Preventing Older Adult Falls:Understanding Risk Factors &

Best Practices

Healthy Aging PartnershipMay 26, 2009

Sally York MN, RNCNorthWest Orthopaedic Institute

Tacoma, WA

Falls in Older AdultsFalls in Older Adults

• 20% - 30% fear falling20% - 30% fear falling11

• 35%-40% of people 65+ fall 35%-40% of people 65+ fall eacheach yearyear22 • Those who fall are 2-3 times more Those who fall are 2-3 times more

likely to fall againlikely to fall again33

• 10%-20% of falls cause serious injuries10%-20% of falls cause serious injuries44

1. Vellas BJ, Age & Aging, 1997; Friedman SM, JAGS, 2002 2. Hornbrook, Gerontologist, 1994; Hausdorff, Arch Phys Med & Rehab, 2001 3. Tinetti, New Eng J Med, 1988; Teno, JAGS,19904. Sterling, J Trauma-Inj Infection & Critical Care, 2001

Fall Injuries in Older Adults• Up to 20-30% of falls in older adults result in an

injury requiring medical care• Most fractures in Medicare population are due to

falls• Falls in older adults are the leading cause of

traumatic brain injury• Men have a higher rate of fatal falls (due to TBI)• Women are more likely to have non-fatal falls

CDC Falls Among Older Adults: An Overview (2009)www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

Fall Risk Factors in Older AdultsFall Risk Factors in Older Adults

1.1. Chronic health Chronic health conditionsconditions

2.2. Physical and functional Physical and functional impairmentsimpairments

3.3. Medication and Medication and alcohol usealcohol use

4.4. EnvironmentalEnvironmental hazardshazards

Primary Fall Risk Factor Concepts• Assess & identify intrinsic (internal) risk factors

Examples- Age, osteporosis, vision loss, dementia

• Assess & identify extrinsic (external) risk factors: Examples- Medications, footwear, assistive devices,

environment

• Assess & identify acquired risk factors: Examples- Facility or hospital admission due to health

change or decline (new environment), delirium due to illness, increased disability due to injury

Secondary Fall Risk Concepts

• Identify modifiable risk factors Examples: Muscle weakness, poor balance, exercise level, medications, environmental lighting, footwear

• Identify non-modifiable risk factorsExamples: Age, chronic conditions, disability,

dementia, vision loss

Goal Individual will modify (reduce) modifiable risk factors

Falls Are Usually Multifactorial

FALLS

Intrinsic Factors Extrinsic Factors

Age changes

Chronic conditions

Medications

LE weakness

Environmental factors

Footwear

Alcohol

Assistive deviceAcquired Factors

related

American Geriatrics Society: Most Common Intrinsic Fall Risk Factors

1. Muscle weakness2. History of falls3. Gait deficit4. Balance deficit5. Assistive device use6. Visual deficit7. Arthritis8. Impaired Activities of Daily Living9. Depression10. Cognitive Impairment11. Age >80 years

American Geriatrics Society (2001), Guideline for the Preventionof Falls in Older Persons, JAGS, 49:664-672.

Modifiable Intrinsic Risk Factors

• Muscle weakness 4.4 x• Gait & balance problems 2.9 x• Vision problems 2.5 x• Psychoactive medications 1.7 x

Relative Risk

2001 American Geriatric Society Clinical Guidelines for the Prevention of Falls, JAGS

ABC’s of Why Older Adults Fall ABC’s of Why Older Adults Fall Usually >1 Risk Factor Causes a FallUsually >1 Risk Factor Causes a Fall

1. Age, ambulatory status, assistive device use2. Balance, behavior at time of fall3. Chronic conditions, cognitive deficits4. Drugs5. Exercise level, environment6. Footwear & flooring

CDC Fall Prevention CDC Fall Prevention Recommendations: Recommendations: the 4 Pearlsthe 4 Pearls

• Regular exercise Regular exercise • Medication review Medication review • Vision examsVision exams• Home safety evaluationHome safety evaluation

Fall Prevention Best Practices: Fall Prevention Best Practices: Multi-component Programs Multi-component Programs Combine Combine >> 2 Best Practices 2 Best Practices

1.1. Individual risk assessmentIndividual risk assessment2.2. Regular strength & balance exerciseRegular strength & balance exercise3.3. Gait & assistive device trainingGait & assistive device training4.4. Medication review & managementMedication review & management5.5. Management of chronic conditions Management of chronic conditions 6.6. Vision correctionVision correction7.7. EducationEducation8.8. Home safety improvementsHome safety improvementsWA State Dept. of Health, Falls Among Older Adults: Strategies for Prevention (2002)WA State Dept. of Health, Falls Among Older Adults: Strategies for Prevention (2002)Centers for Disease ControlCenters for Disease Control

Best Practices for Older Adults from Recent Clinical Studies

1. Clinical assessment & risk reduction2. Exercise to improve balance, gait, strength,

endurance, & flexibility3. Medication management: especially

benzodiazepines, antidepressants, sedatives/hypnotics

4. Multi-component programs

Rubenstein et al, Handbook of Injury & Violence Prevention, 2007

Recommendations for Community-dwelling Older Adults (excl. those with dementia):

Cochrane Review of 111 Studies (2009)

1. Exercise: -multiple component (strength, balance,

aerobic) group classes -Tai Chi -home programs in adults without severe

impairments2. Multifactorial interventions, delivered by

multidisciplinary teamsGillespie et al, Cochrane Review: Interventions for preventing falls in older people living in the community, April 2009

Summary• Risk factors, best practices & effective interventions

have been identified for community-dwelling older adults after many years of research

• Injury prevention is an important goal in populations at high risk for falls

• Comprehensive prevention plans/programs that include individual risk assessment & individualized multi-component/multi-faceted intervention approaches are the most effective in reducing falls & fall risks

Thank You