www.company.comwww.fallcam.be

Falls in home-dwelling Falls in home-dwelling

elderlyelderly

Mieke Deschodt

Center for Health Services and Nursing SciencesKatholiek Universiteit Leuven

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Falls incidence

In home-dwelling elderly28% - 35% of people aged 65 or older fall at least ones

a year

32% - 42% of people aged 75 or older

15% - 50% with two or more fall incidents per year

(Masud & Morris, Age Ageing 2001; Tinetti, NEJM 2003; Milisen et al., Tijdschr Gerontol Geriatr 2004)

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Falls incidence

In institutionalized elderly (e.g. nursing home)30-70% at least one fall incident a year

15-40% with 2 or more fall incidents

Average number of falls per bed1,4 in somatic institutions2,2 in psychogeriatric institutions

(NVKG & CBO richtlijn, 2004)

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Fall incidents per season

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Fall incidents per daily period

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Indoor versus outdoor

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At home versus not at home

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Locations indoor

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Impact on the older person

Physical impact (40% - 60%)

Minor injury: 30% - 50%Bruises, cuts, tissue damage

Major injury: 10% - 15%Fracture: 5% - 10%; Hip fracture: 1% - 2%; Soft tissue injury and head injury: 5%

(AGS panel on falls prevention et al., JAGS 2001; Masud & Morris, Age Ageing 2001; Milisen et al., Tijdschr Gerontol Geriatr 2004; Tinetti, NEJM 2003)

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Impact on the older person

Psychological impact:

Fear of falling again: 32% - 63%

Loss of self-confidence, loss of independency, social isolation, depression,… causes an increased risk of falling and a longer hospitalisation

(AGS panel on falls prevention et al., JAGS 2001; Masud & Morris, Age Ageing 2001; Milisen et al., Tijdschr Gerontol Geriatr 2004; Tinetti, NEJM 2003)

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Impact on the older person

Increased risk of mortalilty Involuntary injury = 5th cause of death in people aged 70

years or older

Fall accidents = most important cause of involuntary injuries

Most important risk factor in older persons with osteoporosis for having a hip fracture

Hip fracture20% becomes immobileonly 14% - 21% regains full ADL-independency25% - 33% mortality risk in the first year

(AGS panel on falls prevention et al., JAGS 2001; Masud & Morris, Age Ageing 2001; NVKG richtlijn & CBO, 2004)

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Financial consequences

Increases use of sourcesInstitutionalisation = 3 x more ofter in fallers

Hospital admission as a result of falling increases 6 times from the age of 65

Fall injury = most expensive category of all traumata in elderly

(Englander et al., J Forensic Sciences 1996; Masud & Morris, Age Ageing 2001)

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Increased age and institutionalisation before the fracture are the most important decisive factors for the additional cost (Haentjens et al. Disabil Rehabil 2005)

(Kneuzing, schaafwonde, …)

€10.528

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Falls

Fall incident = result of a combination of

Intrinsic risk factorsExtrinsic risk factors

Multifactorial problem

multidisciplinary solution

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Effectivity

Multifactorial evaluation followed by multifactorial interventions targeting on identified risk factors

In older persons with increased risk= most effective

25% to 39% reduction of fall incidents Little/no proven effect on incidence of severe injuries

the risk profile of the older person has no influence on the effectivity cave older persons with severe cognitive problems (e.g. dementia)

(Gillespie et al., Cochrane 2003; Tinetti, NEJM 2003; Chang et al., BMJ 2004; Kannus et al., Lancet 2005)

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Inability to get up after a fall incident

1 year follow-up of 90 women en 20 men (90+) at home and in an institution

60% fell at least 1x/year82% of falls occured when the person was alone80% were unable to get up without help> 95% has a personal alarm system, +/- 80% does not

use the alarm system30% had lain on the floor for an hour or more

Pressure ulcers, dehydration, hypothermia, pneumonia, hospital admission, moving into long term care, death

Older persons need training in strategies to get up from the floor after a fall incident

(Fleming et al. BMJ 2008)

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Inability to get up after a fall incident

Cognitive impairment is the only characteristic that predicted lying on the floor for a long time

Need for developing an automatic fall detection system that is not depending on the (cognitive) capacities of the older person

(Fleming et al. BMJ 2008)

Building and validating a camera system for fall detection in home-dwelling elderly

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Camera system

Alarm can be generated independently No action needed of the person in contrast to the personal

alarm system In cases where the person is not fully conscious after the

fall, there will still be an alarm

Because of the alarm a care provider can quickly come to help Preventing that the faller lies on the floor for a long time The system can reduce the fear of falling and enables for

older people to live longer independently at home.

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Camera system

Unlike accelerometers, gyroscopes, or alarm buttons, a camera system is fully contactless elderly people do not have to take along or wear the alarm

button and so they can't forget it The system is not battery-operated

After a fall incident the circumstances can be studied carefully with the camera images, so that preventive steps could be taken to prevent similar falls