Prevention of Falls in the Geriatric Patient

Prevention of Falls in the Geriatric Patient & The Timed up and Go Test

By, Julie Smith

PAS 645 Masters Project

Advisor: Professor David Fahringer Abstract

More than 1/3 of adults over 65 fall each year in developed countries. Falls lead to injury, hospitalizations, loss of independence, and an enormous decrease in quality of life. Falls are not only a problem, but a dreaded fear for our seniors. Witnessing the fear, frustration, and decline in quality of life and even death after a patient’s, or family member’s fall is sufficient for anyone to feel the need to find a way to reduce the chance of falling. I will include causes and statistics of falls, typical injuries, associated risk factors, and predominantly focus on what providers can do to identify and help the potential faller with preventative measures. Can we recognize a potential faller? Can we do this in the clinic? The answer is yes. There are several ways to recognize fallers or potential fallers. The “Get up and go” test is a quick simple tool that I feel can be used practically during office visits. I will also include a fall prevention tip sheet which providers can use for their patients. The reality of a growing geriatric population in clinical practice is evident. I believe the importance of making a significant difference in reducing falls will become more of a necessity than simply a recommendation in the future. Utilizing the tools to improve the safety and quality of life to minimize this inevitable risk may just be enough to make a difference in a patient’s life.

It is time to make that difference. Introduction

Falls continue to plague the elderly population every year. As the elderly population inevitably grows, so do the number of falls. While some falls result with no injury, some only minor injuries, others can lead to hospitalizations, fractures, surgery, head injuries, and even death. Researchs strive to find the cause, and studies reveal again and again that it is not just one, but many factors that lead to falls, and can predispose patients to this problem.

Most people can relate to this problem for our seniors because of a personal experience with a family member or friend. The tragedy is that there is an enormous loss of quality of life associated with falls that result in hip fractures, which involve surgical correction of the fracture by pinning or total hip replacement. Many individuals who fall become hospitalized, may sustain a hip fracture and surgery, and premature entrance into a nursing home up to a year after a major fall. The cost of a nursing home facility can put an enormous financial strain on any family, not to mention the year loss of independence, loss of freedom, social life, and pain and suffering associated with a fall. The bottom line remains that this has become an enormous threat to the quality of life to all of our seniors.

Developing an understanding of the statistics of falls and risk factors affecting the older patient will pave the way to possible solution tactics including preventative measures that seniors can and should take to reduce the incidence of this growing problem. So, who is it that falls? Do women or men fall more often? What are the common injuries sustained by fallers? How many people fall each year?

By, merely looking at the statistics of falls each year can give some insight to begin to answer the obvious questions. FACTS AND FIGURES:

 Falls can occur and any age, but drastically rise after the age of 65

 1/3 of adults over 65 years of age fall each year in developed countries

 Falls are the leading cause of fatal and nonfatal injuries in people 65 and older in the

United States.

 The most common serious injuries are head injuries, wrist fractures, spine fractures, and

hip fractures.

 60 % of falls occur at home, 30 % occur in the community and 10 % occur in nursing homes or other institutions.

 About 25 % of all falls are the result of hazards in the home such as slippery or wet surfaces, poor lighting, inadequate footwear and cluttered pathways in a home

 Most fractures are a result of a fall in a home, usually related to everyday activities such as walking on stairs, going to the bathroom or working in the kitchen.

 Tripping in the home is a cause of many falls

 Women fall more than men = 58%

 15% of people who have fallen, fall again

 Falls account for 80% of all injury related admissions to the hospital of people over 65

years of age worldwide ( Kannus, 5)

 Fractures accounted for only 35% of non-fatal injuries

 Fractures account for 61% of the total costs due to falls

 10-20% of the 1/3 of adults over 65 who fall sustain fractures or head injuries

 Lower extremity injuries 48% vs. Upper extremity injuries 13%

 1.67 million treated in 2002 >65 yo in the Emergency Room

 388,000 in 2002, >65yo ended up being hospitalized

 12,900 older adults died due to falls in the U.S. in 2002 Statistics related to medical costs of falls

