Study Of Falls In The Elderly

Study Of Falls In The ElderlyAging is a normal phenomenon in all oer the institution so that the necessity of h mavinst-to-god sequence c atomic number 18 is very important. WHO states that world countries have accepted the chronological age of 65 years as a definition of elderly. Nowadays, world is developing too fast I all the sectors especially in medical science and technology. It makes great differences in the life sweep and the quality of life of the people.The fastest population increase has been in the number of those venerableer 85 and over, the oldest old. In 1984, there were around 660,000 people in the UK aged 85 and over. Since then the numbers have more than doubled reaching 1.4 million in 2009. By 2034 the number of people aged 85 and over is projected to be 2.5 times larger than in 2009, reaching 3.5 million and accounting for 5 per cent of the total population. (Office of national statics 2010).Falls is one of the more or less plebeian capers in old age. Eld er people locomote frequently and it can cause serious injuries such as fracture, dislocation and head injuries (Dr.Roberts A 1995). Falls represent the most frequent and serious type of accident in the over 65s. While improvements have been made in the cargon of pelvic arch fractures, the constitution reveals 37 per cent of people still arent receiving a locomote sagacity (AgeUK 2010).The work experiences in care home helped me to k forthwith roughly common problems of old age. I understand, water driblet is one of the common problems in old age. However, this lead will helps me to explore about what are the causes of go in the old age and how we can reduce and pr flatt the frequency of fall.Office of national statistics.http//www.statistics.gov.uk/cci/nugget.asp?id=949WHOhttp//www.who.int/wellnessinfo/survey/ageingdefnolder/en/index.htmlAgeUKhttp//www.ageuk.org.uk/latest-press/archive/age-uk-responds-to-national-hip-fracture-database-national-report-2010/SEARCH STRATEGYTo find information about my independent study topic, I came crossways with much verity of articles and literature such as books, journals, eBooks, internet, databases etc. A plenty of databases I were tryed, for example, EBSCO, PUBMEB,BMJ,CINHAL,BNI and Google web search and Google books also. University website helped me to locate and use the relevant databases more effortlessly. These databases helped me to search and study about my topic locomote in the old age care.When I start trenchant about my topic, I found a huge amount of literature in my screen. To sort out the relevant information from the many articles I utilize the inclusion and exclusion methods and some tracewords, that is the literature is not more than ten is years old and research nature, then I used some key words related to my topic such as falls in the old age, causes of falls, endangerment factors of falls and continueion of falls. When I start search in EBSCO, The search exposed few outlets with rele vance to falls among the aged, some results on fractures, three on domestic injuries and deaths and inspection article on speak to to falls and one on urgent situation management of falls. As a part of my study I visited many websites also they are AGE.UK, World wellness Organisation (WHO) and office of national statistics.DEFINITION OF FALLS IN THE OLD AGEAn event, which results in a person come to rest inadvertently on the ground or other lower level. Globally, an estimated 391 000 people slip awayd due to falls in 2002.World Health Organisation.World Health Organisation.http//www.who.int/violence_injury_ stripe/other_injury/falls/en/index.htmlCLASSIFICATIONS OF FALL decree Tideiksaar cited the work of Luckinen, et.al (1994). Falls is classified into mainly four groups.Extrinsic or environmental factorsIt includes. Slips, trips or externally included displacements.Intrinsic factorsMobility or balance disorderliness or overtaking of consciousnessNon-bipedalIt includes person f alls from the bed, chair or device.Non- identified or non classifiable.It includes fall cannot be identified or described by either a person or collateral damage.ReferenceFalling in old age prevention and management (1997)By Rein Tideiksaarhttp//books.google.co.uk/books?id=426l9wOdfyACpg=PA140dq= classification+of+falls.lach+et+alhl=enei=-o3BTLWdDs2Usway-uDpCAsa=Xoi=book_resultct=resultresnum=3ved=0CDoQ6AEwAgv=onepageqf= absurdR.B. Shukla, D. Brooks(1996) a guide to care of the Elderly.CAUSES OF FALLS IN THE OLD AGEFalls and unsteadiness of gait are major problems go about by the elderly. accidental injuries and fatalities due to fall indicate substantial morbidity and mortality in the elderly. (B. Everett Gray,1990).Among all negative outcomes derived from elderly health conditions, falling is considered one of the main causes of functional impairment.