Falls and Falls Prevention in Older Adults

• Lecture is about Falls and Falls Prevention in older adults.

Learning Outcomes

• Explain age-related changes affecting mobility.
• Differentiate between falls risk screening and falls risk assessment.
• Describe interventions to reduce the risk of falling in older people.
• Be aware of the need for risk assessment in older adults.

Age-Related Changes: Bone Strength

• Aging, influenced by intrinsic and extrinsic factors, leads to reduced bone mass.
• Bone loss occurs in women after menopause due to estrogen deficiency.
• Bone loss occurs in men due to deficiencies in estrogen and testosterone.
• Bone flexibility decreases due to reduced collagen tissue.
• The spinal cord may become curved and compressed.
• Foot arches become less pronounced.
• Bony spurs may form on the vertebrae due to wear and tear.

Age-Related Changes: Muscle Mass

• Loss of skeletal muscle mass and strength occurs, known as age-related sarcopenia.
• Decrease found in the size and number of muscle fibers.
• Muscle fibers deteriorate and are replaced by connective tissue and fat.
• Muscle cell membranes may fail, leading to loss of fluid and potassium.

Age-Related Changes: Joints

• Synovial fluid thins.
• Cartilage thins and decreases.
• Ligaments shorten and lose flexibility.
• Joints become stiff, reducing the range of motion.
• Posture and gait changes.
• These changes leading to pain, impaired mobility, self-care deficits, and increased risk of falls.

Falls

• Fall: Inadvertently coming to rest on ground, floor, or lower level (WHO 2007).
• Injurious Fall: Any fall resulting in physical harm.
• Fear of Falling: Psychological concern about falling, leading to restricted activity and increased future fall risk.

Incidence of Falls and Fall-Related Injuries

• Falls are common among older people.
• Approximately one-third of older people experience one or more falls annually.
• 10% of falls cause severe injuries requiring hospitalization.
• Australia had 125,021 hospital admissions due to falls in individuals aged 65+ in 2016-2017.
• Serious injuries from falls include head injuries (26%) and hip or thigh fractures (22%) of all admissions to hospitals.

Falls Risk Screening and Assessment

• Falls Risk Screening Tools: Brief evaluations or checklists indicating the overall falls risk level.
• Screening tools do not provide specific falls risk factors.
• Falls Risk Assessment Tools: More in-depth evaluations for older people with an increased risk of falling.
• Assessments are based on falls risk screening tool results.
• Assessments are based a conditions associated with high falls risk like stroke, Parkinson's, or dementia

Falls Risk Factors

• Intrinsic factors include previous falls and vision impairment.
• Reduced balance and impaired mobility are intrinsic factors.
• Polypharmacy, chronic health problems, cognitive impairment, and urinary incontinence also contribute.
• Extrinsic factors include poor lighting and loose carpets.
• Slippery surfaces, poor footwear, and unsafe outdoor environments are also factors.
• Behavioral risk factors include a mismatch between activities, abilities, and safety.

Falls Intervention Approaches

• Falls risk assessment must be undertaken
• Vision assessment and correction should be done
• Balance and strength training are important.
• Medication review is key
• Screen for delirium and review falls risk factors for people with dementia.
• Conduct a medical review, assessment of internal and external environments.
• Use safe footwear
• Review regularly performed activities.

Risk Factors for Injuries from Falls

• Osteoporosis or osteopenia
• Vitamin D deficiency
• Low calcium intake
• Corticosteroid use
• Smoking
• Low levels of physical activity

Outcomes of Mobility Limitations

• Active and healthy older adults experience few adverse consequences.
• Those with restricted mobility (e.g., due to co-morbidity) suffer more.
• They may experience muscle fatigue after little exercise.
• Decreased movement may affect activities of daily living (ADLs).
• Increased dependency and social isolation occur.
• Diminished pleasure in leisure activities can result.
• Mobility limitations can lead to falls, pressure sores, and even malnutrition.

Promoting Health in Older Adults

• Single, multiple, and multifactorial falls prevention approaches reduce falls.
• Nurses, medical, and allied health staff play essential roles in understanding falls risk factors and interventions.
• Falls prevention programs can be safely and effectively implemented for those at high risk, including people with cognitive impairment.
• Health promotion can focus on musculoskeletal function, exercise, and diet.
• Stages of Behavior Change (Transtheoretical Model): Precontemplation, Contemplation, Preparation, Action, and Maintenance.
• Should focus on the abilities of the older person
• Incorporate joint decision-making
• Address the risk of future falls
• Encourage older people to report new health problems for early treatment and management.

Summary

• Mobility in older adults is affected by age-related changes.
• Older adults in general are at risk of falls.
• Assessment is crucial in prevention.
• Health promotion and education can help older adults.