PTA Home Assessment

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Falls Risk Reduction
And Prevention

Physical therapists can use this Power Point to provide live educational sessions for Seniors or individuals who may be at risk for falls within the community.

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1 The American Geriatrics Society. AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older Persons (2010). http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2010/

What Is a Fall?

  • An event whereby an individual unexpectedly comes to rest on the ground or another lower level without known loss of consciousness1

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Why Are Falls Important to Me? 1

  • More than 1/3 of adults 65 and older fall each year in the United States.
  • Among older adults, falls cause over 39% of injury deaths, making them the leading cause by a wide margin.
  • In 2007, 18,334 people 65 and older died from injuries related to falls.

1 Centers for Disease Control and Prevention, http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html.

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Why Are Falls Important to Me? 1

  • In 2009, 2.2 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 581,000 of these patients were hospitalized.
  • By 2020, the cost of fall injuries is expected to reach $54.9 billion (in 2007 dollars).

1 Centers for Disease Control and Prevention, http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html.

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Why Are Falls Important to Me?1

  • 20% to 30% of people who fall suffer moderate-to-severe injuries such as bruises, hip fractures, or head traumas.
  • Fall injuries can limit mobility and independent living, and can increase the risk of early death.
  • Every hour, there are 2 deaths and 251 emergency department visits for falls-related injuries among older adults.

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1 Centers for Disease Control and Prevention,http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html.

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What Are the Risk Factors
For Falling?

Research shows that a combined effect of many interacting factors increases fall risk.2

Difficulty With Walking/Balance

Multiple

Medications

Dizziness

Muscle

Weakness

Foot Problems

Heart Rate/ Rhythm Problem

History of

Falls

Vision

Problems

2Panel on Prevention of Falls in Older Persons. Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. American Geriatrics Society/British Geriatric Society.

http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2010.

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Am I at Risk for Falling
As I Age?

Falling and fear of falling as you age should NOT be accepted as a “normal” process of aging.

The causes of falls can be found and addressed.

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Am I at Risk for Falling
As I Age?

There are certain changes that may cause people to fall:

  • Less flexibility in the lower extremity joints
  • Decreased muscle strength around the ankles, knees, and hips
  • Slower walking speed, tendency to take smaller steps

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Am I at Risk for Falling
As I Age?

There are certain changes that may cause people to fall (cont’d):

  • Decreased balance
  • Less coordination
  • Decreased reflexes and longer reaction time
  • Changes in vision and sensation
  • Decreased activity

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Is a lasting concern about falling that can lead to an individual avoiding activities that he/she remains capable of performing3

Is a serious and widespread problem among older adults

3Tinetti M, Powell L. Fear of falling and low self-efficacy: a case of dependence in elderly persons. J Gerontol. 1993;48:35-38.

Fear of Falling …

Am I at Risk for Falling
As I Age?

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Can restrict a person’s normal activities causing less independence

Includes these risk factors: Fair/poor perceived health, feeling unsteady, having 2 or more falls4

4Lach HW. Incidence and risk factors for developing fear of falling in older adults. Public Health Nurs. 2005;22:45-52.

Fear of Falling …

Am I at Risk for Falling
As I Age?

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Am I at Risk for Falling
As I Age?

Certain medical conditions may increase the risk of falling as you age:

Diabetes (peripheral neuropathy, visual & sensation changes)

Arthritis

Osteoporosis (changes in posture, increased risk of fracture with fall)

Stroke

Cardiovascular conditions (irregular heart rate, dizziness when standing (orthostatic hypotension)

Neurological diseases (Parkinson)

Others

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What Else Can Cause Me to be at Risk for a Fall?

Intrinsic Factors: These are factors are internal and specific to the individual.

Extrinsic Factors: These factors are external to the individual.

Often, a fall is a result of the interaction between the intrinsic and extrinsic factors.

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What Else Can Cause Me to be at Risk for a Fall?

Lower extremity weakness

Previous falls

Gait & balance disorders

Decline in vision

Depression

Functional & cognitive impairment

Dizziness

Low body mass index

Urinary incontinence

Female sex

Being over age 80

Taking over 4 prescription medications

Stairs

Clutter

Wet surfaces

Loose rugs/carpets

Cords

Poor lighting

Hurrying/rushing

Intrinsic Factors

Extrinsic Factors

AGS/BGS Clinical Practice Guideline:
Prevention of Falls in Older Persons (2010). http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2010/

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Extrinsic Factors

The home is the PRIMARY location for non-fatal unintentional falls.