 In 2000, .2 Billion $ in medical costs for fatal falls, 19 billion for the non-fatal injuries

 63%(12 bill) of the non-fatal injury costs were for hospitalizations, 21% (4 bill) for ER

visits, 16%9 (3 bill) for outpatient settings

 Women’s healthcare costs associated with falls were 2-3 x higher than men’s costs

overall

(Stevens, JA. The costs of fatal and non-fatal falls among older adults

Hip fracture statistics

 90% of the more than 352,000 hip fractures in the United States each year are the result of a fall. By the year 2050, there will be an estimated 650,000 hip fractures annually. This is nearly 1,800 hip fractures a day.  Women have two to three times as many hip fractures as men. White, post-menopausal women have a 1 in 7 chance of hip fracture during a lifetime. The rate of hip fracture increases at age 50, doubling every five to six years.

 Nearly one half of women who reach age 90 have suffered a hip fracture.

 The risk of hip fracture for women 5'8 " or taller is twice that of women who are under 5'2. " Studies show that women who have broken their arm in the past have an increased risk of breaking a hip. Among people age 50 and older who fall, women have two to three times as many hip fractures as men.

 Only 25 percent of hip fracture patients will make a full recovery; 40 percent will require nursing home care; 50 percent will need a cane or walker; and 24 percent of those over age 50 will die within 12 months.

 Nearly one-in-four hip fracture patients will die within 12 months after the injury because of complications related to the injury and the recovery period.

 The cost of hip fracture care averages $35,000 per patient.

 There were 220,000 total hip replacements performed in the United States in 2003 (Source: National Center for Health Statistics; Centers for Disease Control and Prevention; 2003 National Hospital Discharge Survey). Last reviewed and updated: July 2007 (www.orthoinfo.org) The Tristate area of West Virginia, Ohio, and Kentucky has a large geriatric population. A small local

West Virginia physical therapy clinic was asked for their reported fall statistics over a recent 6 month period. They asked to remain anonymous. What’s interesting to note is that Medicare is now requiring physical therapy clinics as of January 1, 2008, to record and report fall history information on all of their new patients over 65 years old. The incidence of falls are obviously making their mark.

Data collected between Aug 1, 2007- Jan 25, 2008

32 patients fit this criteria.

 11/32 or 34% reported a fall.

 3/11 had fallen more than once= 27%

 5/11 (45%) of those who did fall, fell with resultant injury.

 6/11(54%) did not report an injury.

 8/11(72%) who fell were female

*As we can see from the statistics reported nationally and locally, older females consistently

predominate the numbers.

Injuries sustained from Falls The most common serious injuries from falls are head injuries, with resultant brain bleeds, wrist fractures from bracing a fall, spine fractures, and hip fractures, resulting in pinning or hip replacement.

Among the many injuries large and small sustained by falls, fractures and head injuries result in a dramatic life changing events which lead to the decline in activities of daily living, loss of independence, and even death.

*Nearly all hip fractures occur as a result of a fall and many fall again soon after sustaining the fracture. Osteoporosis with low bone mineral density puts older people who fall at high risk of sustaining fractures. A first hip fracture is associated with a 2.5 fold increased risk of a subsequent fracture. A population based study among people aged 85+ showed that 21% of those with a hip fracture had suffered at least two hip fractures. (Stenvall, M. 2007) Etiology/Risk Factors Addressing the possible causes of falls is vital in caring for the older patient. Understanding the statistics also gives us insight to possible causative agents. If we can identify why a particular person is falling, or identify a risk factor for a potential faller, then preventative measures may reduce the incidence or number of falls incurred by a patient, thus improve the quality and longevity of life of the older population. There are several risk factors involved with falls. They include, but are not limited to balance, functional mobility, muscle strength, proprioception, fear of falling, flexibility. A study was conducted involving these particular risk factors. It included 116 people over the age of 65 living in a nursing home, and evaluated the relationship between the risk factors for falling and the quality of life in older patients. They concluded that balance, functional mobility, muscle strength, and the fear of falling were associated with quality of life, while flexibility and proprioception were not correlated with quality of life. Quality of life can mean different things to all of us. For some of us, it can include age, social life, marital status, income, occupation, and to others it may mean independence, ability to drive a car, freedom, capability, being free of disease, free of stress, but falls in particular are a major health problem that affects quality of life and threatens its’ status in many ways. It also was found that quality of life was not correlated with age. This result suggested that the quality of life does not change with aging but age affects the risk factors for falls.

