Research and Develop a Fall Risk Program 3-5 pages APA

FALLS

Andy Geller, MD

THE AMERICAN GERIATRICS SOCIETY

Geriatrics Health Professionals.

Leading change. Improving care for older adults.

AGS

MR. C

• 84-year-old man

• Status post quadriceps tendon repair

• Ambulating with cane

• Wife concerned about his risk of falls

Slide 2

MR. C

• Suspected falls since discharge

• Decreased activity level

• In chair most of the day

• Soon to get a scooter?

Slide 3

MR. C

• Formerly very active

• Gait unsteadiness

• Former boxer

• Veteran

Slide 4

MR. C:

PAST MEDICAL HISTORY

• Non insulin-dependent diabetes

• Hypertension

• Hypercholesterolemia

• Gout

• Obesity

• Insomnia

• Osteoarthritis

Slide 5

MR. C:

MEDICATIONS

• Metformin

• Benazepril

• Amlodipine

• Allopurinol

Slide 6

MR. C:

PHYSICAL EXAMINATION

• BP 175/90, HR 65 (supine); BP 152/85, HR 68

(standing)

• Fingerstick blood glucose 380

• Normal heart and lung exams

• Normal abdominal exam (obese contours)

Slide 7

MR. C:

PHYSICAL EXAMINATION

• Visual impairment

• Bilateral sensory loss in feet

• Unchanged manual muscle testing

• Right knee crepitus

• Difficulty arising from seated position

Slide 8

MR. C:

FURTHER HISTORY

• The patient’s wife reports he hasn’t been

sleeping well of late

• On further questioning, the patient admits to

feeling “sorry” for his Army buddies, “who are

all gone now…and I don’t have much time left

myself”

Slide 9

QUESTIONS

• Can you identify at least 4 risk factors in this

patient for falling?

• Would a scooter be appropriate for this

patient?

• Can you suggest a different assistive device

for this patient?

Slide 10

Answers: Can you identify at least

4 risk factors in this patient for falling?

• Unsteadiness of gait after quadriceps tendon rupture

• Comorbid arthritis/gout

• Impaired balance due to diabetic neuropathy

• Obesity and deconditioning

• 4+ medications

• Orthostasis

• Decreased visual acuity

• Depressive symptoms

• Possible cognitive impairment due to boxing history

• Abnormal “Get Up and Go” test

• History of prior falls

Slide 11

Answer: Would a scooter

be appropriate for this patient?

• This patient is able to ambulate, and the risks of scooter

use would likely outweigh the benefits

• For example, in a recent article in the American Journal of

Cardiology, entitled “Effect of motorized scooters on quality

of life and cardiovascular risk,” scooter use was found to be

correlated with increased cardiovascular risk, even as self-

perceived quality of life improved

• The authors concluded that “interventions, such as

scooters, that improve self-perceived quality of life, can

have detrimental long-term effects by increasing

cardiovascular risk, particularly insulin resistance”

Slide 12

Answers: Can you suggest a different

assistive device for this patient?

• Mobility is strongly linked to quality of life. In this patient, a home safety evaluation would be appropriate, in conjunction with a multidisciplinary care team including PT, OT, physiatry, and nursing.

• Based on the evaluation of the multidisciplinary team, a cane or walker might be selected, both to aid in stability and maximize mobility.

• In the vignette, the type of cane the patient is using is not specified; however, if it is a single-point cane he might do better with another type of cane, such as an offset cane or a 4-pronged cane.

Slide 13

REFERENCES

• The FAB scale, Berg balance scale, and multidirectional reach test: http://www.stopfalls.org/service_providers/sp_bm.shtml

• The “Get Up and Go” screen for elderly fall risk assessment:

http://www.aan.com/practice/guideline/uploads/273.pdf

• Lecture on falls: http://www.pogoe.org/km/getdoc/9700

• Peeters G et al. Fall risk: the clinical relevance of falls and how to integrate

fall risk with fracture risk. Best Pract Res Clin Rheumatol. 2009;23(6):797-

804.

• Practice module, “Assistive Devices for Ambulation in the Elderly”:

http://www.pogoe.org/AngelUploads/applications/astdevice/AstDevice.html

• Zagol BW, Krasuski RA. Effect of motorized scooters on quality of life and

cardiovascular risk. Am J Cardiol. 2010;105(5):672-676.

Slide 14

ACKNOWLEDGMENTS

• Emory University School of Medicine

• American Geriatrics Society and the John

Hartford Foundation

Slide 15

Visit us at:

Facebook.com/AmericanGeriatricsSociety

Twitter.com/AmerGeriatrics

www.americangeriatrics.org

THANK YOU FOR YOUR TIME!

linkedin.com/company/american-geriatrics-

society

Slide 16