Emergency Management of Falls
Important Note
Falls are the most common cause of traumatic injury from the sixth decade on.
One in three older people fall once every year.
10-15% of falls cause serious injury. Almost all cause significant psychological injury, ranging from embarrassment to curtailment of health-maintaining activities.
Why are older people predisposed to falls?
- Changes in the central nervous system – slower nerve conduction, slower reflex response
- Changes in the musculo-skeletal system – arthritis, decreased muscle mass — make older people stiffer and less coordinated
- Visual, hearing and memory impairments
- Decreased proprioception and vibration sense
- Drugs: some drugs – alcohol and prescription meds such as antihypertensives, sedatives, diuretics, autonomic meds – can cause falls; other drugs – particularly anticoagulants – can worsen the injuries of falls
Discussion: Emergency Management of Falls
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confusion, delay in response from staff, unfamiliar environment, polypharmacy can all be causes of falls.
Fear of falling is REAL
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dont overlook normal pressure hydrocephalus as a cause of gait instability
makes sense
Noted
noted
alrighty then
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Worsening eye sight, decreased core strength to catch themselves from falling.
degenerative eyesight, slower reaction time among other things can contribute
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yes, I concur.
yup
Yeah.
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Good information
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none
done
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AGREED. ACCURATE MEDICATION HISTORY VERY IMPORTANT
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good
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Good list>
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Thanks
i am awarev of the causes of falls in the older patients
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Older people are predisposed to falls for many reasons.
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often we only focus in the injuries
o
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need lots of oupt fu
I cannot agree more
very true
hmm
psychological effects may be more far-reaching than they seem
Rushing is often another cause of falls. The delayed response to the need to void often causes rushing to the washroom and a fall occurs.
true
I concur
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great
okay
Shoes and weather play role as well
great point
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such a good reminder about the psychological impact of falls/functional impact of falls
Difficult to discharge with lack of social support. Physical therapy consult sometimes required and providing a walker for home use.
Una caída en el anciano puede ser el inicio de cuadros médicos severos o descubrimiento de patologías.
important to know about falls risks in older patients
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History of a fall can provide clues as to the cause, falling is a symptom. It can be caused from an illness, medical condition, age related changes, drugs, environmental conditions. Teasing out the information surrounding the falls, combined with objective data gives a more complete picture to try and prevent similar future falls.
i couldn’t agree more
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Waling is a complex behavior that takes half a decade to perfect and can be easily lost if sensory, proprioceptive or cognitive impairment occurs
good info
yes
Consider other factors that can cause a fall that are beyond the physical aspect of disease such as the patient’s environment which can include falls due to bed rails, bed is not in the lowest possible position, improper footwear, etc.
address the cause and ways to prevent it in the future
cause of fall is important
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good info
good info
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Good info
good info
Good info
Often patients are reluctant to share numbers of falls they are experiencing due to fear of being forced to accept more help in the home or move to a safer environment
We often don’t realize how geriatric psychiological health is effected after trauma or even a medical event. It is good to be reminded to include this as something to include as part of assessments.
noted
Noted
agreed
I am surprised, now that I am getting old, how if you don’t maintain your mobility, you lose it.
In my experience, elderly with fall (especially multiple) are prone to increased morbidity and mortality.
Agreed, and also consider living conditions, clutter and capability of maintaining safe environment
i say again, getting old is balls
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I’m more aware now in helping to prevent future falls
need to look for medical causes as well as social causes in detail.
Any suggestions on how to mitigate the psychological impact of falls?
I explore with the patient what would be helpful in addressing their limiting their activities/being embarrassed re: falls/having to use a gait aide. I discuss alternative transportation options and discuss alternative exercises options e.g. walk inside a mall in the winter. Another strategy I find helpful is to refer a patient for an OT home safety assessment if they have had a fall at home or changes in their functional reserve recently/developed a fear of falling and mention in the referral that the patient is more isolated now b/c of the falls, more axnxious etc. I also at times recommend a referral to a Geriatric Day Hospital or Falls Program (outpatient) where patient can work with a team and also meet other patients who are experiencing similar psychological effects of the falls.
los adultos mayores son complicados por su condición de fondo
son abordajes complicados
🙂
I agree with Scapa 18
cool
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I like Nada’s point about ‘near falls’.
Always consider fall as either something wrong with pt (illness), or their environment
I agree with Scapa 18.
The psychological impact of a fall is often underestimated especially in generation of further falls. Decreased confidence compounds poor functioning.
I would also add “near falls” . Where patients furniture cruise or have a care-giver nearby to help. I always make it a point to ask family members, caregiver and RN staff about “near falls”.
Also, consider other intrinsic risk factors such as a history of urinary incontinence and previous falls. Extrinsic factors in the home (stairs, clutter, lack or improper use of assistive devices)and hospital (restraints, Foley catheters) are other considerations.
i am awarev of the causes of falls in the older patients