( Arlete female horse Valente Coimbra and et al, 2009).Physical causesArthritisParkinsons diseaseFoot problemsStrokesCardiac fail ureMental causes DepressionDementiaAlzheimers diseaseDrugs and MedicationSedativesDiureticsHypotensive ageEnvironmental factorsHazards in the home (rugs, mats, loose carpets, poor lightings)weather conditionsAge- related changesBalance/gaitGeneral frailtyPoor visionPoor mobilityNon AccidentalElderly abuseCriminal injuryBOOK referredR.B. Shukla, D. Brooks(1996) A guide to care of the Elderly.R.B. Shukla(1999) Care of the elderly.Falls in the elderly of the Family Health Program (2009)Arlete Maria Valente Coimbra, Natalia Aquaroni Ricci, Ibsen Bellini Coimbro, Llian Tereza Lavras Costallat,http//www.sciencedirect.com.ezproxy.uwe.ac.uk/science?_ob=MImg_imagekey=B6T4H-4YCGKNF-1-1_cdi=4975_user=122883_pii=S0167494310000245_ logical argument=search_coverDate=12%2F31%2F2010_sk=999489996 outlook=cwchp=dGLbVlb-zSkWAmd5=bb481983dd92110f0721752512e8a78fie=/sdarticle.pdfSlips, stumbles and falls pedestrian footwear and surfaces By B. Everett Gray, ASTM Committee F13 on Safety and Traction for F ootwear.http//books.google.co.uk/books?id=1LMK0x-eZiICpg=PA7dq=falls+in+the+elderlyhl=enei=YxbITMerK4qOjAeH_ehysa=Xoi=book_resultct=resultresnum=6ved=0CEQQ6AEwBQv=onepageq=falls%20in%20the%20elderlyf=falseRISK FACTORS OF FALLS IN THE ELDERLYIn 2007, 81% of fall deaths were among people 65 and older. Men are more likely to die from a fall. After adjusting for age, the fall fatality rate in 2007 was 46% higher for men than for women. (CDC). Risk factors for fall are categorized according to their origin as follows, age related changes, common pathologic changes and functional impairment, medicinal drug effects and environmental factors. (Miller.C, 2008). According to the 2007, WHO report on falls prevention in the old age, classified into four endangerment factors can cause fall,behavioural risk factorsEnvironmental risk factorsBiological risk factorssocioeconomic risk factorsBehavioural risk factorsBehavioural risk factors include human actions, emotions or daily choices. The main Behavioural risk factors areMultiple medications UseExcess alcoholic beverage intakeLack of ExerciseInappropriate FootwearEnvironmental risk factorsEnvironmental factors encapsulate the interplay of individuals physical conditions and the surrounding environment, including home hazards and hazardous features in public environment. It includesPoor building designSlippery floors and stairsLooser rugsInsufficient lightingCracked or uneven sidewalksBiological risk factorsBiological factors embrace characteristics of individuals that are pertaining to the human body. For instance, age, gender and race are non-modifiable biological factors. The risk factors areAgeGenterRaceChronic illnessReduced physical, cognitive and affective functSocioeconomic risk factorsSocioeconomic risk factors are those related to influence social conditions and economic status of individuals as well as the capacity of the community to repugn them. It includes,Low incomeInadequate housingLack of social interact ionsLimited access to health and social serviceLack of community resourcesReferenceWHO, Global report on prevention of falls in the old age, (2007)http//www.who.int/ageing/publications/Falls_prevention7March.pdfhttp//books.google.co.uk/books?id=ms9o2dvfaQkCprintsec=frontcoverdq=WHo+Global+report+on+falls+Prevention+in+older+Agehl=enei=_rLKTPiRFMuNjAeZ5c3LDwsa=Xoi=book_resultct=resultresnum=1ved=0CCwQ6AEwAAv=onepageqf=falseCDC, Falls among Older Adults An Overviewhttp//www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.htmlNursing for wellness in older adults.Carol A. Miller(2008) p 465http//books.google.co.uk/books?id=yUx01gmNLboCpg=PA465dq=risk+factors+of+fallshl=enei=M7zOTPr_C9jPjAfmjdXXBwsa=Xoi=book_resultct=resultresnum=2ved=0CDMQ6AEwAQv=onepageq=risk%20factors%20of%20fallsf=falseCOMPLICATIONS OF FALLSComplications results from falls are the leading cause of death from the injuries in men and women aged over sixty five-spot years and older, with men older eighty five years and older having the highest death rate, more than 180 death in per 100000 population.(john.c.beck, 2004). Falls related mortality is a critical problem in the old population. While the majority of falls among old persons do not result death, falls experienced by this age group are a leading cause of mortality.(Tidekasaar,1997). Fractures of hip and lower extremities are more common and lead to prolonged disability because of impaired mobility. (Robert. K, 2004). The common complications of falls are fearsome soft tissue injuriesFractures Hip Fractures Femur Fractures Humerus Fractures Wrist Fractures Ribs Fractures Subdural hematoma Hospitalization Complications of immobilisation Risk of iatrogenic diseases Infections and Inflammations Disabilities damage mobility because of physical injury Impaired mobility from fear, loss of self confidence and restrictionOf ambulation. Risk of institutionalisation DeathEssentials for clinical geriatrics, (Robert Kane, 2004)http//books.google.co .uk/books?id=zYgxA_XAM7QCprintsec=frontcoverdq=essentials+for+clinical+geriatrics,robert.l.