  • The home is defined as the
    inside of the home and the outside areas immediately surrounding the home.
  • The outside environment can pose several major safety hazards such as stairs with no handrails and uneven pathways.

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How do I Find Out My
Risk for Falls?

To assess your fall risk, you should see a physical therapist for a fall risk assessment.

The physical therapist will take a thorough history, perform tests and measures, and provide you with interventions to reduce your risk for falling.

To find a physical therapist in your area go to: www.apta.org/findapt.

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What Is My Risk for Falls?

Here is a quick test:

  • If you are unable to balance 5 seconds on one leg you are at risk for INJURIOUS falls.
  • Goal is 30 seconds for single leg stance.

Do not attempt to do this test alone—make sure that you have someone next
to you to decrease the potential risk of falling.

If you have a history of falls, you are at risk.

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What Can I Do to Decrease
My Risk of Falls?

The most effective program is multi-factorial.

This means using more than one strategy:

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What Can I Do to Decrease
My Risk of Falls?

Successful programs for fall prevention may include:

  • Physical therapy
  • Exercise
  • Education
  • Medication management
  • Environmental modification
  • Other approaches targeted to individual risk factors that may contribute to falls (such as impairments in vision, foot problems, continence)

The expertise of many health professionals may be involved in your fall prevention program.

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Physical Therapy

A physical therapist will:

  • Conduct an examination and evaluation for fall risk
  • Design an individual plan of care to address:
  • Strength
  • Mobility
  • Balance
  • Posture
  • Gait
  • Complete a home assessment for safety to:
  • Eliminate hazards
  • Recommend safety equipment and task re-design
  • Recommend structural changes

  • Flexibility
  • Appropriate footwear
  • Need for assistive devices
  • Pain
  • Function/ADL

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Exercise to Prevent Falls

Benefits:

  • Reduce fear of falling
  • Improve flexibility, strength, endurance
  • Improve cardiovascular health
  • Help decrease depression
  • Reduce sleep disorders

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Exercise to Prevent Falls

  • Have sufficient intensity to improve muscle strength
  • Are regular and sustainable
  • Include dynamic balance activities
  • Can be done at home or at a center/clinic
  • Can be group or individual programs
  • Are simple and low cost

Characteristics of successful programs:

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Exercise and Programs

  • Walking program
  • Tai Chi
  • Yoga
  • Aerobic exercises
  • Bowling, dancing, gardening

Examples:

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Exercise and Programs

  • Tai Chi Moving for Better Balance
  • Stepping On
  • Otago Exercise Program


Specific Program Examples:

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Balance Exercises

Hand support

No hand support

Eyes closed

Unstable surface

Progression:

Hand support

No hand support

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Sample Balance Exercises

The following slides are examples of balance exercises that your physical therapist may prescribe. Do not begin any exercise program without consulting with your physical therapist.

Do not attempt to do the exercises alone—make sure that you have someone next to you to decrease the potential risk of falling.

Note: Information is provided for informational purposes only and is not a substitute for professional advice. You should seek the advice of a health care professional in all matters relating to your health.

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Sample Balance Exercises

Stand straight; hold onto a sturdy table or chair for balance.

Slowly stand on tip toe, as high as possible.

Hold position for 1 second.

Slowly lower heels all the way back down. Pause.

Repeat 10 to 15 times.

Heel Rises

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Sample Balance Exercises

Stand straight; hold onto a sturdy table or chair for balance.

Slowly bend your right knee toward your chest—do not bend at the waist.

Hold position for 1 second.

Slowly lower the leg all the way back down. Pause.

Repeat with the left leg.

Alternate legs so you have repeated 10 to 15 times on each leg.

Hip Bending

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Sample Balance Exercises

Stand straight, feet slightly apart; hold onto a sturdy table or chair for balance.

Slowly lift your right leg straight out to the side—keep your back straight and your toes pointing forward.

Hold position for 1 second.

Slowly lower the leg all the way back down. Pause.

Repeat with the left leg.

