FALLS PREVENTION IN GERIATRIC CARE
Definition of a
fall
A fall is an
event which results in a person coming to rest inadvertently on the ground or
other lower level.
This includes a
headlong tumble down a flight of stairs, a loss of balance resulting in a fall
to the floor into a sitting or lying position, sliding out of bed or slip off
the kerb onto the road.
Consequences
IMPACT of falls
·
Fractures – approx 96% of
fractures follow a fall.
·
Dislocations
·
Lacerations
·
Sprains
·
Deep bruises
·
Joint pain – leading asymmetry
·
Loss of confidence
·
Decreased mobility
·
Soft tissue injury
Costs of falls
·
Falls, falls related injuries
and the fear associated with falling have a huge cost, both to the NHS and to
the individuals themselves, their family and carers.
(Dolan and Torgerson, 1998)
·
6 months after hip surgery, 50%
of patients will have died, entered a nursing home, or will be in hospital
again.
·
Only 20% regain full
pre-fracture mobility
(Lord 1992)
Ratio Of age
The incidence of falls is high among the older
population:
aged 65+ 1 in 3
women fall each year &1 in 5 men fall each year
aged 85+ 1 in 2
men and women fall each year
Risk factors of falls
·
History of falling
·
Medication
·
Impairments of gait and balance
·
Dizziness
·
Neuromuscular factors
·
Dependence in any activity of
daily living
·
Low body mass index
·
Chronic diseases
·
Visual impairment
·
Cognitive impairment
·
Physical activity
·
Alcohol
·
Environmental hazards
·
Multiple risk factors – more
than 4 – high risk
·
When assessing a falls patient,
it is advisable to keep DAME in your mind:
·
Drugs and alcohol
·
Age related physiological
changes
·
Medical
·
Environment
Physiotherapy
INTERVENTION
·
Gait re-education
·
Improve balance
·
Improve muscle power
Gait
re-education
·
Parallel bars –
·
Improves confidence
·
Isolate abnormal points of gait
which lead to falls
·
Eg at ankle – toe drag during
swing – weak dorsiflexors
·
Foot slap at initial contact –
below normal dorsiflexor activity
·
At knee – diminished extension
during stance phase – reduced ROM at knee
·
Limited flexion at knee during
swing phase – compensating for reduced flex at hip or ankle
·
At hip – hip hiking during
swing phase – weak hip, knee or ankle flexor muscles
·
Trendelenburg gait – weak hip
abductors
Static and
dynamic balance
Static balance
is the maintenance of the body mass above the BOS that is not moving. Dynamic
balance is when the balance is maintained above a BOS that shifts. An example
of static balance is single leg stance. An example of dynamic balance is
walking.
Balance
strategies
- An adequately
functioning balance system is integral to most of our other abilities. Our
bodies have developed highly adaptive balance mechanisms and numerous safety
systems.
- Information
about movement and the environment is supplied to the CNS by vision,
proprioception and labyrinthine discharges.
- There are three
postural control strategies which counteract challenges to balance:
- Ankle strategy –
motion around ankle joint when balance is challenged
- Hip strategy –
this is characterised by quick flexion and extension forces generated by the
muscles around the hip in an effort to maintain a persons centre of gravity
above the base of support.
- Stepping
strategy – this is the action of one or more steps as a response to
displacement of a persons centre of gravity outside the base of support.
Program
·
Warm up
·
Walk on spot
·
Stretch
·
Calf
·
Hamstrings
·
Hip flexors
·
Strength exercises
·
Dorsiflexion
·
Quads
·
Gluteals
·
Balance
·
Balance recovery
sideways/backwards
·
Eye tasks
·
Head/eye movement with object
Equipment used
1.
Weights
2.
Wobble boards
3.
Parallel bars
4.
Steps
5.
Gymball
Dorsiflexion
exercises
1.
Tapping toes against the ground
2.
Toe raises
3.
Walking on heels
Quads exercises
1.
Knee extension in sitting (with
or without weights)
2.
Inner range quads on quads bar
3.
Leg swings
4.
Marching
5.
Stair practice
Hip extensor
exercises
1.
Pushing heel into bed/plinth
2.
Bridging
3.
Sit to stand
4.
Posterior leg swing
5.
Squats
6.
Active extension with ankle
weight
Hip abductor
exericses
1.
Sidestepping
2.
Single leg stance – active
abduction
3.
Resistance – ankle weights
Balance recovery
1.
Balance exercises with a
gymball
2.
Lateral weight transfer
3.
Front to back weight transfer
4.
Throwing and catching ball
5.
Functional reach exercises
6.
Practise stepping strategy
Eye tasks
1.
Point to point, head still
2.
In and out
3.
Tracking
4.
Eyes still, head moves
This is some info that we can use to let the geriatric patient is learning and to improve their function ,fall is one of the risk can cause a lot of problem for elderly , so the prevention measurement is important to take action..wallahuaklam..