Falls prevention in older adults . High level evidence exists for a range of effective falls prevention strategies. Objective/s. To provide an evidence based update of falls prevention recommendations, applicable to the primary care setting. Discussion. For older adults in the community, exercise programs and vitamin D supplementation in those with deficiency are highly effective in preventing falls. Psychoactive drug withdrawal, home visits, vision optimisation and a multifactorial approach are also effective. In residential aged care, routine vitamin D supplementation is highly effective in preventing falls and fractures. General practitioners are well placed to identify those at risk of falls and implement prevention strategies utilising other healthcare professionals as required. The general practitioner. General practitioners may identify patients who will benefit from fall prevention measures, develop and implement treatment plans with other health professionals and support patient uptake of recommendations. An Enhanced Primary Care plan may facilitate implementing falls prevention strategies. Why older people fall. Many falls are multifactorial in nature and linked to both patient specific and environmental risk factors. Key intrinsic risk factors are age, sensory decline, reduced lower limb strength and comorbidity. Cognitive impairment, even subtle deficits, increases risk. A single identifiable major factor accounts for up to 2. Assessment of falls and risk factors. The strongest predictors of risk are previous falls, with injurious falls and a walking or balance difficulty increasing risk even further. Screening balance tests can help identify those with deficits who will benefit from an exercise program (Table 1). High risk patients may require a more complex multifactorial assessment. Table 1. Screening tests for balance deficits. Test. Method. Scoring. Interpretation. Single leg stance test. Observe patient standing on one leg with their eyes open on a firm surface for 1. Repeat two more times. A score of 2 or 3 indicates significant sensory and strength impairment. Timed Up and Go (TUG) test. Patient to stand from being seated in a chair, walk at a comfortable speed for 3 metres to a line on the floor, turn, return to the chair, and sit down. Time in seconds from beginning to end of test. A time of 1. 5 seconds or longer identifies those with a high risk of falling. The event has an obstacle course challenge for all: Super Sprint 5K obstacle racing, Super Spartan 8+ mile obstacle course and the Spartan Death race - arguably the. Parkes Attractions, Activities. Country Show - Peak Hill Agricultural Show offers. Key components of a multifactorial assessment include: a detailed falls history, medication review, risk factor assessment including osteoporosis, urinary incontinence and cardiovascular diseasephysical examination including gait and balance, neurological and cognitive function, lower limb strength, visual acuity, feet and footwearfunctional assessment such as activities of daily living, perceived functional ability and fear of falling. The history should identify presyncope, syncope and unexplained falls as these presentations have considerable overlap and may require specialist referral (Table 2). History from an observer is invaluable, as older people may have 'amnesia of syncope' or cognitive deficits effecting recall. Carotid sinus syndrome (CSS) is a neurally mediated cause of syncope which may account for a portion of 'unexplained falls' attending emergency departments. Pacemaker insertion in this group can reduce the rate of falls, however trial results have been mixed. Table 2. High risk patients who may benefit from geriatrician or falls clinic review. The mission of LeadingAge is to expand the world of possibilities for aging. Corporate Alliance Program. PEAK Leadership Summit. Peak Hill Central School is a school on the move to excellence from Kindergarten to Year 12. Dumas's Crazy Fast Winning Run from the 2016 Pikes Peak Hill Climb. Target population = community dwelling older adults. Frequency. Recurrent falls (two or more falls in past 1. Clinical features. Unexplained falls with syncope, dizziness or poor recall*Falls as part of downward physical, social or psychological spiral. Falls occurring at low threshold (such as basic activities or daily activities)Falls with head injury, low trauma fracture or on floor > 1 hour. Gait disturbance or unsteadiness present* Consider cardiologist referral if cardiogenic syncope is suspected. Falls prevention strategies in the community. The cornerstone of effective falls prevention is identifying modifiable risk factors and intervening with effective strategies (Table 3). In general, multiple strategies should be used for high risk patients, however for selected patients a single strategy may be equally effective and more acceptable. Osteoporosis diagnosis and management should also be addressed. Table 3. Evidence for fall prevention strategies. Community dwelling older adults. Strategy. Rating. Patients who benefit. Practice points. Exercise. Effective for both high falls risk and general older adult populations. Adaptation may be required if cognitive impairment present. May be home or group program, requires balance component. Needs to be performed