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Gerontology Mod07
Falls in the Older Adult
| Question | Answer |
|---|---|
| Falls are an inevitable consequence of aging. T/F | False. May be due to physical dysfunction, medications, environmental hazards |
| How many of those 65+ experience a fall related incident per year? | >1/3. Rate is as high as 44% per year |
| How much greater is the risk for nursing home residents vs community dwelling older adults? | 3 times greater |
| Falling in the past 6-12 months is a risk factor in falls. What % have falls more than once per year? | 40% |
| Falls are the leading cause of injury, death, and disability for those over 65. Fall related injures occur how often with falls? | ~15% of falls result in injury |
| What % of older individuals who remain on the ground after a fall for longer than 6 hours died within 6 months? | 50% |
| What is typically observed with falls during the months preceding death? | Clustering of fall occurances |
| What are the most common places for falls to occur at home? | Stairs, to and from the bathroom, and in the bedroom. 85% of falls occur at home. |
| Intrinsic risk factors for falls. (11) | Frail, Alzheimer's disease, Parkinson's disease, stroke, depression, RA, hip fx, LE amputation, weakness, altered vision, FOF |
| Extrinsic risk factors for falls. | Environment (ie. dim light, floor coverings, pets, footwear). Extrinsic factors contribute to up to 37% of all falls. |
| Extrinsic risk factors make up what % of falls that require medical assistance? | ~50%. These risk factors effect more mobile older adults. |
| Institutional extrinsic risk factors. (3) | Time of day, staffing levels on nursing floor, and room distance form nurses' station |
| Other risk factors for falls. (6) | Poor health status, impaired mobility from inactivity or chronic illness, postural changes or instability affecting COG, limitations in ROM or joint mobility, coordination problems, and gait deviations. |
| Hirase 2014 "7 Risk Factors for Falls" | 1) Fall in the past year 2) Cross the street without resting 3) Walk an entire kilometer 4) Put on socks while standing on 1 leg 5) Admitted self to hospital in past year 6) Ever had a stroke &) Have a FOF or avoid going out due to FOF |
| Falls and near falls can generate what psychological factors? | Fear, anxiety, and loss of confidence. |
| Tinetti's definition of FOF | "Lasting concern about falling that leads to an individual avoiding activities that the person remains capable of performing" |
| Excessive FOF with activity limitation can lead to: | Loss of mobility, decreased social stimulation, and loss of strength and function. |
| FOF results in what activity modifications? | Limited activities or guarded during activities, altered gait habits, or inactivity. |
| FOF can be caused by reasons other than suffering a fall. T/F | True. FOF can be caused by knowing someone that has fallen. |
| A use of ________ or more prescription medications is a possible risk for falling. | 4 |
| The postural control system (PCS) receives information from what systems? | Receptors in propioceptive, visual, and vestibular. |
| 3 strategies used to maintain balance. | Ankle, hip, and stepping strategies. |
| Impairments in what 2 things are significantly related to gait speed variability? | dynamic balance and upper extremity mobility |
| Gait speed is a strong predictor for fall risk and disability. After age 60 gait speed declines at what rate per decade? | 12-16% |
| What is the minimum gait speed to be independent with all ADLs? | 1.0 mph. Persons will be dependent on 1 or more ADLs with a gait speed < 1.0 mph. |
| Optimal control of balance is maintained up until what age? | 60 |
| There is a 50% increase in latency in older adults from sensory integration. Causing them to increase their usage of what strategy? | Stepping strategy |
| Vestibular system plays a major role in control of COG position when there is a conflict between visual and somatosensory information. T/F | True. It plays a minor role when somatosensory and visual information are adequate though. |
| The vestibular system assists in stabilizing gaze during head and body movements by _____. | Generating conjugate smooth eye movements opposite in direction and ~ equal velocity to head movements. |
| 4 basic domains of fall assessment | 1) Specific patterns and injuries 2) Physical function and functional activity level 3) Psychological consequences 4) health related quality of life |
| Examples of screening tools for frail elderly? New patient? | TGUG for frail elderly. Morse Fall Scale for new patients |
| Medications most commonly associated with falls by community dwelling older adults | Benzodiazepines, beta-blockers, and diuretics |
| 3 age related changes that increase adverse reactions to medications. | Altered drug metabolism and absorption, changes in distribution, and elimination. |
| Morse Fall Scale (Location of use, time to do, scoring, limitations) | Used in VA and acute care settings. Takes < 3 minutes 0-24 no risk, 25-45 moderate risk, 46-125 high risk Does not take into account medications. |
| Timed Single Legged Stance (Location of use, time to do, scoring, limitations) | Community dwellers ~30 seconds Norm 10 sec with EO Sensitive to clinical interventions |