Alternate legs so you have repeated 10 to 15 times on each leg.

Side Leg Raise

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Sample Balance Exercises

Stand up and sit down from a chair without using your hands and keeping your back straight.

Stand on 1 leg while waiting in line (you can use a counter or other stable object for balance).

Exercises you can do anywhere

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Education

  • Risk factors for falls
  • Fall prevention
  • Fall injury reduction
  • Medication management
  • Home safety
  • Physical activity

Can include education on:

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Medication Management

  • Review your drugs with every health care provider.
  • Always carry a list of your medications.
  • Remember to take your medications as prescribed.
  • Do not share medications.
  • Know the common side effects/“red flag” symptoms.
  • Ask to be prescribed the lowest dose possible.
  • Consult your physician prior to taking any herbal or over the counter medications.

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Environmental Modifications

Includes physical changes:

  • To the place where you live
  • To your vehicle
  • To your workplace

Environmental modifications
help you to live with greater independence and safety.

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Environmental Modifications

  • Protect all stairs and steps with a secure banister or hand-rail on both sides and keep them clear of clutter.
  • Use the highest safe wattage in light fixtures. Nightlights can help light the way during night-time hours.

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Environmental Modifications

  • Use a non-slip mat, or install adhesive safety strips or decals in bathtubs and showers.
  • Install grab bars in bath and shower stalls.
  • Choose a latex-backed bath mat to avoid slipping when getting out of the tub and shower.

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What Can I Do to Reduce the Impact of Extrinsic Factors?

Do a home safety check:

  • To find and fix hazards
  • To remove clutter

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Extrinsic Hazards That Can Be Modified

Hazard Modification
Is there clutter on the floor? Remove clutter from walkways; keep floors, stairs, and pathways clear
Is there liquid or food on the floor? Sweep often; wipe up spills immediately
Are there throw rugs in walkways? Remove or secure unsecured rugs
Do you have to walk over or around electrical cords or wires? Tape cords and wires to the wall; keep cords hidden and away from walking areas
Is lighting inadequate? Keep rooms well lit, change burned-out bulbs, keep flashlights handy
Are stools/chairs unstable? Discard or fix wobbly chairs
Are there stairs, or hazardous steps or curbs? Avoid, fix, use handrails, and keep well lit

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Keep Your Bathroom Falls Free

  • Add grab bars in the shower, tub, and toilet areas.
  • Use nonslip adhesive strips or a rubber mat inside and outside the shower/tub.
  • Sit on a shower bench or chair in the shower/tub.
  • Use an elevated toilet seat.

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What Do I Do if I Fall?

You should always have a plan to get help in case of an emergency. If you fall:

Stay calm: If you are hurt, put your emergency plan into place. If you are not hurt badly, you can begin to get up from the fall.

First, roll onto your side.

Next, find a sturdy piece of furniture (chair, kitchen table, countertop)
and crawl or roll over to it.

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What Do I Do if I Fall?

Then, from a kneeling position, put your arms up onto the stable surface.

Finally, put one foot flat on
the floor and push up into
the stable surface.
Sit down and rest.

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What Can I Do to Prevent Falls?

  • Exercise regularly.
  • Review your medications with your health care provider or pharmacist.
  • Have your vision and hearing checked.
  • Correct common home safety hazards.

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Special Thanks to:

  • Kathryn Brewer, PT, GCS, MEd, CEEAA
  • Roberta Newton, PT, PhD, FGSA, FAPTA
  • Judy Daniel, PT, MS, GCS
  • Cathy Cioleck, PT, DPT, GCS

For their expertise, generous support, and dedication to falls prevention.

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Resources

The American Physical Therapy Association: http://www.moveforwardpt.com/

Centers for Disease Control and Prevention: http://www.cdc.gov/Homeandrecreationalsafety/Falls/adultfalls.html/

Home Safety Council: http://www.homesafetycouncil.org/SafeSeniors/sen_safeseniors_w001.asp

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Resources

Center for Healthy Aging: http://www.healthyagingprograms.com/content.asp?sectionid=107

National Council on Aging: http://www.ncoa.org/

National Safety Council: http://www.nsc.org/ safety_home/Resources/Pages/Falls.aspx

The National Blueprint: http://www.agingblueprint.org/tips.cfm

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