LTC Resources - Falls & Mobility

A fall is a sudden and unintentional change in position resulting in an individual landing at a lower level such as on an object, the floor, or the ground, with or without injury. Falls are among the most common and serious problems facing elderly persons. Most falls are predictable and preventable: a fall can cause a loss in confidence which can lead to a decline in health and function and contribute to future falls. (1)

Why is it important?                           

  • Falling is associated with increased mortality, morbidity, reduced functioning, and LTCH admissions
  • Increased risk of serious falls in first six weeks after admission to LTC
  • Almost 62% of injury-related hospitalizations for seniors are the result of falls.
  • Fall-related injury rate is 9 times greater among seniors over 65 than those less than 65 years of age.
  • 50% of seniors who fall experience a minor injury: 5% to 25% sustain an injury like a fracture or sprain
  • Falls cause 90% of all hip fractures in seniors: 20% die within a year of the fracture.
  • Often families are unable to provide care: 40% of LTCH admissions occur as a result of falls
  • Fall-related injury coupled with co-morbid diseases (e.g., osteoporosis) and age-related physiological decline (e.g.,slower reflexes) make a mild fall dangerous. 

Common Causes

The risk of falling dramatically increases as the number of risk factors increases.

Predisposing

Intrinsic

Extrinsic

Sensory input
   (vision, hearing and
    proprioception)

 Nerve conduction

 Number motor neurons

 Fast twitch fibers

 Muscle mass

 Vascular changes -
   prone to postural
   hypotension

  • Lower extremity weakness, balance / gait problems
  • Visual deficits, hearing loss
  • Acute or chronic illness
  • Decreased sensation
  • Depression, cognitive impairment
  • Dizziness / postural hypotension
  • Functional / ADL impairment

Certain medications:

  • Psychotropics/Benzodiazepines; Digoxin, Diuretics
  • Class 1a anti-arrhythmics
  • Polypharmacy (5 or more)

Behavioural:

  • History of falls, fear of falling
  • Excessive alcohol use (≥14 /wk)
  • Risk-taking behaviours (lack of insight)
  • Improper use (or lack of use) of assistive device
  • Stairs
  • Home hazards (kitchen, bathroom, bedroom)
  • Outdoor hazards
  • Public / community hazards
  • Improper footwear

 

Long-term care providers can significantly decrease the fall risk of their elderly patients by:

  • Screening for fall risk on admission and annularly.
  • Conducting a comprehensive post falls assessment to identify contributory causes and risk factors
  • Implementing multidisciplinary management strategies that target modifiable risk factor especially environmental factors and footwear
  • Review Beers criteria 2012 http://www.americangeriatrics.org/files/documents/beers/PrintableBeersPocketCard.pdf
  • Assess for osteoporosis risk and presence of fragility fractures.  Consider use of bisphosphonates and/or equivalent treatments in presence of history of fragility fractures.
  • Consider use of hip protectors

References

1.  Public Health Agency of Canada, Division of Aging & Seniors.  (2005). Report on Seniors’ Falls in
     Canada. 
Retrieved Feb. 2014 from:
     http://publications.gc.ca/collections/Collection/HP25-1-2005E.pdf

Recommended Readings / Guidelines

1.  Anderson, K.E. &  McKay C.  (2010). How to manage falls in community dwelling older adults: 

     a review of the evidence.  Postgrad Med J. 2010 May; 86 (1015):299-306. 
     Retrieved March, 2014 from: 
     http://www.ncbi.nlm.nih.gov/pubmed/20406801

2.   Cook, W.L., Donaldson, M.G., Janssen, P.A., Khan, K.M. and Sobolev B.  (2009). Analysis of
      recurrent events: a systematic review of randomised controlled trials of interventions to prevent falls
.
      Age Ageing. 2009 Mar; 38(2):151-5. Retrieved March 2014 from:
      http://www.ncbi.nlm.nih.gov/pubmed/19106254

3.   National Institute for Health and Care Excellence. (2013).  Falls: assessment and prevention of falls
      in older people
: June 2013 NICE. Retrieved March 2014 from: 
      http://guidance.nice.org.uk/CG161

4.   Registered Nurses’ Association of Ontario. (2002, 2005, 2011).   Prevention of Falls and Fall Injuries in
      the Older Adult
. Retrieved March 2014 from: 
      http://rnao.ca/bpg/guidelines/prevention-falls-and-fall-injuries-older-adult