Another major risk factor includes medication and the side effects. Medicines that affect the ability to maintain balance, or have side effects of dizziness or hypotension are of great concern. At age 65, falls begin to occur more often, and should be a good cue for a provider to review a patients’medicine list regularly to avoid this risk factor. Medications to be aware of which may put a patient at risk for falls: Alpha Blockers, especially on the initial dose, antidepressants, benzodiazepines, sedative- hypnotics, and vasodilators just to mention a few.

Fall history is a reliable predictor of future falls. Statistics show that 15% of fallers have fallen more than once. Therefore, taking a proper history is indicated in all patients over the age of 65. Including this information on patient information questionnaires may be a very helpful tool in identifying a potential faller, or identifying the need for implementation of a prevention program.

Visual and hearing disturbances are also risk factors for falls. Inner ear infections can cause vertigo, and balance dysfunction leading to unsteadiness in gait. Visual disturbances due to cataracts, glaucoma, diabetes, or simply the aging process can put patients at risk for falls due to lack of awareness of their surroundings, making it difficult for the patient to negotiate in their surroundings.

Regular eye and ear check ups are encouraged. Prompt treatment of an ear infection or eye dysfunction may reduce these risk factors.

Peripheral Neuropathies, especially associated with Diabetes Mellitis are a risk factor contributing to the loss of balance with decreased sensation in the extremities, namely in the feet. These patients are encouraged to wear shoes at all times to protect their feet, and improve stability. Their loss of sensation is progressive with the disease. Encouraging control of glucose levels will prolong and prevent this risk factor.

Osteoporosis is a metabolic disease effecting older women, particulary who are post menopausal, causing porous bones prone to fracture, and is likely the cause of the discrepancy between men and women’s health care costs and injuries. Women sustain fractures more than men, with hip fractures especially being extremely debilitating. Hip fractures commonly need to be corrected surgically, may require premature admission to a nursing home for up to 1 year, thus, a big contributor to women’s healthcare expenses as compared to men’s. Addressing Osteopenia, Osteoporosis, and family history early on with medication and exercise is especially important for our senior women. Osteopenia and

Osteoporosis are medical conditions effecting the result from falls, not necessarily a cause of falls.

Knowing that many falls result in fractures, by addressing these conditions, and improving the bone density of our senior women we can attempt to reduce the number of debilitating fractures sustained by falling. The medications associated with osteoporosis and Osteopenia are associated with good compliance, and therefore are an easy preventative measure to implement. Asking about family history, menstrual patterns, and keeping in mind that Osteoporosis can occur prior to the age of 65 addresses this important issue to recognizing and treating this condition as early as possible.

Home hazards are considered a risk factor for falls as well. 6 case controlled studies examined the correlation between the patient’s environment and falls. One study revealed that 2 of the most common problem areas in the home of those who had fallen were uneven floors and lack of hand rails.

(#7) While only 2 of the 6 studies found correlations between home hazards and falls, the other 4 did not.

“ The existence of home hazards is insufficient to cause falls, and the interaction between an older person’s physical abilities and their exposure to environmental stressors appears to be more important. Taking risks or impulsivity may further elevate falls risk. Some studies have found that environmental hazards contribute to falls to a greater extent in older vigorous people than in older frail people. This appears to be due to increased exposure to fall hazards with an increase in the proportion of such falls occurring outside the home. Reducing hazards in the home appears to not be an effective falls- prevention strategy in the general older population and those at low risk of falls. Home hazard reduction is effective if targeted at older people with a history of falls and mobility limitations. “(7)

So, is it worth it to do a home check even though some studies suggest that it’s ineffective?