+kanehl=enei=sgjITInvC4vQjAfkyuRosa=Xoi=book_resultct=resultresnum=1ved=0CDUQ6AEwAAv=onepageq=complications%20of%20fallsf=falseG R S, (Geriatric study Syllabus), john.c.beck.http//books.google.co.uk/books?id=zjPf6bJt9RYCpg=PA149dq=complications+of+falling+in+the+elderlyhl=enei=kqDKTOXWIMWOjAeZvZDnDwsa=Xoi=book_resultct=resultresnum=9ved=0CF4Q6AEwCAv=onepageq=complications%20of%20falling%20in%20the%20elderlyf=falsePREVENTION OF FALLS IN THE ELDERLYPrevention of falls is crucial to the health of all older persons, including those without a history of falling, even older persons with no history of falls expresses fearful anticipation of falling. Such persons usually have an underlying gait dysfunction or imbalance problem that may lead to self imposed restriction of activities and mobility and may result in them being house bound or chair bound. Falls cannot be prevented unless the risk factors are identified(National guideline for prevention falls in older persons, 2000)Stephan.R (2007) cited the work of The Kellogg International working group (1987) on the prevention of falls in the elderly as defined as unintentionally coming to the ground or some lower level and other than as a consequences of sustain a violent blow, loss of consciousness, sudden onset of paralysis as in the stroke or an epileptic seizure. Considerable evidence now exists that most falls among older persons are associated with identifiable and modifiable risk factors and that targeted prevention efforts are shown to be cost-effective. Most falls and resulting injuries among older persons are shown to result from a combination of age and disease-related conditions and the individuals interaction with their social and physical environment (WHO,2008). Ebrahim S and A Kalache (1996) describes the causes and prevention of fallsCausesPreventionUses of drugsPsychological factorsExtrinsic factors alcohol useAs sistive devicesCognitive/behavioural/Social programmeClinical estimate of risk.(Rai G 2006)Warn older person against self medicationRational prescribing of medicationAssist disoriented person to take medicationUse CNS drugs very carefully and cautiously.Counselling of older people with try out related disorders put forward divertional therapyEnvironmental factors must be accessed and correctedEnsure obstacles free environmentEnsure adequate light and contrastEnsure No loose mat or slipping surfaceProvide night lightHand railsAdvice on safe drinking patternReview combination of alcohol with other drugsProvide appropriate walking aidsMinimise restraint devicesBalance and gait trainingRestore confidenceProvide social contactTeach avoidance of risk taking behaviour to person or care giver.History and circumstances of fallsAny loss of consciousnessAny loss of movement or involuntary movementAny incontinenceAll prescribed and the over the counter medicationsAny new acute and/or ongoing chronic medical problemsAny previous problems with gait and balanceChest painPalpitationHearing problemsEye green goddess problemsMemory lossDepressionHabits relating to alcohol or recreational drugs.(Rai G 2006)The Global report of prevention of falls in the elderly (WHO, 2007) states that multi factorial approach is helpful to prevent falls in the community and elderly. The approaches areBalance and gait training with appropriate use of assistive devicesEnvironmental risk assessment and modificationMedication review and modificationManaging visual problemsProviding education and trainingAddressing foot and shoe problemsAddressing orthostatic hypotension and other cardiovascular problemsMulti factorial approaches are shown to be the most effect prevention strategy in residential settings. Components of successful multi factorial interventions include staff training and guidance, changes in medication, resident education, environmental assessment and modification, supply and repai r of aids, exercise, and use of hip protectors (WHO, 2007).Hip protectors (a plastic shield sewn into special underwear so that it lies over the greater trochanter) are cognize to absorb energy when a patient falls, thus reducing the incidence of hip fractures. They are especially beneficial in patients who live in breast feeding homes and residencial homes, who are very frail and hence have thin bones and prone to recurrent falls and fractures.( Shukla.R, 1999).ReferencesFalls in the older people risk and strategies for prevention (2007).Stephen R. Lord, Catherine Sherrington, Hylton B. Menzhttp//books.google.co.uk/books?id=1enrvVe81YgCpg=PA21dq=prevention+of+falls+in+the+old+agehl=enei=XNXKTL7hH5SSjAeWqIjIDwsa=Xoi=book_resultct=resultresnum=4ved=0CEEQ6AEwAwv=onepageq=prevention%20of%20falls%20in%20the%20old%20agef=falseWHO, Global report on prevention of falls in the old age, (2007)http//www.who.int/ageing/publications/Falls_prevention7March.pdfhttp//books.google.co.uk/books?id=m s9o2dvfaQkCprintsec=frontcoverdq=WHo+Global+report+on+falls+Prevention+in+older+Agehl=enei=_rLKTPiRFMuNjAeZ5c3LDwsa=Xoi=book_resultct=resultresnum=1ved=0CCwQ6AEwAAv=onepageqf=falseEbrahim S and A Kalache (1996), Epidemiology in old age. P.364, BMJ group.Gurucharan Rai, Joe reosethal, Jacqueline morris Steave iliffe (2006) shared out care of older people.R.B. Shukla(1999) Care of the elderly.National guideline for prevention falls in older persons, 2000MANAGEMENT OF FALLSMulti factorial factors had an influence in the falls