Friday, March 29, 2019
Study Of Falls In The Elderly
Study Of F boths In The Elderly jump ondness is a normal phenomenon in solely all all over the world so that the necessity of honest-to-goodness age c atomic number 18 is very important. WHO states that world countries postulate accepted the chronological age of 65 years as a definition of older. Nowadays, world is developing too fast I all the sectors especially in medical knowledge and technology. It makes great differences in the lifetime span and the quality of life of the plebeianwealth.The fastest population increase has been in the number of those aged 85 and over, the over-the-hillest sr.. In 1984, there were around 660,000 citizenry in the UK aged 85 and over. Since then the numbers have to a greater extent(prenominal) than doubled reaching 1.4 million in 2009. By 2034 the number of great deal aged 85 and over is projected to be 2.5 times large than in 2009, reaching 3.5 million and accounting for 5 per cent of the numerate population. ( great power of nati onal statics 2010). move is one of the most viridity capers in aged(prenominal) age. Elder people pickpockets frequently and it shadow bewilder grievous injuries much(prenominal) as fracture, dislocation and head injuries (Dr.Roberts A 1995). move set up the most frequent and serious type of accident in the over 65s. While improvements have been made in the cargon of hip fractures, the get over reveals 37 per cent of people still arnt receiving a travel discernment ( come onUK 2010).The work experiences in care home helped me to know ab proscribed common problems of octogenarian age. I infer, locomote is one of the common problems in erstwhile(a) age. However, this c at a timeive testament helps me to explore about what are the causes of locomote in the archaic age and how we crapper curve and prevent the frequency of locomote.Office of national statistics.http//www.statistics.gov.uk/cci/nugget.asp?id=949WHOhttp//www.who.int/ healthinfo/survey/ageingdefn ol d(a)/en/index.htmlAgeUKhttp//www.ageuk.org.uk/latest-press/archive/age-uk-responds-to-national-hip-fracture-database-national- continue-2010/SEARCH STRATEGYTo abide by information about my independent study division, I came across with such(prenominal) verity of articles and literature such as books, journals, eBooks, internet, databases etc. A mount of databases I were searched, 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 go in the old age care.When I start searching about my topic, I give a huge amount of literature in my screen. To sort out the relevant information from the many articles I used the inclusion and expulsion methods and some key actors line, that is the literature is not more than ten is years old and research nature, then I used some key words related to to to to my topic such as move in the old age, causes of hits, put on the line factors of fall and saloon of travel. When I start search in EBSCO, The search exposed few tops with relevance to falls among the aged, some results on fractures, three on domestic injuries and deaths and review article on address to falls and one on urgent situation vigilance of falls. As a part of my study I visited many websites also they are AGE.UK, World health Organisation (WHO) and office of national statistics.DEFINITION OF fall IN THE OLD AGEAn event, which results in a person deal to rest inadvertently on the ground or other dismantle level. orbiculately, an estimated 391 000 people drawd due to falls in 2002.World Health Organisation.World Health Organisation.http//www.who.int/violence_injury_ taproom/other_injury/falls/en/index.htmlCLASSIFICATIONS OF FALLRein Tideiksaar cited the work of Luckinen, et.al (1994). Falls is categorise into mainly four groups.Extrinsic or environmental factors It embroils. Slips, trips or outwardly allow ind displacements.Intrinsic factorsMobility or balance disorder or privation of consciousnessNon-bipedalIt includes person falls from the bed, chair or device.Non- identified or non classifiable.It includes fall cannot be identified or described by both a person or collateral damage. recognitionFalling in old age prevention and management (1997)By Rein Tideiksaarhttp//books.google.co.uk/books?id=426l9wOdfyACpg=PA140dq= sorting+of+falls.lach+et+alhl=enei=-o3BTLWdDs2Usway-uDpCAsa=Xoi=book_resultct=resultresnum=3ved=0CDoQ6AEwAgv=onepageqf= ludicrousR.B. Shukla, D. Brooks(1996) a guide to care of the Elderly.CAUSES OF move IN THE OLD AGEFalls and unsteadiness of rate are major(ip) problems faced by the elderly. Accidental injuries and fatalities due to fall indicate true morbidity and mortality in the elderly. (B. Everett Gray,1990).Among all negative outcomes derived from elderly health conditions, falling is con postred one of the m ain causes of operable impairment.( Arlete Maria Valente Coimbra and et al, 2009).Physical causesArthritisParkinsons maladyFoot problemsStrokesCardiac failureMental causes DepressionDementiaAlzheimers unhealthinessDrugs and MedicationSedativesDiureticsHypotensive ageEnvironmental factorsHazards in the home (rugs, mats, unclouded carpets, poor lightings)weather conditionsAge- related changesBalance/gaitGeneral vicePoor visionPoor mobilityNon AccidentalElderly abuse outlaw 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_origin=search_coverDate=12%2F31%2F2010_sk=999489996view=cwchp=dGLbVlb-zSkWAmd5=bb481983dd92110f07217525 12e8a78fie=/sdarticle.pdfSlips, stumbles and falls pedestrian footwear and surfaces By B. Everett Gray, ASTM Committee F13 on Safety and Traction for Footwear.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 fourth-year. 