Eliminating potential hazards makes for a safer place to live. What can it hurt?

Preventing falls in the home of independent individuals I feel is extremely important, but we also need to realize that falls also occur in hospitals and nursing homes as well.

A hospital setting is not a safe place for elderly people but is actually associated with increased risk of falling. “(5, Kannus) This is a scary thought. One would think that in a hospital of all places, one would be safe. Upon admission though, a patient is exposed to a new strange environment that is unfamiliar to them. They may be confused, have co-morbidities, feel weak, and may have impaired balance due to medications they may not be accustomed to. This would cause anyone to have an unsteady gait, putting them at risk for falls. A promising study was done to address increased risk of falling in hospitals. Unfortunately, it was not a randomized trial, but their results were impressive in reducing fall risk by 19% and reducing the risk of falls resulting in serious injury by 77%. This was achieved through a multistrategy prevention improvement project in the hospital focused on reducing falls in frail older patients in the hospital. Fonda and colleagues aimed at modifying the environment, fall risk screening, work practice changes for the staff, after fall assessments, equipment changes, and patient and family support and education. There project was a huge success and an inspiration to reduce the risk of falls in a hospital setting. More studies were suggested to investigate this with randomized control studies to validate their success.

Regardless of this study, I personally believe that we should consider the home as a threat for falls.

We know from other statistics that a large number of falls occur in the home. Consider the changes in flooring from room to room, thresholds, throw rugs, support bars in bathrooms, stairs, and lighting as potential sources of concern. My grandmother fell and broke her hip, and received a hip replacement in her early 60’s due to slipping on a throw rug. I think that this can happen to anyone, whether you’re

40, 60, or 80. The problem remains that we become less resilient to falls as we age. Eliminating these hazards is only a small part of what we can do to reduce the incidence of falls.

PREVENTION

What can we do to help reduce the incidence and injuries from falls? Identifying risk factors associated with falls allows us to then assess and modify those risk factors to decrease the risk of falls.

Age, gender, and heredity are non-modifiable risk factors. But, home hazard assessments and modifications, medication review, regular check ups, maintaining activity levels, addressing co- morbidities such as diabetes and osteoporosis and in particular, testing an individual for fall risk can be a helpful adjunct in identifying an individual at risk. One such test is called the timed up and go test, also known as the TUG test. The TUG TEST

There are many ways to assess whether a patient may be at risk for falls.

The TUG or Timed “Up and Go” test is a test that assesses involves fall risk with regard to mobility and ambulatory function. This test is quick and simple to perform for both patient and provider. It is a measurement of the time that it takes an individual to get up from a chair with arms, walk 3 meters, turn 180 degrees, walk back to their seat, and sit down. It is suggested that though this is a reliable indicator of fall risk, it has a missing element of an obstacle, something that our bodies need to adjust to while walking. A major cause of falls in the elderly involves tripping over an obstacle of some sort.

This missing element of an obstacle was added to the TUG test assess the tripping element, and is called the TUGO test or Timed up and go with an obstacle. Studies show that tripping is a major cause of falls in the home. Because this tripping element is included, it is believed to be a more reliable, and more realistic, more functional way to test an individual’s ability to negotiate an area. In this test with the obstacle, the subject stands from an arm chair, walks 5 meters, steps over a box 120 cm wide and

20 cm high. The height of the box varied in the testing from simply a sheet of paper on the floor, to 5-

20 cm high. In comparing the TUG test and the TUGO test, the total time required for the patient to complete the test was significantly increases, and therefore assesses the mobility of a patient more effectively. The subject performs a practice test, and the second try is then recorded. If patients use a walking aid, they are to use it during the test. The reason why this test is so important is because it assesses the basic daily movements needed to ambulate in our environment. This test requires mobility, function, balance, strength, standing on one leg in order to step over the object, and requires the subject to change directions, and of course standing up and sitting down. These movements require a subject to change their center of gravity and equilibrium throughout different body positions and functions, a problem for most fallers at risk. In essence, this test unlike many others I researched, objectively and simply assesses the functional mobility of a patient, in a timely fashion that requires nothing more than a hallway and a piece of paper or box of tissues. The decline of functional mobility is a major risk factor in falls. Inactivity in the elderly population is a major contributor to this dysfunction. Inactivity leads to lower extremity weakness, ambulatory dysfunction, and fear of falling. This decline in function leads to decreased quality of life and dependence of others. (Demura S,