in the elderly and causes falls so a multi factorial approach management is helpful to prevent falls in the elderly. Multi disciplinary management includes medical examination assessment, nursing, physiotherapy, education, occupational therapy, social worker, the dietician, Chiropodist, orthodist and specialist Nurses. (Shukla. R 1996)Rai. G, 2006 states that management of any patients with falls with clearly guided by the findings from history, examination and investigation, such that any identified risk factors or causes of falling can be specifically addressed. Much of the management focuses on prevention of further falls. This will always include careful review of the risk and benefits of any medication which the patient is currently taking. Physiotherapy and occupational therapy can be helpful in identifying and reducing environmental risk for falling. might and balance exercise can help individuals learn to get up after a fall. Multi disciplinary management have an important role in the prevention of falls, improving health, risk assessment, health education.ReferencesGurucharan Rai, Joe reosethal, Jacqueline morris Steave iliffe (2006) shared care of older people.R.B. Shukla, D. Brooks(1996) A guide to care of the Elderly.SummeryThe most important goal of this study was to expand more information about two sets of possible risk factors for falls, causes, prevention and management of falls. The main aetiology of falls is recognized as native and extrinsic factors.Most of the falls in the older people can be prevented or reduced in frequency if clinicians first begin to view the falls as symptomatic or an underlying problem and , second perform comprehensive assessment to uncover a magnitude of medical, psychological and environmental factors that may cause falls. (R Tideiksaar, 1988).ReferencesFalls in the elderly.R Tideiksaarhttp//www.ncbi.nlm.nih.gov/pmc/articles/PMC1629317/?page=16ConclusionFall and fall related injuries are major public health challenges that call for global attention.This problem will increase in magnitude as the numbers of older adults increase in manynations throughout the world( WHO) all(prenominal) old age person was classified as having an intrinsic or extrinsic fall using the information obtained at the fall assessment. Extrinsic falls were related to environmental hazards (slip, trip or externally induced displacement), whereas intrinsic falls were related to mobility or balance d isorder, muscle weakness, orthopaedic problems, loss of consciousness, neurally liaise cardiovascular disorder or sensory impairment.IN my point of view, Prevention is better than cure it an old proverb. It is perfectly applicable in the case of falls in the elderly. As a part of this I understand early detection of risk factors and cause of falls is the most relevant method to prevent injuries, haemorrhage, disabilities, etc in old age. Provide comfortable house and ensure the nursing homes or residential homes are hazards less It can prevent extrinsic factors of fall and environmental hazards.ReferencesWHO, Globel report of prevention of falls in the elderly.http//www.who.int/ageing/projects/1.Epidemiology%20of%20falls%20in%20older%20age.pdfRECOMMANDATIONSCenter for disease control and prevention (CDC) states that older adults can take several travel to protect their independence and reduce their chances of falling. They canExercise regularly. Its important that the exercises fo cus on increasing leg strength and improving balance. Tai Chi programs are especially good.Ask their doctor or pharmacist to review their medicines-both prescription and over-the counter-to reduce side effects and interactions that may cause dizziness or drowsiness. fork up their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision.Make their homes safer by reducing tripping hazards, adding grab bars and railings, and improving the lighting in their homes.Additional ways to lower hip fracture risk includeacquiring adequate calcium and vitamin D in your diet.Undertaking a program of weight bearing exercise.Getting screened and treated for osteoporosis.Center for disease control and prevention (CDC), Falls among Older Adults An Overview.http//www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.htmlREFLECTIONReflective practice is a process of review an experience of practice in order to describe analyses and pass judgment and so i nform learn from practice (Sarah B, P 161). WHO has done a study on falls in the elderly and reflected it and states that by building on the three pillars of falls prevention, the model proposes specific strategies forBuilding awareness of the importance of falls prevention and treatmentImproving the assessment of individual, environmental, and societal factors that increase the likeliness of falls.For facilitating the design and implementation of culturally-appropriate, evidence-based interventions that will significantly reduce the number of falls among older persons.As a part of my independent study I came across with the topic of falls in the elderly. It gives a huge knowledge about elderly care and how to prevent falls in the elderly.