Fall prevention
Fall prevention or fall prophylaxis includes all preventive measures against falls, especially against falls in old age .
Falls and fall injuries are common medical problems for seniors . About a third of all seniors over 65 years of age fall once a year and half of them fall several times a year. Due to osteoporosis and reduced mobility and reflexes , falls often result in hip and other fractures , head injuries, or even mortality . Accidental injuries are the fifth leading cause of death in older adults. 75% of hip fracture patients do not fully recover and their general health is reduced.
The most consistently proven predictive factors for an individual's risk of falling are previous year's fall history and gait and balance abnormalities . Poor visibility, certain medications (especially psychotropic drugs, but also antihypertensive drugs , muscle relaxants and diuretics ) or limited cognitive abilities are also associated with an increased risk of falling.
Measures to prevent falls
Research suggests that multifactorial intervention programs can reduce the number of falls; In a meta-analysis of studies in seniors in general, the fall reduction was 27% and in seniors with a history of falls or other risk factors it was 14%. Although more research is needed, strength and balance training, risk assessment of the home environment, discontinuation of psychotropic medication, and t'ai chi are judged to be promising measures. T'ai chi exercises reduced the risk of falling by 47%, with less evidence of gait parameters than of self-confidence measurements. (To avoid falls, especially in care facilities, see: Expert standard for fall prophylaxis .)
Physiotherapeutic measures
Physiotherapists analyze the patient's gait and balance ability and can identify problems in these areas. An exercise program tailored to the individual client is then created.
Adjustments to the environment
Frequent locations for a fall are stairs or bathtubs . Adjustments to the home environment aim to remove stumbling blocks and help a person carry out their daily activities around the house. Adjustments can include: minimizing clutter, installing grab bars in the shower or bathtub and near the toilet. Stairs can be equipped with handles on both sides, handrails can also be installed in the apartment where possible, the lighting conditions can be improved, color contrasts between the steps are possible. Non-slip carpets or rubber mats can have a supportive effect, cables lying on the floor should be avoided. The removal or padding of pointed corners and sharp edges on furniture, as well as lowering the bed at bedtime, is advantageous in the event of a fall in order to avoid injuries.
Fall Risk Factors
The multifactorial causes of a fall in old age make it difficult to predict the risk easily. Furthermore, falls are a sensitive topic for many people affected and they are reluctant to talk about. For general practitioners, a valid instrument for assessing the risk of falling must, on the one hand, accurately and reliably record people at risk of falling, and, on the other hand, be easy and quick to use. One way for general practitioners to differentiate in their anamnesis those at risk of falls from those not at risk of falls is the following questionnaire:
- Two or more falls in the past 12 months?
- Is the fall the current reason for the doctor's visit?
- Walking difficulties or balance disorders (subj. Assessment of the patient)?
If the answer to at least one question is yes, the fall risk factors must be further clarified. These can be:
- Risk of tripping due to uneven or slippery floors
- Inappropriate, especially long clothes and poorly fitting shoes
- Insufficient lighting
- Unavailable holding and support options
- Sensory nervous system, e.g. B. impaired by neuropathy
- Insufficient attention to disturbances such as medication, drugs or illnesses
- Function of the central nervous system (CNS) disturbed, e.g. B. by dementia , Parkinson's disease or medication
- Paralysis,
- Decreased physical strength or lack of mobility
- Previous falls, fear from falling experiences
- Continence problems
- Advanced age
Other questionnaires, some of which are similar, for assessing the risk of falling are the Hendrich scale , the Morse scale and STRATIFY . A physical test procedure that uses 14 short, practical tests to check the function of the sense of balance is the Berg Balance Scale .
literature
German
- Adriano Pierobon, Manfred Funk: Fall prevention in older people: Risks - Consequences - Measures. Georg Thieme Verlag , Stuttgart 2007, ISBN 978-3-13-143761-7 .
- Clemens Becker, Ulrich Rißmann, Ulrich Lindemann, Andrea Warnke: Fall prophylaxis - risk of falling and fall prevention in homes. Vincentz Network Publishing House , Hannover 2006, ISBN 3-87870-131-4 .
- German Institute for Applied Nursing Research e. V. (Hrsg.): Preventive home visits with seniors - Consultant manual. Schlütersche Verlagsgesellschaft , Cologne 2008, ISBN 978-3-89993-204-1 .
- Clemens Becker, Ellen Freiberger u. a .: Fall prevention training. Deutscher Turner-Bund (Ed.). 3. Edition. Meyer & Meyer Verlag, Aachen 2015, ISBN 978-3-89899-579-5 .
- Ellen Freiberger, Daniel Schöne: Fall prevention in old age: Basics and modules for planning courses , Deutscher Ärzte Verlag, Cologne 2009, ISBN 978-3-7691-0557-5
- Rein Tideiksaar: falls and fall prevention / assessment - prevention - management. 2nd Edition. Huber Verlag, Bern 2008, ISBN 978-3-456-84570-8 .