Uchiyama M)

The literature listed the TUGO test as an sensitive and efficient predictor of falls, especially in a patient with osteoarthritis. Realistically, the use of this test is a quick, simple, effective test for both the patient and provider to perform.

The only problem with the TUGO test that I encountered is the fact that the literature does not reflect any set parameters for the time element to predict falls. The TUGO test literature proves that with the addition of an obstacle, the time element is extended in the test, reflecting that avoiding an obstacle while ambulating takes a significant amount of time to do, and is a more functional assessment of fall risk, but doesn’t give the provider means to assess a patient by any given parameters other than the fact that the longer it takes to complete the task, the higher the risk of falling.

Due to the difficulty in finding examples of TUGO standards, I’ve included TUG test statistics and measurements that are related to fall risk in assessment of a patient at risk to fall.

The following tables 3,4,5 reflect statistics from a study on the TUG test without the obstacle related to falls and patients with osteoarthritis. Table 3 Frequency of fall, near-falls, mechanism, location and injuries sustained from falls

Variable Frequency Percent Participants reporting at least 1 fall in past year 48 45.3

Frequency of falls • 1 fall 37 77.1 • 2 or more falls 11 22.9

Location of fall* • In home or residence 29 49.2 • Outside the home or residence 10 17.0 • Indoors in the community 5 8.5 • Outdoors in the community 15 25.4

Mechanisms or causes of the fall* • Tripped (impact of swing leg on external object) 21 35.6 • Slipped (sliding of support leg) 16 27.1 • Lost balance 15 25.4 • Missed curb or step 4 6.8 • Muscle weakness/leg gave away 3 5.0

Activity at time of the fall • Ambulating 33 55.9 • Ascending or descending stairs or step 13 22.0 • Reaching 7 11.9 • Getting up or down from chair or bed 6 10.2

Injuries sustained from falls reported* • Fracture 6 10.2 • No fracture, but other injuries beyond minor scratch or bruise 18 30.5 Variable Frequency Percent • No injury 35 59.3

Frequency of Near falls** • Frequent (1/week or more) 31 29.8 • Occasional (< 1/week but more than once or twice in past year) 49 47.1 • Never 24 23.1 * Total of 59 falls recalled by 48 fallers; ** n = 104 BMC Geriatr. 2007; 7: 17. Published online 2007 July 4. doi: 10.1186/1471-2318-7-17. Copyright © 2007 Arnold and Faulkner; licensee BioMed Central Ltd.

Table 4 Mean values and standard deviations for age, mobility and other demographic factors comparing three TUG categories: < 10 seconds, 10 – 13.99 sec. and 14 or > sec.

Variable < 10 sec. 10 – 13.99 sec. 14 or > sec. Age (n = 106) 70.4 (4.2) 73.5 (5.5) * 79.7 (5.7) * † Mobility rating (1–10; n = 100) 7.4 (1.8) 6.4 (1.7) * 5.5 (1.4) * # prescription meds (n = 81) 1.5 (1.9) 2.8 (2.8) 4.0 (2.0) * # co-morbidities (n = 105) 1.6 (0.9) 2.1 (1.1) 2.9 (1.6) * † Length of time hip OA (yrs; n = 73) 5.8 (5.6) 7.6 (7.2) 10.4 (10.9) * p < 0.05 comparing to < 10 sec.; †p < 0.05 comparing to 10 – 13.99 sec. category using Tukey's post- hoc analysis BMC Geriatr. 2007; 7: 17. Published online 2007 July 4. doi: 10.1186/1471-2318-7-17. Copyright © 2007 Arnold and Faulkner; licensee BioMed Central Ltd

As we can see from the above TUG scores, as age, prescription medications, co-morbidities, and length of time with osteoarthritis increased, so did time to complete the test. Not surprisingly, the mobility rating also decreased with increased time needed to complete the task.

