Hi Muhammad

There is a recent increase in interest into this area, with many trials being conducted testing various methods to reduce falls in the elderly (successfully), such as

http://informahealthcare.com/doi/abs/10.3109/09638288.2012.737084

http://www.sciencedirect.com/science/article/pii/S0020138313001332

Best wishes

Clarissa

Dear Clarissa

Thank you very much for these links. They contain very useful and practical methods of checking falls in the elderly.

Greetings

Muhammad

One out of three older adults (those aged 65 or older) falls each year.  but less than half talk to their healthcare providers about it.

Among older adults, falls are the leading cause of both fatal and nonfatal injuries.

Falling is a common problem in older people. Amongst people over the age of 65, around one in three living in the community, and around half of those in care homes, fall each year. Falls increase in frequency with advancing age and increasing frailty.

Falls used to be considered an inevitable consequence of aging, but this is not the case. This special collection contains four Cochrane reviews which focus on the prevention of falls and fall-related injuries in older people, and provide evidence of effective interventions.

Kindly see the following links for your questions:

http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

http://www.thecochranelibrary.com/details/collection/4376241/Preventing-falls-and-fall-related-injuries-in-older-people.html

Among the most serious clinical problems of the elderly, falls and balance unstable causing high morbidity and mortality rates, as well as contributing substantially to the limitation of mobility and premature entry into assisted living.

In the U.S., nearly three-quarters of the deaths due to accidental falls occur among the over-65s (which constitute only 13% of the population): it is therefore mainly a geriatric syndrome. Among the elderly hospitalized after a fall, only half survive more than a year, while the repeated falls and instability precipitate admission to assisted living.

Many population studies have described the epidemiology of falls in the elderly in different contexts, and the rates vary considerably: the lowest (30-160 per 100 persons per year, on average, 65 to 100) were detected in the elderly that living in the community, usually among people aged 65 and over. Although most of these falls do not cause major injuries, about 5% causes a fracture or require hospitalization. Moreover, the rates of falls and associated complications increase significantly with age and doubled in people over 75 years.

Interventions and effective strategies to prevent the risk of falling by the National System guidelines (SNLG): "Falls in the home: knowing the risk to avoid it"

With regard to the social and demographic characteristics, women are more at risk, but men have a higher chance of falling in nursing homes (20): this can be explained by the fact that men, when they are institutionalized, they tend to be more often sick or disabled. Another demographic factor is associated with age itself, since, in the elderly, the risk of falling increases linearly with age. This factor is important in terms of public health, because octogenarians are one of the fastest growing groups in many parts of the world.

There is an association between falls and psychotropic drugs (OR = 1.7). In addition, the daily consumption of four or more medications is associated with falls, probably because it implies an increased risk of misuse of drugs, adverse reactions and drug interactions. Adverse reactions are particularly common in the elderly and their prevalence, estimated at about 5% when taking only one drug, increased to almost 100% when they take ten or more.

However, one must be cautious in stating that polypharmacy due to falls in the elderly, as it is also an indicator of ill health. In any case, the relationship between drugs and falls stresses the importance of health care in the prevention of falls: the rational use of drugs, through periodic inspections and monitoring of doses, can promote patient safety.

Some clinical and functional disorders such as muscle weakness, gait and balance, and inability to perform activities of daily living are strongly associated with falls. In some cases, these variables have been identified along with the other covariates closely related, such as: arthritis, diabetes, and neurological diseases.

Individuals who are physically active retain the balance, muscle strength, coordination and reflexes due to physical activity.

We found an increased risk of falls in people with cognitive impairment. However, the strength of this association may be underestimated, since several studies have excluded patients with severe cognitive impairment or unable to understand simple commands.

The risk indicator most common is the presence of a history of falls. An indicator that, while not providing information on the etiology underlying suggests that - if the physical damage and environmental hazards that caused the fall of the previous year are not investigated and corrected - it is likely that the elderly will fall back to the same cause. Therefore, protocols for falls prevention interventions consider the history of falls as a key feature to initiate a preventive intervention.

Older adults are the dear ones who are about to say good-bye to this life. Some of them depart softly & some of them depart in a hard manner. The latter type may fall breaking some bone which takes long time to heal or may lead to other negative repercussions.

It is unhealthy or unreasonable to prevent the older adults from mobility to avoid their fall & the subsequent effects. It is NOT practical to appoint "around the clock" guard to protect the old from causing self-harm.

I think that we need to approach this subject in a scientific way by formulating a specialization "might be called Care for Old-Aged" within the field of nursing. Whatever the mechanism followed, patience & endurance (from all those around) are key psychological factors in alleviating the pains & preventing further worsening.

@Ierardi : "There is an association between falls and psychotropic drugs (OR = 1.7). In addition, the daily consumption of four or more medications is associated with falls, probably because it implies an increased risk of misuse of drugs, adverse reactions and drug interactions".

and

"Some clinical and functional disorders such as muscle weakness, gait and balance, and inability to perform activities of daily living are strongly associated with falls".

Thank you very much for your contribution.

@Kamal: Thanks for the RG thread bearing a very useful link as well.

Thank you very much Gopinath and thank you very much Dr. Matar for your inputs so far. They are immensely useful!

Dear Sir:  I contacted my publisher about sharing the full-text article "Fall risk reduction in home health and hospice" with you, which I think could assist with this research question.  The publisher has all rights to the article, therefore you will need to purchase the article (~5 euros) or if your institutional library has access, they should be able to obtain it for you. 

