Falls: Low Vision and Falls

Jag Mallya1-09-2010

Definition:

A fall is an event which results in a person inadvertently coming to rest on the ground, the floor or other lower level.

No evidence of: sudden onset of paralysis, epileptic seizure, or Loss of consciousness overwhelming external force

Epidemiology of Falls > 65 years – 30% > 75 years – 40% 50% of falls in people who fall twice or more in a year.

Consequences of Falls Commonest cause of Accidental injury in older people.

Commonest cause of Accidental Death in > 75 years of age.

6% falls > 65 years result in a fracture.

Commonest cause for older people to attend A & E > 75 years hip fractures predominate.

Fragility fracture also costs £1.7 billion per year (In-patient & long term provision.)

Table 10: Cost of an individual hip fracture

Category Cost

Hospital care £4,760

Ambulance £171

Long stay residential care £20,010

GP use £164

Outpatient use £319

Total Cost £25,424

Cost of Hip Fracture in Elderly in UK.Hospital Costs: $ 430,407,013Social Care Costs: $ 933,420,670Other: $ 18,000,000

Approx Total Cost: $1,382,932,183

Ref: “The Economic cost of hip fracture in the UK.”

Social Costs of Falls By 2051 = Falls (Population of Australia: 22,403,920)

Direct health cost attributed to falls related injury will increase 3 fold.

2500 additional hospital beds will need to be permanently allocated to falls.

3320 additional Nursing Home places.

Ref: Health Service impacts and costs of falls in older age (WHO) Dongbu Fu

Falls are Multifactorial:

Intrinsic Factors Extrinsic Factors

FALLS

Medical conditions

Impaired vision and hearing

Age related changes

Medications

Improper use of

assistive devices

Environment

Falls in the Community

Accidents/environment 37%

Weakness, balance, gait 12%

Drop attack 11%

Dizziness or vertigo 8%

Orthostatic hypotension 5%

Acute illness, confusion, drugs, decreased vision

18%

Unknown 8%

Rubenstein JAGS 1988

Causes of Falls: Summary of 12 Studies

Accident/environment Gait/balance disorder Dizziness/vertigo Drop attack Confusion Postural hypotension Vision problem Other specified Unknown

31%171310 4 3 315 5

Rubenstein LZ, Josephson KR. Clin Geriatr Med. 2002(May);18(2):141-158

Age related changes affecting balance

Normal Changes with Aging Neurologic:

Increased reaction time Decreased righting reflexes Decreased Proprioception

Vision Changes: Decreased accommodation & dark adaptation

Decreased muscle mass: Strength

Assessment andManagement of Falls

Periodic case finding inPrimary Care:Ask all patients aboutfalls in past year

No falls Nointervention

Recurrent Single fallfalls

Gait/balanceproblems

Check forgait/balanceproblem

Noproblems

Fall Evaluation*

AssessmentHistoryMedicationsVisionGait and balanceLower limb jointsNeurologicalCardiovascular

Multifactorial intervention(as appropriate)Gait, balance, exercise - programsMedication - modificationPostural hypotension - treatmentEnvironmental hazards - modificationCardiovascular disorders - treatment