Table 5 Odds ratios and 95% confidence intervals for predicting fallers and frequent near-fallers Faller OR (95% CI) Frequent near-faller OR (95% CI) Uses walking aid vs. none 0.84 (0.4 – 1.8) 1.4 (0.6 – 3.3) Age 75 + vs. < 75 1.6 (0.8 – 3.6) 3.0 (1.3 – 7.3) Hip pain bilateral vs. unilateral 0.9 (0.4 – 2.2) 0.5 (0.2 – 1.4) Limited activity vs. light or moderate 0.9 (0.4 – 1.9) 2.2 (0.9 – 5.1) Female vs. male 1.0 (0.4 – 2.3) 0.7 (0.3 – 1.9) TUG score 10 sec or > vs. < 10 sec 1.0 (0.4 – 2.3) 3.1 (1.0 – 9.9) TUG score 14 sec. or > vs. < 14 sec. 1.4 (0.6 – 3.4) 2.4 (1.0 – 6.1) BMC Geriatr. 2007; 7: 17. Published online 2007 July 4. doi: 10.1186/1471-2318-7-17. Copyright © 2007 Arnold and Faulkner; licensee BioMed Central Ltd.

Looking at table 5, statistics reveal that participants were three times more likely to be a frequent near- faller if their TUG score was > 10 seconds or if they were over the age of 75. This is a significant aspect of both the TUG test and the TUGO test. The longer it takes to complete the test, the more likely the individual is to fall.

Another study, in 2003, aimed at assessing a proper cut off point to assess normal in the TUG test related to institutionalized and community dwelling elderly patients. They came up with 12 seconds being the cut off of normal in the timed test from the instant they left the chair to the time they sat down. Normal for these individuals ranged anywhere from 6 seconds to 11 seconds. Therefore they concluded that anything over 12 seconds was related to a risk for falling. (Bischoff, et al)

Tinnetti test is a competitor of the TUG and TUGO tests using gait, balance, and time to complete the test as assessments of the patient’s fall risk. The description is included below. The test is reliable and predictive of falls, but unfortunately, it takes 10-15 minutes to perform on average, a luxury most clinicians don’t have at an office visit. Several other tests are available, such as

Berg test for balance, proprioception assessment, strength testing measured by dynomometers, the flexibility sit and reach test, and the fear of falling visual analogue assessment are other options, but all are quite time consuming for a physician, physician assistant, or nurse practitioner to use.

Assessments like these can be further investigated with referral to a physical therapist, who has more time and expertise to evaluate possible dysfunctions in gait, weakness, and other possible contributing factors.

There is more research needed to create time standards for the TUGO test associated with low, medium, and high risk of falls for patients. Until then, I feel that providers can the TUG test because it is simple, reliable, costs nothing, and is minimally time consuming taking less than a minute to complete. Even if they just put the patient through the test without timing them to merely observe their performance during this simple task to provide a baseline for completion of rising from a chair, ambulating, turning, and sitting down. This test could be included in annual physical exams for patients 65 and older.

The home hazard checklist as mentioned before is a handy tool for the elderly to identify potential problems in the home. A checklist has been included.

Preventative programs involving balance and proprioception training clinics are now becoming more popular in urban areas. Many YMCA gyms, a more accessible modality, have pool exercise classes for arthritic patients, which are very helpful and enjoyable for those who are comfortable in the water to gain strength and mobility with little risk of injury in the water. Although water exercise will not promote much bone building to prevent osteoporosis, by eliminating weight bearing element, mobility and ease of motion is enhanced allowing less painful movements to build and maintain muscle strength and activity levels.

Encouraging regular check ups and patient education for the elderly patient. Educating the patient of potential side effects from medications or potential problems with sight deficits and ear infections especially need to be addressed.