The letter to the editor re: morphine doses in hospice is attached.

Sorry for any inconvenience.

Fall prevention is a primary concern when a person gets older. The primary cause of hip fractures in older people, falls have been shown to be the contributing cause of premature death in many seniors. We need to make sure seniors homes are equipped with senior friendly modifications to ensure they do not suffer fall injuries while trying to navigate stairs  and walkways and in their performance of ADL to keep them safe. This is also a primary cause of their being placed in a SNF long before their time. Break a hip and your chances of returning to your own home to live out your golden years are pretty slim indeed. Other contributing factors to falling are medication reactions, loose fitting throw rugs, slippery bottomed slippers and shoes, and unmodified older home environment factors, such as no handrails on stairs, hallways, or bathtubs, lots of stair climbing due to living in the common 2 story home in later life. Add in lower bone density in older adults chemical makeup and you can understand how fall prevention becomes a priority that all seniors need to become aware of and act accordingly so they do not suffer a fall injury in their own homes.

Home is the most common place for fall-related injury deaths, especially adults aged 40 and older. More than a third of fall-related injury hospitalisations followed by ‘unspecified place’. Falls in all age groups can result in ongoing disability. Severe fall-related injuries, particularly to the spinal cord and brain, can lead to lifetime disability or the need for long-term rehabilitation to restore physical and mental function. Serious fractures can result in long-term hospitalisation and restrictions on activity. Time away from work, study and/or play has social and financial costs for the injured person, their careers and families.

New Zealand Government Intervention - National Strategy

www.acc.co.nz/PRD_EXT_CSMP/groups/...ip/.../wcm2_020951.pdf

@Krishnan: Thank you very much for your answer and link. "Home is the most common place for fall-related injury deaths, especially adults aged 40 and older".

You stated ...especially adults aged 40 and older. Let us look at the group aged 40...what could possibly be responsible for this age group to prone to fall at home? Is it considered that their physical condition is being compromised?

Reasons could be many but more compelling ones can be

A fall can be defined as an unintentional event, whereby the affected person accidentally either get in contact lying flat on the ground or to a lower surface other than his or her originally positioned surface.

There are several factor that may be responsible for a fall. However different group of persons (patients) may be indirectly affected by some several different factors.

I would like to consider here, the geriatric patient.

There are four classical geriatric syndromes, of which all of them begins with an "I";

these syndromes are namely:

(1) Intellectual reduction

(2) Immobility

(3) Instability and

(4) Incontinence

The above aforementioned geriatric syndromes, especially (2) and (3) seriously contributes to falls of elderly patients or residence, as the case may be.

There is no intention whatsoever, to restrain any patient´s or resident´s free movement, rather than a measure that is sole reached by a team of interdisciplinary professionals coming together to decide what is the best way to prevent fall of any fall prone patient/residents.

The aims of Fall Management are:

(a) Ensuring the required medical measures after a fall

(b) Defined action of an interdisciplinary team after a fall

There are also structural criteria to follow, which are laid down by the physician in charge. These criteria should be followed by the nurse (RN) on duty or an assistant, as the case may be.

Process description

RN and or assistant should do the following in the case of a fall:

(i) Inform the physician in charge

(ii) Documenting the fall and completing a fall protocol

(iii) Enquire and checking vital signs (blood pressure and pulse)

(iv) Observing the patient

The physician carries out a clinical test:

(i) Vital signs

(ii) Blood pressure and pulse

(iii) Neurological status (reaction of the pupils & neck stiffness)

(iv) Mobility of the extremities (active/passive)

(v) Signs of outer/peripheral injuries

(vi) Treating injuries(peripheral)

(vii) Documenting test results in the medical/care documentation and in the fall protocol

(viii) Registering acute CT where necessary

(ix) Ordering further observation:

(1) Blood pressure and pulse

(2) Continued vigilance

Observation and documenting clinical developments

In the case of a suspected foul play, a complain be lodged according the medical and nursing decree.

Results Criteria:

Further medical measures be taken in case any further assessment signalling danger

Test results be appropriately documented for further reference

In case of any serious injuries, E.g Head injuries, appropriate emergency measures carried out.

Ref: K. Mosser & G. Thür ; 2014/04 Standard/SOP

Sturzmanagement nach Sturz

auf den Kopf

These are some of the essential procedures required for a proper and effective fall management.

@Elizabeth: 

Ensuring medical measures - when I said after a fall is regarding fall management. These measures were enumerated as well; checking vital signs: blood pressure, pulse, temperature, breathing/oxygen level.

A team of interdisciplinary professionals; physicians, nurses, physiotherapists, ergotherapists, dieticians and logopaedics. One party does not conclude to take measures to check and investigate falls to prevent any future falls.

Yes this measure is working well and it has positively helped in reducing fatal injuries resulting from falls.

It is quite understood that some measures are seen by some as restrictions and or violence, especially by those who are not directly working with, treating or nursing any fall prone patient.

There are laws guiding when it comes to restrictions and or fixation. No one carries out any measure outside the act

@Francesca: 

Normally in the nursing homes residents are not regarded as patients, rather as "BewohnerInnen" residents. That is the case where it is exclussively a nursing home. But here we have a system quite different from the normal everyday nursing home routine, but a modern and comprehensive care with medical, therapeutic and the normal nursing home care. Therefore they are interchageably termed as either patients or residence.

I agree with Krishnan Umachandran