Chapter 5a. Presentation Content The Falls Management Program Manual On This Page:Slide 1. Facts About FallsSlide 2. Facts About Falls (continued)Slide 3. Facts About Falls (continued)Slide 4. Intrinsic Fall Risk FactorsSlide 5. Intrinsic Fall Risk Factors (continued)Slide 6. Intrinsic Fall Risk Factors (continued)Slide 7. Extrinsic Fall Risk FactorsSlide 8. Extrinsic Fall Risk Factors (continued)Slide 9. Extrinsic Fall Risk Factors (continued)Slide 10. Physical RestraintsSlide 11. Consequences of FallsSlide 12a. Staff Strategies to Reduce Fall RiskSlide 12b. Staff Strategies to Reduce Fall Risk (continued)Slide 13. How You Can HelpSlide 14. Remove ClutterSlide 15. Provide Safe FootwearSlide 16. Promote Safety During TransferSlide 17. Use Low Blood Pressure PrecautionsSlide 1. Facts About FallsOpening slide of this Falls Management Program presentation.Slide 2 Facts About Falls (continued)General Population 34.9 million people ≥65 years of ageOne in three elderly persons living in the community fall each yearOf deaths caused by a fall, 60% involve people who are ≥75 years of ageFalls account for 87% of all fractures in people ≥65 years of ageSlide 3. Facts About Falls (continued)Nursing Facilities The average age at admission to a nursing facility is 82.6 yearsOver 50% of those admitted to a nursing facility have three or more admitting diagnosesOne in two patients in nursing facilities fall every yearOf those patients who fall, 30-40% will fall againPeople ≥85 years are 10-15 times more likely to experience hip fractures than those people who are 60-65 yearsSlide 4. Intrinsic Fall Risk FactorsEffects of Normal Aging Vision - decreased acuity, decreased contrast sensitivity, increased sensitivity to glare, decreased peripheral vision, decreased night visionHearing - decreased hearing sensitivityChanges in gait and balance - reduced arm swing, decreased step length, slowed reaction time, slower movementsUrological - feelings of urgent need to urinate and having to urinate frequentlySlide 5. Intrinsic Fall Risk Factors (continued)Acute and Chronic Diseases (Parkinson's, Alzheimer's, stroke, arthritis, depression, cancer, osteoporosis) Confusion, disorientation, agitation, impaired judgmentWeakness, dizziness, faintingParalysis, tremorsLoss of joint mobility, contracturesLower extremity weaknessDrop in blood pressure upon standing, after meals or after voidingIncontinenceSlide 6. Intrinsic Fall Risk Factors (continued)Side Effects of Medications (antidepressants, sedatives/hypnotics, and antipsychotics) DizzinessConfusion, impaired judgmentWeakness, impaired gaitSedation, slowed reaction timeDrug interaction and/or polypharmacySlide 7. Extrinsic Fall Risk FactorsEnvironment ClutterInadequate lighting, glareUneven or wet floors, raised thresholds, missing tiles or linoleumUnstable or lightweight furnitureInsecure toilet seat or handrailHard-to-reach personal itemsUnstable wheelsLow toilet seatLack of handrail support in bathroomSlide 8. Extrinsic Fall Risk Factors (continued)Personal Safety Unsafe shoes or slippersHard-to-manage clothingSlide 9. Extrinsic Fall Risk Factors (continued)Equipment Missing wheelchair partsIncorrect wheelchair fitInadequate wheelchair seatingBroken partsSlide 10. Physical RestraintsPhysical restraints increase the likelihood of serious injury resulting from a fall.Not a method of fall preventionSlide 11. Consequences of FallsSerious injury such as hip fractureIncreased risk of death associated with hospitalization and complicationsLoss of independence and decreased ability to functionLoss of self-confidence and fear of fallingReduced quality of lifeIncreased need for careSlide 12a. Staff Strategies To Reduce Fall RiskFalls assessment to determine problems with medications, behavior, vision, gait, and mobility, or presence of postural hypotensionMedical evaluationMedication reviewGait and balance trainingSlide 12b. Staff Strategies To Reduce Fall Risk (continued)Hip protectorsIndividualized wheelchair seatingLow beds, mats½ or ¼ side railsToiletingAlarms/sensorsActivities and exercise programsBehavioral strategiesSlide 13. How You Can HelpRemove clutter from room and bathroomProvide safe shoes and slippersPromote safety during transfer and bathroom useUse low blood pressure precautions when neededRemove clutter from room and bathroom - Provide safe shoes and slippers - Promote safety during transfer and bathroom use - Use low blood pressure precautions when neededSlide 14. Remove ClutterHelp keep pathways around bed and to bathroom clearProvide only stable furniture from homeRemove items no longer neededSlide 15. Provide Safe FootwearShoes and slippers should have tread, fit well, have a firm shape, and have low, even heels.Examples: tennis shoes with Velcro fasteners, oxford style shoes, canvas or leather slip-on shoes, fitted, soft slippers with tread.Slide 16. Promote Safety During TransferCall for help when unsure about safetyProvide easy-to-manage clothing with elastic waist and Velcro fastenersLock wheelchair brakes before transferKeep all seating items in wheelchairSlide 17. Use Low Blood Pressure PrecautionsFor residents with low blood pressure:Sit on edge of bed and dangle feet before risingFlex feet backwards several times before risingDo not tilt head backwardsGet up slowly and use assistance - Report dizziness Current as of February 2010 Internet Citation: Chapter 5a. Presentation Content: The Falls Management Program Manual. February 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/injuries/fallspx/chap5slide1.html