English
- Stephen R. Lord, Catherine Sherrington, Hylton B. Menz, Jacqueline CT Close: Falls in Older People - Risk Factors and Strategies for Prevention. Cambridge University Press , Cambridge 2007, ISBN 978-0-521-68099-8 .
Web links
- LD Gillespie, MC Robertson, WJ Gillespie, C. Sherrington, S. Gates, LM Clemson, SE Lamb: Interventions for preventing falls in older people living in the community. Cochrane Library , Verlag John Wiley & Sons , Hoboken, New Jersey 2012, doi: 10.1002 / 14651858.CD007146.pub3 (an evaluation of 159 randomized controlled trials with 79,193 participants) (registration required)
- Interventions for preventing falls in older people living in the community. (Short summary of the above reviews with key data), Cochrane Library Database of Systematic Reviews, PDF112KB, engl.
- Measures to prevent falls in the elderly who live at home. Cochrane, September 24, 2013. (Brief description of the above-mentioned review in German)
- Guidebook for Preventing Falls and Harm From Falls in Older People: Australian Community Care - A Short Version of Preventing Falls and Harm From Falls in Older People: Best Practice Guidelines for Australian Community Care. Australian Commission for Safety and Quality in Health Care. Australian Commission on Safety and Quality in Health Care (ACSQHC), 2009, PDF985KB, English
- Best practice study “Fall Prevention” sub-project within the framework of the “Best Practice Health Promotion in Old Age” project , February 2011, University Hospital Basel Akutgeriatrie m. Support d. bfu , PDF 694 KB
- Safety at home - tips against accidents in the second half of life. Austrian Road Safety Board , PDF 1.96 MB
Individual evidence
- ↑ Kyle C. Moylan, Ellen F. Binder: Falls in older adults: risk assessment, management and prevention . In: The American Journal of Medicine . tape 120 , no. 6 , June 2007, ISSN 1555-7162 , p. 493.e1-6 , doi : 10.1016 / j.amjmed.2006.07.022 , PMID 17524747 .
- ↑ Stephen R. Lord, Stuart T. Smith, Jasmine C. Menant: Vision and falls in older people: risk factors and intervention strategies . In: Clinics in Geriatric Medicine . tape 26 , no. 4 , November 2010, ISSN 1879-8853 , p. 569-581 , doi : 10.1016 / j.cger.2010.06.002 , PMID 20934611 .
- ↑ Sirpa Hartikainen, Eija Lönnroos, Kirsti Louhivuori: Medication as a risk factor for falls: critical systematic review . In: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences . tape 62 , no. October 10 , 2007, ISSN 1079-5006 , p. 1172-1181 , PMID 17921433 .
- ↑ Torsten Kratz, Albert Diefenbacher: Psychopharmacotherapy in old age. Avoidance of drug interactions and polypharmacy. In: Deutsches Ärzteblatt. Volume 116, Issue 29 f. (July 22) 2019, pp. 508–517, p. 512 ( substances that increase the risk of falling ).
- ↑ Fuzhong Li, Peter Harmer, K. John Fisher, Edward McAuley, Nigel Chaumeton: Tai Chi and Fall Reductions in Older Adults: A Randomized Controlled Trial . In: The Journal of Gerontology: Series A . tape 60 , no. 2 , February 1, 2005, ISSN 1079-5006 , p. 187–194 , doi : 10.1093 / gerona / 60.2.187 ( oup.com [accessed July 8, 2017]).
- ↑ Fall prevention: A feeling of security in the bathroom - which measures can be taken to reduce the risk of falling. VdK Social Association, October 31, 2016, accessed July 9, 2017.
- ↑ Best practice study “Fall prevention” - sub-project within the framework of the project “Best Practice Health Promotion in Old Age” ( page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. , February 2011, University Hospital Basel Acute Geriatrics m. Support d. bfu , PDF 694 KB, p. 10, accessed July 9, 2017.
- ^ Adriano Pierobon, Manfred Funk: Fall prevention in older people: Risks - Consequences - Measures. (on Google Books). Georg Thieme Verlag , Stuttgart 2007, ISBN 978-3-13-143761-7 , p. 39. Accessed July 9, 2017.
- ^ Annette Kulbe: Basic knowledge of geriatric care: Health and illness in old age . Kohlhammer Verlag, Sturrtgart 2017, ISBN 978-3-17-031760-4 .
- ↑ Dagmar Wiederholt: Nursing Alphabet Von Absaugen am Zystitisprophylaxe , 3rd edition, Urban & Fischer Verlag, Munich 2013, ISBN 978-3-437-27993-5 , page 114
- ↑ Clinical and laboratory measures of postural balance in an elderly population. in Archives of physical medicine and rehabilitation K. O. Berg, B. E. Maki et al. Volume 73, Number 11, November 1992, pp. 1073-1080, ISSN 0003-9993 . PMID 1444775 .