A Medic Alert bracelet or necklace for those living alone with or without full time help along with well visible and accessible contact numbers to family and friends in case of an injury or emergency are also a must for the elderly patient.

One interesting approach to hip fracture prevention from falls is wearing hip protector pads. A randomized controlled trial was conducted to assess the effectiveness in reducing hip fractures with the use of wearing hip protectors. This study included 561 patients 70 or older. It was thought that essentially the hip protectors would absorb the impact of a fall, thereby reducing the risk of fracture. The conclusion of the trial revealed that the hip protectors were not effective in preventing hip fractures. A few of the major reasons for failure of this device were noted including non-compliance of wearing the protector due to discomfort or asthetics, not wearing the protectors at night, a common time to fall, and 4/18 in one of the intervention groups actually sustained a hip fracture while wearing the hip protector. (prev of hip fx ext hip prot.) 10 Reminders for Fall Prevention for the Medical Provider

1. Ask all patients over 65 about any previous or near falls 2. Medication review: Take note of all meds, eliminate unnecessary meds with contributing side effects: especially benzodiazepines, sleeping meds, neuroleptics, antidepressants, seizure meds 3. TUG TEST - watch for extended amounts of time, trouble getting out of chairs, scores > 4. Visual/Audio -Visual acuity <20/60 puts at risk for depth perception deficits. Refer if needed -Ear checks- ear infections, vertigo symptoms 5. Bone density: Family history, Osteopenia and Osteoporosis; Dexa scans and Treat 6. Impaired neurological exam, proprioception deficits, DM patients with peripheral neuropathies 7. Gait. Abnormal gait, improper use of walking aids lead to falls, Refer to Physical Therapy 8. Musculoskeletal abnormalities/weakness, balance deficits-Refer to Physical Therapy 9. Home hazard safety - communication with patient and family to eliminate hazards 10. Medic Alerts especially for those living alone

Tips for Reducing Home Hazards related to Falls  Eliminate or secure all throw rugs with non-slip pads  Assess lighting, and have nightlights for evening bathroom trips  Install hand rails in bathrooms and stairways  Remove clutter on floors and stairways, cords especially  Always wear shoes or slippers with rubber soles  Non-skid surface in bathtubs and showers  Evaluate thresholds for potential tripping dangers  Shower chairs and bedside commodes are helpful  Take medicine as instructed Others/general for the elderly  Easy access to contact and emergency numbers  Slow changes in positions from lying to sitting to standing  Sit in chairs with arms  No high heels ladies!  Proper use of walking aids include actually using them  Ear infections and eye problems can lead to falls  Report any side effects from medications involving dizziness  Stay active and practice a good nutritional diet

Conclusion

Reducing the incidence of falls in the geriatric population is not a problem that we can make better overnight, but there are several preventative measures that providers can utilize to minimize the drastic incidence and effects of falls in the elderly population. Even though controversy exists concerning home hazards and their effects on falls, I believe that we need to protect and educate the elderly population in any way that we can to ensure and promote quality of life. I do believe that reducing the hazards in the home will make a difference, and at the very least, ease the minds of the patient and family that they are in a safer environment for them as they age.

I also feel that providers can make a difference early on especially with consistent review of medications, educating patients of the risk factors of falls, performing the TUG test and identifying those patients with scores over 11-12 seconds. Also, keeping in mind that prevention of osteoporosis could go a long way for the women of the elderly population by diagnosing and treating this disease as early as possible. We have to find a way to lower the incidence of falls. 1 out of every 3 people over

65 falling each year is unacceptable, not only for the potential injury and decline in quality of life to the patient, but also to the health care system itself. As the cost of healthcare continues to rise, so will the financial burden related to the injury care, surgery, and possible post injury care.

We need to take the old expression “Learn from your elders,” to heart, and let the falls of the elderly population be a lesson for us to find ways to take the right steps to ensure safety and quality of life for our seniors.

Instructions to perform the TUG test are listed below

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http://orthoinfo.aaos.org/topic.cfm?topic=A00121 VIDEO http://www.youtube.com/watch?v=xx1XCpglOc