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). stake factors for fall are categorized jibe to their origin as follows, age related changes, common pathologic changes and functional impairment, medicine effects and environmental factors. (Miller.C, 2008). According to the 2007, WHO report on falls prevention in the old age, classified into four find factors can cause fall,Behavioural hazard factorsEnvironmental adventure factorsBiolog ical risk factorssocioeconomic risk factorsBehavioural risk factorsBehavioural risk factors include military man actions, emotions or daily choices. The main Behavioural risk factors areMultiple medical specialtys UseExcess alcohol intakeLack of cropInappropriate FootwearEnvironmental risk factorsEnvironmental factors encapsulate the interplay of individuals physiological conditions and the surrounding environment, including home hazards and hazardous features in public environment. It includesPoor create 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 somatogenic, cognitive and affective functSocioeconomic risk factorsSocioeconomic risk factors are those related to influence complaisant conditions and economic status of individuals as well as the capacity of the conjunction to challenge them. It includes,Low incomeInadequate housingLack of social interactions special(a) 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+ stripe+in+ former(a)+Agehl=enei=_rLKTPiRFMuNjAeZ5c3LDwsa=Xoi=book_resultct=resultresnum=1ved=0CCwQ6AEwAAv=onepageqf=falseCDC, Falls among Older Adults An Overviewhttp//www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html treat for wellness in quondam(a) 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 jazzing cause of death from the injuries in men and women aged over sixty quin years and old, 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 arePainful soft tissue injuriesFractures pelvis Fractures Femur Fractures Humerus Fractures Wrist Fractures Ribs Fractures subdural hematoma Hospitalization Complications of immobilisation Risk of iatrogenic indispositions Infections and Inflammations Disabilities Impaired mobility because of physical injury Impa ired mobility from fear, acquittance 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 Review 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 explanation of falling, even older persons with no history of falls expresses fearful anticipation of falling. Such persons usually have an central gait dysfuncti on or imbalance problem that may lead to self imposed restriction of activities and mobility and may result in them being brook 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 advent to the ground or some lower level and other than as a consequences of sustain a violent blow, loss of consciousness, sudden approach of paralysis as in the stroke or an epileptic seizure. vast 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 factorsAlcohol useAssistive devicescognitive/behavioural/Social programmeClinical assessment of risk.(Rai G 2006)Warn older person against self medicationRational prescribing of medicationAssist disoriented person to take medicationUse central nervous system drugs very carefully and cautiously.Counselling of older people with stress related disordersProvide divertional therapyEnvironmental factors must be accessed and correctedEnsure obstacles bring out environmentEnsure adequate light and contrastEnsure No loose mat or slipping surfaceProvide iniquity lightHand railsAdvice on safe drinking numberReview combination of alcohol with other drugsProvide appropriate walk of life aidsMinimise restraint devicesBalance and gait prepare be restored confidenceProvide social contactTeach avoidance of risk taking behaviour to person or care giver.History and destiny of fallsAny loss of consciousnessAny loss of style or involuntary movementAny incontinenceAll official and the over the counter medicationsAny recent acute and/or current chronic medical problemsAny previous problems with gait and balance dressing table painPalpitationHearing problemsEye sight 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 instrumental 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 prev ention strategy in nonmigratoryial settings. Components of successful multi factorial interventions include staff training and guidance, changes in medication, resident education, environmental assessment and modification, supply and repair of aids, ferment, 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 known to absorb energy when a diligent falls, thus reducing the incidence of hip fractures. They are especially just in patients who live in nursing homes and residencial homes, who are very sapless 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=0CEEQ6AE wAwv=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=ms9o2dvfaQkCprintsec=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) share 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 useful to prevent falls in the elderly. Multi disciplinary management includes Medical assessment, nursing, physiotherapy, education, occupational therapy, social w orker, 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. Strength 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 Elderl y.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 intrinsic and extrinsic factors.Most of the falls in the older people can be prevented or reduced in frequency if clinicians early begin to view the falls as symptomatic or an vestigial 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)Every old age person was classified as having an intrinsic or extrinsic fall using the in formation 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 disorder, muscle weakness, orthopaedic problems, loss of consciousness, neurally arbitrate 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 theme 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 disea se control and prevention (CDC) states that older adults can take several steps to protect their independence and reduce their chances of falling. They canExercise regularly. Its important that the exercises focus on increasing wooden leg strength and improving balance. Tai Chi programs are especially good. invite 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.Have their eye 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 includeGetting 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 Adult s An Overview.http//www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.htmlREFLECTION pensive do is a process of review an experience of practice in order to describe analyses and evaluate and so inform 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 personate proposes specific strategies forBuilding awareness of the importance of falls prevention and interventionImproving the assessment of individual, environmental, and societal factors that increase the likelihood of falls.For facilitating the design and carrying into action 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.