contributing Factors

Berber O, Singh B. Correlation of Overactive Bladder Symptoms and Falls With Injuries In Older People. MOJ
Age and Ageing 2006; 35-S2: ii37–ii41 Gerontol Ger. 2018;3(6):422-424
 Mechanisms of Fall
Contributing
Intrinsic: factors Extrinsic:
Aging, Poor balance Home hazards

• Polypharmacy – four or more prescription medications

combination
• Home hazards
• Clutter, or loose rugs
• Poor lighting on stairs and hallways
• Lack of bathroom safety, e.g. grab bars in bathtub
• Footwear
• Busy street or elevated walkways
 Mechanisms of Fall
Contributing
Intrinsic: factors Extrinsic:
Aging, Poor balance Home hazards

Occurrence of falls
 Mechanisms of Fall
Contributing
Intrinsic: factors Extrinsic:
Aging, Poor balance Home hazards

Occurrence of falls

Fall consequences No injuries

 Mechanisms of Fall
Contributing
Intrinsic: factors Extrinsic:
Aging, Poor balance Home hazards

Occurrence of falls

Fall consequences No injuries

Soft tissues Loss of Disability,

Fractures injures, Reduced
Confidence
trauma quality of life
Assessment strategy

Screening at the Prevention

No fall strategies
Primary care

Single
Recurrent Fall
Falls
Gait/ Bal Check for gait/ No prob,
problem Bal prob Reassess
periodically

Fall Evaluation & Multifactorial

Assessment intervention

American Geriatrics society, British Geriatrics society & AAOS panel on falls prevention
 Fall screening
Tool

Morse Fall scale

It is a rapid and
simple method of
assessing a
patient’s likelihood
of falling

http://www.networkofcare.org/library/Morse%20Fall%20Scale.pdf
Fall Assessment

• History • Location & circumstances of Fall

• Physical exam • Associated symptoms
• Functional exam • Injury & ability to get up
• Special test • Medications (Psychotropics, sedatives,
antidepressents) and alcohol
• Risk factor identification
Fall Assessment

• History • Vital signs – orthostatic hypotension

• Physical exam • Consider acute medical illness related
• Functional exam • Higher mental functions
• Special test • Special senses
• Muscle strength & ROM
• Joint proprioception
• DTR
• Co-ordination
Fall Assessment

• History • Balance
• Physical exam • Sharpened Romberg
• Functional exam • Modified single leg stance
• Special test • Functional reach test
• Berg balance scale
• Gait
• Timed getup and go test
• Tinetti Gait and Balance Evaluation
Fall Assessment

• History • Balance
• Physical exam • Sharpened Romberg
• Functional exam • >30 low risk; <30 High risk

• Special test
Fall Assessment

• History • Balance
• Physical exam • Sharpened Romberg
• Functional exam • Modified Single Leg Stance
• Special test • Look out for pelvic drop
Fall Assessment

• History • Balance
• Physical exam • Sharpened Romberg
• Functional exam • Modified single leg stance
• Special test • Functional Reach Test

0 – not able to reach

1 – <6 inch reach - high risk of fall
2 – 6 - 10 inch reach - moderate risk of fall
3 – >10 inch - low risk of fall
Fall Assessment

• History • Balance
• Physical exam • Sharpened Romberg
• Functional exam • Modified single leg stance
• Special test • Functional reach test
• Berg Balance Scale
Total score is 56
41 – 56 = low risk
21 – 40 = medium fall risk
0 – 20 = high fall risk
Fall Assessment

• History • Balance
• Physical exam • Berg Balance Scale
• Functional exam • Functional reach test
• Special test • Sharpened Romberg
• Modified single leg stance
• Gait
• Gait speed ( 4 mtr distance take
>5sec is slow )
 Fall Assessment

• History • Balance
• Physical exam • Berg Balance Scale
• Functional exam • Functional reach test
• Special test • Sharpened Romberg
• Modified single leg stance
• Gait
• Gait speed
>14 high risk of fall • Timed getup and go (3 mtr) test
> 24 predictive of fall with 6 month
> 30 require assistive device for fall and dependent in ADL
Fall Assessment

• History • Balance
• Physical exam • Berg Balance Scale
• Functional exam • Functional reach test

• Special test • Sharpened Romberg

• Modified single leg stance
• Gait
Total Tinetti Tool Score is 28 • Gait speed
≥ 24 - low fall risk
• Timed getup and go test
19-23 - moderate fall risk
≤18 - high fall risk • Tinetti Gait and Balance Evaluation
• (Balance section & Gait section)
http://hdcs.fullerton.edu/csa/Research/documents/TinettiPOMA.pdf
Fall Assessment

• History • Osteoporosis test

• Physical exam • Ophthalmology
• Functional exam • Hearing function
• Special test • Psychology
• Imaging techniques
Fall Management

• Falls prevention • Goals

• Low risk 1. Improve the joint ROM / Muscle
• High risk length
• 3-5 stretch / day / Min 2 days a
week
• Major muscle groups (Hip, knee,
ankle, shoulder, elbow & hand)
• Avoid ballistic / quick stretch
Management

• Falls prevention • Goals

• Low risk 1. Improve the joint ROM / Muscle length
• High risk 2. Strengthen the LL muscles
• 60-80% of 1 RM / 8-10 rep per set / 2-3
set / Min 2 days a week
• Major muscle groups (calf, hamstring, hip
Warm Workout Cool
up min 20 down flexor)
2–3 minute 2–3 • Mode of resistance
min with rest min
• Lifting light weights
• Resistance bands
• Body weight for resistance (modified
push ups, sit ups)
Management