for 2 hours/week on an ongoing basis. High dose vitamin DLow vitamin D level (< 6. L)Cholecalciferol > 8. IU/daily prevents fractures and falls. Psychoactive medication withdrawal. Taking benzodiazepine or other psychoactive medication. GP supported stepped withdrawal, average five visits. Occupational therapy home visit. High risk patients especially those with visual impairment or recent hospitalisation. Hazard reduction, training and education. Best as part of a multifactorial strategy. Restricted multifocal spectacle use. Active older people using multifocal lenses (caution . Prevents fractures if worn. However, strategies that help maintain independence and emphasise that falls are not inevitable with age are better received. Discussing the positive aspects of falls prevention such as social and health benefits as well as engaging the family improves adherence. The evidence for effective falls prevention strategies for people with dementia living in the community is not well established. Guidelines recommend that falls prevention interventions should not be withheld, but may need modification and supervision. Multifactorial assessment and targeted interventions. This approach involves a detailed assessment, often by multiple health professionals, followed by development and implementation of a targeted intervention plan to address modifiable risk factors. Common interventions include exercise, a home safety review, optimising management of medical conditions and a medication review. Falls clinics apply this model and the evidence shows that it achieves a reduction in falls, and improved mobility, balance and confidence. Single strategies. Exercise programs. The link between exercise and decreased falls in older people living in the community is well- established. There is also good evidence that disability can be reduced by well- designed exercise in this population. There have been four systematic reviews and a number of more recent trials that have demonstrated that well- designed exercise can reduce falls in older people living in the community. Systematic reviews have also identified that tai chi can reduce falls by 3. New Zealand developed, Otago Exercise Programme, by 3. The Otago Exercise Programme also significantly reduces the risk of death. Characteristics of effective programs from the largest and most recent review are outlined in Table 4. Exercise uptake can be hampered by concerns about increased pain or lack of efficacy, however recommendation from the GP significantly increases uptake. Table 4. Characteristics of effective exercise programs. Moderate or high challenge to balance (eg. Meta- analysis supports this stepped withdrawal method. In recent years, melatonin has been used by clinicians to support sedative withdrawal, which also appears effective. Optimised vision. Visual impairment is an independent risk factor for falls and fractures. Multifocal spectacles increase falls risk by distorting the lower visual field (Figure 1). Adults who undertake regular outdoor activity can reduce their falls risk by using single lens distance glasses instead of multifocals when going outside or to an unfamiliar environment. This advice however, increases falls risk in less active adults. Improving spectacle prescription alone has not resulted in falls prevention. Short waiting time for first eye cataract surgery is an effective falls and fracture prevention strategy. Figure 1. Distortion of lower vision field in a patient wearing multifocal spectacles. Home modification. Home safety modifications in association with transfer training and education are effective in high- risk populations. The benefits are greater when delivered as part of a multifactorial strategy. Falls prevention strategies in residential aged care settings. Falls rates are high in residential aged care facilities (RACFs), with 1 in 2 residents falling within a 6 month period. Residents have increased rates of cognitive impairment, continence problems, comorbidities and polypharmacy, which contribute to the increased falls risk. The evidence for falls prevention is outlined in Table 3. Vitamin D deficiency is very high in Australian RACF residents, with 8. D level < 6. 0 nmol/L. Falls and fractures can be prevented with cholecalciferol supplementation (8. Multifactorial assessment and intervention can be effective when delivered by a multidisciplinary team. Hip protectors reduce hip fractures when worn, however, their effectiveness as an injury prevention strategy is not established, as programs are hampered by poor acceptance and adherence. Key points. Challenging balance exercise for 2 or more hours per week on an ongoing basis reduces falls risk in older adults living in the community. Daily 8. 00. The epidemiology of domestic injurious falls in a community dwelling elderly population: an outgrowing economic burden. Eur J Public Health 2. Falling is not just for older women: support for pre- emptive prevention intervention before 6. Climacteric 2. 00. Geriatric falls: injury severity is high and disproportionate to mechanism. J Trauma Acute Care Surg 2. Falls in the nursing home: are they preventable? J Am Med Dir Assoc 2. S5. 3. Fear- related avoidance of activities, falls and physical frailty.
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