| Berg Balance Scale (Location of use, time to do, scoring) | Community dwelling adults and institutionalized adults 15 min to administer 0-20 w/c bound, 21-40 walking with assistance, 41-56 independent |
| Functional Reach Test (Scoring) | < 25.4 cm 2x as likely to fall < 15.2 cm 4x as likely to fall 0 cm 8x as likely to fall |
| Modified Clinical Test of Sensory Interaction on Balance mCTSIB (Use, test, limitations) | Assesses how well an individual can balance when 1 or more of their sensory inputs are compromised 1) solid, level surface EO 2) EC 3) Foam EO 4) Foam EC Limitations: can't discern patterns of sensory dysfunction, doesn't predict in community-dwellers |
| Physical Performance Test (Use, Time, Scoring) | Screen for falls, frailty, and ADLs. Predict need for institutionalization and likelihood of death 10 min to administer 32-36 not frail, 25-32 mild, 17-24 moderate, <17 unlikely to function in community |
| Dynamic Gait Index (Use, Scoring) | Effectiveness of intervention for community dwelling adults and vestibular disorders 8 aspects of gait scored 0-3 (3 normal) < 20 is a high risk for falls |
| Functional Gait Assessment (Use, Scoring) | Reduces ceiling effect of DGI Good validity for PD Predicts falls within next 6 months 10 items scored fro 0-3 with higher total representing better balance and gait ability |
| 5 Times Sit-to-Stand Test (Use, Scoring) | Measures functional LE strength and dynamic balance Times > then norms are associated with increased disability and morbidity 12 sec 60-69; 13 seconds 70-79; 15 seconds 80-90 |
| Timed Up and Go (Use, Scoring) | Designed for frail adults > 14 sec in community dwelling adults associated with a high fall risk > 30 in frail older adults = require assistive device for ambulation and dependent in ADLs |
| Performance-Oriented Mobility Assessment POMA (Scoring) | Observe gait and balance Balance scale 9 items total score out of 16 Gait scale 8 items total score out of 12 Risk of falls >24 Low 19-24 Medium <19 High |
| Psychosocial screenings for fall risk | FOF, depression, and cognitive impairment |
| Falls Efficacy Scale (FES) | Elderly in long-term care Self reported scores for 10 ADLs (1 - totally confident to 10 - no confidence) Average > 6 indicative of FOF |
| Modified Falls Efficacy Scale (MFES) | 4 outdoor activities added to FES Use visual analog scale 0 = not confident 10 = completely confident Average < 8 indicates FOF |
| Survey of Activities and Fear of Falling in the Elderly (SAFE) | 11 items representing ADLs and IADLs Activity level scale 0 = no 1 = yes FOF scale 0 = not worried 3 = very worried Higher scores = > FOF |
| Activities specific Balance Confidence Scale (ABC) | Self-report measure of balance confidence 16 items rated from 0% - no confidence to 100% - complete confidence < 50 low level of functioning 51-80 medium level of functioning > 80 high level of functioning Better than FES on high vs low mobility pts. |
| Depression and falls | Can be a contributor to and a result of falls |
| Center for Epidemiological Studies Depression Scale (CES-D) | self-report scale to assess depression not used to make a diagnosis 20 statements to reflect pt's feelings in previous week Max score 60 >21 major depression 15-21 mild to moderate depression < 15 absence of depression |
| Geriatric Depression Scale (GDS) | Long form: 30 item questionnaire 5-7 min to complete Short form: 15 questions 0-4 normal 5-8 mild depression 9-11 moderate 12-15 severe |
| Mini Mental State Exam (MMSE) | < 24 indicates cognitive decline |
| Cornerstone of management of balance disorders | Balance re-organization strategies |
| Fall interventions should promote | orientation, gaze stabilization, postural realignment, muscle strength, and joint mobility |
| Fall prevention program and safety education | 1) Identify fall risks 2) Safety in the home and environmental adaptations 3) Allow plenty of time for functional activities 4) Test for postural hypotension |
| Flexibility exercises for fall prevention | Ankle flexibility important for proprioceptive efficiency of ankle joint receptors |
| Balance exercises | 1) Postural control or response to perturbations 2) Weight shifting 3)Anticipatory adjustments to limb movements |
| 1st Motor Response (<50 ms) | Spinal cord = automatic reflexes Impulse Technique Isometric Stabilization (ITIS) - medicine ball, perturbations Oscillating Technique Isometric Stabilization (OTIS) - band resistance, body blade |
| Impulse Technique Isometric Stabilization (ITIS) | Quick and repetitive loading and unloading Facilitates mechanoreceptors which stimulate joint proprioceptors and reflex adaptation |
| Oscillating Technique Isometric Stabilization (OTIS) | Stimulates mechanoreceptors and muscle spindle activity Leg is stabilized it reacts to weight shifting generated by the arms increasing proprioception |
| 2nd Motor Response (70 -120 ms) | Brainstem = facilitates co-contraction Bilateral > SLS > EO > EC Stable > unstable > Head turning |
| Placing band around the forefoot for monster walks has what action? | Selective enhancement of gluteal muscles vs TFL by adding ER to the hips |
| Tai Chi | Participants >70 3x/week for 6 months significantly decreased # of falls, reduced FOF, and improved functional balance and physical performance |
Created by:
jpwittman
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