Slide 2 Facts About Falls (continued)General Population 34.9 million people ≥65 years of ageOne in three elderly persons living in the community fall each yearOf deaths caused by a fall, 60% involve people who are ≥75 years of ageFalls account for 87% of all fractures in people ≥65 years of age
Slide 3. Facts About Falls (continued)Nursing Facilities The average age at admission to a nursing facility is 82.6 yearsOver 50% of those admitted to a nursing facility have three or more admitting diagnosesOne in two patients in nursing facilities fall every yearOf those patients who fall, 30-40% will fall againPeople ≥85 years are 10-15 times more likely to experience hip fractures than those people who are 60-65 years
Slide 4. Intrinsic Fall Risk FactorsEffects of Normal Aging Vision - decreased acuity, decreased contrast sensitivity, increased sensitivity to glare, decreased peripheral vision, decreased night visionHearing - decreased hearing sensitivityChanges in gait and balance - reduced arm swing, decreased step length, slowed reaction time, slower movementsUrological - feelings of urgent need to urinate and having to urinate frequently
Slide 5. Intrinsic Fall Risk Factors (continued)Acute and Chronic Diseases (Parkinson's, Alzheimer's, stroke, arthritis, depression, cancer, osteoporosis) Confusion, disorientation, agitation, impaired judgmentWeakness, dizziness, faintingParalysis, tremorsLoss of joint mobility, contracturesLower extremity weaknessDrop in blood pressure upon standing, after meals or after voidingIncontinence
Slide 6. Intrinsic Fall Risk Factors (continued)Side Effects of Medications (antidepressants, sedatives/hypnotics, and antipsychotics) DizzinessConfusion, impaired judgmentWeakness, impaired gaitSedation, slowed reaction timeDrug interaction and/or polypharmacy
Slide 7. Extrinsic Fall Risk FactorsEnvironment ClutterInadequate lighting, glareUneven or wet floors, raised thresholds, missing tiles or linoleumUnstable or lightweight furnitureInsecure toilet seat or handrailHard-to-reach personal itemsUnstable wheelsLow toilet seatLack of handrail support in bathroom
Slide 8. Extrinsic Fall Risk Factors (continued)Personal Safety Unsafe shoes or slippersHard-to-manage clothing
Slide 9. Extrinsic Fall Risk Factors (continued)Equipment Missing wheelchair partsIncorrect wheelchair fitInadequate wheelchair seatingBroken parts
Slide 10. Physical RestraintsPhysical restraints increase the likelihood of serious injury resulting from a fall.Not a method of fall prevention
Slide 11. Consequences of FallsSerious injury such as hip fractureIncreased risk of death associated with hospitalization and complicationsLoss of independence and decreased ability to functionLoss of self-confidence and fear of fallingReduced quality of lifeIncreased need for care
Slide 12a. Staff Strategies To Reduce Fall RiskFalls assessment to determine problems with medications, behavior, vision, gait, and mobility, or presence of postural hypotensionMedical evaluationMedication reviewGait and balance training
Slide 12b. Staff Strategies To Reduce Fall Risk (continued)Hip protectorsIndividualized wheelchair seatingLow beds, mats½ or ¼ side railsToiletingAlarms/sensorsActivities and exercise programsBehavioral strategies
Slide 13. How You Can HelpRemove clutter from room and bathroomProvide safe shoes and slippersPromote safety during transfer and bathroom useUse low blood pressure precautions when neededRemove clutter from room and bathroom - Provide safe shoes and slippers - Promote safety during transfer and bathroom use - Use low blood pressure precautions when needed
Slide 14. Remove ClutterHelp keep pathways around bed and to bathroom clearProvide only stable furniture from homeRemove items no longer needed
Slide 15. Provide Safe FootwearShoes and slippers should have tread, fit well, have a firm shape, and have low, even heels.Examples: tennis shoes with Velcro fasteners, oxford style shoes, canvas or leather slip-on shoes, fitted, soft slippers with tread.
Slide 16. Promote Safety During TransferCall for help when unsure about safetyProvide easy-to-manage clothing with elastic waist and Velcro fastenersLock wheelchair brakes before transferKeep all seating items in wheelchair
Slide 17. Use Low Blood Pressure PrecautionsFor residents with low blood pressure:Sit on edge of bed and dangle feet before risingFlex feet backwards several times before risingDo not tilt head backwardsGet up slowly and use assistance - Report dizziness
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