• Falls prevention • Goals

• Low risk 1. Improve the joint ROM / Muscle length
• High risk 2. Strengthen the lower limb muscles
3. Improve the aerobic capacity
• 2 hours and 30 minutes (150 minutes)
of moderate-intensity aerobic activity (i.e.,
Warm Workout Cool brisk walking) every week
up min 20 down
2–3 minute 2–3 Or
min with rest min • 1 hour and 15 minutes (75 minutes)
of vigorous-intensity aerobic activity (i.e.,
jogging or running) every week
Management

• Falls prevention • Goals

• Low risk 1. Improve the joint ROM / Muscle length
• High risk 2. Strengthen the lower limb muscles
3. Improve the aerobic capacity
4. Advice to reduce the risk factors
• Treat the primary cause
• Reduce or stop the modifiable risk factors –
smoking, alcohol
• Use the sensory cues
Management

• Falls prevention • Goals

• Low risk
1. Improve the joint ROM / Muscle length
• High risk
2. Strengthen the lower limb muscles
3. Improve the aerobic capacity
4. Advice to reduce the risk factors
5. Educate the lifestyle modifications
• Environmental
• Behavioral
Management

• Falls prevention • Environmental modification

• Low risk • Provide night light or supplemental
• High risk lighting
• Keep floor surfaces clean and dry
• Clean up spills promptly
• Install handrails in bathrooms, room
and hallway
• Maintain clutter-free care areas
Management

• Falls prevention • Behavioral modification

• Low risk • Ensure wearing of non-slip, well-
• High risk fitting footwear
• Prevent inactivity
• Group therapy
Management

• Falls prevention 1. Maintain joint ROM and muscle

• Low risk flexibility
• High risk 2. Improve muscle power
– Same as low risk
Management

• Falls prevention 1. Maintain joint ROM and muscle

• Low risk flexibility
• High risk 2. Improve muscle power
3. Improve the aerobic capacity
– 2 hours and 30 minutes (150 minutes)
of moderate-intensity aerobic
activity (i.e., brisk walking) every
week
Management
1. Maintain joint ROM and muscle flexibility
• Falls prevention
2. Improve muscle power
• Low risk
3. Improve the aerobic capacity
• High risk 4. Prescribe the safety measures
• Proper use of mobility aids
• UL and LL muscle strength <3 – use sliding board or
mechanical device for transfer or wheel chair or provide
helper for ADL
• LL muscle strength <3/5 and BBS score <20 or TUG score
> 30 - personalized wheel chair /walker or provide helper
for ADL
• LL muscle strength > 3/5 and BBS score between 21 – 40
or TUG score between 14 – 30 - provide mobility aids;
cane (stick / tripod)
Management

• Falls prevention 1. Maintain joint ROM and muscle

• Low risk flexibility
• High risk 2. Improve muscle power
3. Improve the aerobic capacity
4. Prescribe the safety measures
• Proper use of mobility aids
• Provide protective aids
Management

• Falls prevention 1. Maintain joint ROM and muscle flexibility

• Low risk 2. Improve muscle power
• High risk 3. Improve the aerobic capacity
4. Prescribe the safety measures
5. Educate the life style modification
• Environmental modification
• Behavioral modification
Management

• Falls prevention • Environmental modification

• Low risk • Familiarize the patient to the environment
• High risk • Place call bell within reach and have patient
demonstrate use
• Position necessary items within patient reach
• Keep bed in low position with brakes locked
• Provide cued toileting at least every two
hours while awake
Management

• Falls prevention • Behavioral modification

• Low risk • Proper management for associated
• High risk diseases
• On-fall management
• Do not panic
• Keep calm
• Get proper support
• Call for help
• Ensure treatment immediately
Management

• Falls prevention • Treat acute injury & underlying medical

• Post-Fall care conditions
• Remove unnecessary medications
• Rehab, exercises, assistive devices
• Correct sensory impairments
• Environmental modifications & safety
References

• Lewis CB, Bottomley JM. Geriatric Rehabilitation: A Clinical Approach, 2nd Edition. USA:
Prentice Hall; 2002. ISBN-13:978-083-8522-844. Chapters 9, 10. pp. 292-361.
• Alia A. Alghwiri PT, MS,, Susan L. Whitney PT, DPT, PhD, NCS, ATC, FAPTA, Geriatric
Physical Therapy (3rd edition) 2012.
• Paul E.H. Ricard, in Acute care Handbook for physical therapist (4th edition), 2014.
• Phelan EA, Mahoney JE, Voit JC, Stevens JA. Assessment and management of fall risk in
primary care settings. Med Clin North Am. 2015;99(2):281-293.
doi:10.1016/j.mcna.2014.11.004
• Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British
Geriatrics Society. Summary of the Updated American Geriatrics Society/British Geriatrics
Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr
Soc. 2011 Jan;59(1):148-57. doi: 10.1111/j.1532-5415.2010.03234.x. PMID: 21226685.
 DISCLAMER
The contents of this presentation, can be used only for the
purpose of a Lecture, Scientific meeting or Research
presentation at Gulf Medical University, Ajman.

www.gmu.ac.ae