Chapter 7: Preventing Falls in Older Adults 5 CC Hours
By: Sara Migliarese, PT, PhD, NCS Learning objectives After completing this course, the learner will be able to: Discuss the definition of falls and their impact. Describe risk factors for falls along with age-related body changes that may contribute to that risk. Identify evidence-based fall risk screening tools that can be performed in the community. Course overview Have you heard the phrase “Silver Tsunami”? This popular metaphor has been used since the 1980s to describe health and economic changes, among other things, that accompany an aging population (Barusch, 2013). This term does not paint a hopeful picture of what happens to older adults as they age; rather, it sounds scary and ominous. Physical and occupational therapists may apply this phrase to the mounting incidence of falls in older adults. A fall is defined as “any unintended non-medical event resulting in a person finding themselves on a lower supporting surface” (Renfro et al., 2016). An older adult falls every second of every day, with more than 29 million falls occurring in 2014, resulting in more than 7 million injuries (Centers for Disease Control and Prevention, 2016). Although agencies such as the Centers for Disease Control, the American Occupational Therapy Association, and the American Physical Therapy Association have developed resources aimed at reducing this adverse event, a reduction in the actual number of falls has yet to occur, and may not decline any time soon with more than 10,000 people in the U.S. turning 65 years of age every day. That means 10,000 new Medicare-eligible older adults who will access the health care system, at some point, many of whom are at risk for falls. Falls are also the leading cause of injury in adults aged 65 years or older, with 30% to 40% of community-dwelling older adults falling at least once per year (Tromp et al., 2001). This number is projected to increase as baby boomers age (AHA, 2007). The shocking reality of these statistics is that more elderly are dying as a result of injurious falls. These numbers should motivate every therapist who works with older adults to learn as much as they can about fall prevention. This need for enhanced education reaches across every practice setting for older adults as they can fall in acute care settings, in outpatient rehabilitation centers and their community, in skilled nursing facilities and assisted living centers, and especially in their own home.
Identify evidence-based assessment tools that measure fall risk and assist in therapeutic treatment planning. Design therapy interventions supported by evidence-based practice that decrease fall risk and potentially prevent future falls in older adults.
Rehabilitative and movement specialists are obligated to learn more about fall prevention in order to transform the older adult population from inevitable fallers to active, independent elderly aging in place. The purpose of this intermediate-level course is to provide healthcare professionals in the areas of physical and occupational therapy with the knowledge they need to successfully identify those at risk for falls, assess individuals, and develop interventions targeted at reducing fall risk in older adults. The target population for this course is the therapist practicing at an intermediate level of clinical skill as it relates to fall prevention in the older adult population. The audience for this course should expect to gain the knowledge and expertise needed to effectively identify older adults at risk for falls, assess and measure the risk factors that contribute to fall risk, and be able to design a rehabilitation program that can make a significant impact on the likelihood of future falls. Although therapists may be aware of the need to assess and treat older adults for risk for falls, they may not be fully abreast of approaches that are supported by evidence and are proven to truly reduce the incidence of falls. A key to successful interventions for fall prevention, which will become evident throughout the course, is that an interdisciplinary approach to this healthcare emergency is crucial to producing any significant impact on fall incidence. No single evidence-based instrument exists that can accurately identify the older adult at risk for falls. Effective, evidence-based interventions for falls employ a variety of approaches, making it important for the therapist to understand the variety of fall risk factors that influence someone’s risk for future falls. Effective interventions have the potential to reduce serious fall-related injuries, emergency room visits, hospitalizations, nursing home placements, and functional decline.
EPIDEMIOLOGY OF FALLS
Falling down does not sound so serious in the large landscape of healthcare issues in the United States. After all, people fall down all the time and get back up and continue their day. Falls would probably not be considered the same degree of health threat that cancer, diabetes, or heart disease are to our quality of life and mortality. The definition of a fall, “an unintended non-medical event resulting in a person finding themselves on a lower supporting surface” (Renfro et al., 2016), doesn’t sound threatening either. But falls are an emergency for an older adult who, because of a fall, might sustain a fracture, lose independence, or even die. With an annual cost of $30 billion spent on direct and indirect costs resulting from falls, older adults who fall may see this as a health emergency. Of adults 65 years or older, one of every three will fall at least once per year, and 30% of fallers will sustain an estimated 13 million injuries requiring medical treatment each
year. Of those who fall, 20% will experience a serious injury that requires emergency room treatment, such as lacerations, hip fractures, and head trauma (Tinetti, Han, & Lee, 2014). More than two-thirds (81%) of traumatic brain injuries in adults 65 years of age or older are a result of falls (Cameron, Schneider, Childress, & Gilchrist, 2015). Fractures are, in general, the most common injury resulting from falls in older adults. Common fracture sites include the hip, wrist, humerus, and pelvis and result from a combination of the fall, osteoporosis, and other health factors that make older adults susceptible to injury. In 2013, more than 25,000 older adults died as a result of injuries from unintentional falls. An average hospital stay for a fall injury costs $35,000 (Cameron et al., 2015). What cannot be quantified in dollar amounts is the fear of falling that develops in many older adults, despite the type or degree of injury. A fear of falling can result in limited physical activity,
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Book Code: PTCA2622B
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