Preventing Falls, 3hr/$21

Course  A13    Test 7168      Preventing Falls, 3 CE-hours, $21

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Professor Rudolf Klimes, PhD, welcomes you to this online course. Keep going.

START the course here. TAKE the exam at the end. PAY after the exam.

Fall Prevention, 3 CE hrs

Course Description: This course explores fall prevention, primarily reasons for increased fall incidents and recommendations to to prevent ongoing falls. The scope of fall prevention is vast and many are at risk. Fortunately, this is a crises that can often be avoided by maintaining consistent daily health practices.

Objectives: In this course the following objective will be met. 1) How big is the problem 2) What outcomes are linked to falls in the elderly 3) Who is at risk 4) How can older adults prevent falls 5) How to maintain healthy bones 5) Basic information on bone diseases 6) Basic tips on fall prevention in children 6) Available resources and references

Course Format: Online linked resources and lectures that you can use anytime 24/7. One multi-choice test.

Course Developers and Instructors: R. Klimes, PhD, MPH (John Hopkins U), well known author and scholar in health-related research and health behaviors. Co-author Dr. Heather Hawkins is a scholar in Patient Safety and prevention modalities.

Course Time: About three hours for online study, test taking with course evaluation feedback and certificate printing.

3 CE hours course accredited by the California Board of Registered Nursing

 

What do you know? Preliminary quizzes.

Falls and Older Adults Quizzes

Test your knowledge about Falls and Older Adults by taking one of these quizzes:

Falls Among Older Adults

Each year, millions of adults aged 65 and older fall.1 Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. Fortunately, falls are a public health problem that is largely preventable.

How big is the problem?

  • One out of three older adults (those aged 65 or older) falls each year but less than half talk to their healthcare providers about it.
  • Among older adults, falls are the leading cause of both fatal and nonfatal injuries.
  • In 2012, 2.4 million nonfatal falls among older adults were treated in emergency departments and more than 722,000 of these patients were hospitalized.
  • In 2012, the direct medical costs of falls, adjusted for inflation, were $30 billion.

What outcomes are linked to falls?

Photo: older happy couple
  • Twenty to thirty percent of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, and head traumas.  These injuries can make it hard to get around or live independently, and increase the risk of early death.
  • Falls are the most common cause of traumatic brain injuries (TBI).
  • In 2000, 46% of fatal falls among older adults were due to TBI.
  • Most fractures among older adults are caused by falls. The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.
  • Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness, and in turn increases their actual risk of falling.

Who is at risk?

Caution Fall Risk

Fall-related Deaths

  • The death rates from falls among older men and women have risen sharply over the past decade.
  • In 2011, about 22,900 older adults died from unintentional fall injuries.
  • Men are more likely than women to die from a fall. After taking age into account, the fall death rate in 2011 was 41% higher for men than for women.
  • Older whites are 2.7 times more likely to die from falls as their black counterparts.
  • Rates also differ by ethnicity. Older non-Hispanics have higher fatal fall rates than Hispanics.

Fall Injuries

  • People age 75 and older who fall are four to five times more likely than those age 65 to 74 to be admitted to a long-term care facility for a year or longer.
  • Rates of fall-related fractures among older women are more than twice those for men.
  • Over 95% of hip fractures are caused by falls.15 In 2010, there were 258,000 hip fractures and the rate for women was almost twice the rate for men.
  • White women have significantly higher hip fracture rates than black women.

How can older adults prevent falls?

Photo: adults exercising

Older adults can stay independent and reduce their chances of falling.18,19 They can:

  • Exercise regularly. It is important that the exercises focus on increasing leg strength and improving balance, and that they get more challenging over time. Tai Chi programs are especially good.
  • Ask their doctor or pharmacist to review their medicines—both prescription and over-the counter—to identify medicines that may cause side effects or interactions such as dizziness or drowsiness.
  • Have their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision.  Consider getting a pair with single vision distance lenses for some activities such as walking outside.
  • Make their homes safer by reducing tripping hazards, adding grab bars inside and outside the tub or shower and next to the toilet, adding railings on both sides of stairways, and improving the lighting in their homes.

To lower their hip fracture risk, older adults can:

  • Get adequate calcium and vitamin D—from food and/or from supplements.
  • Do weight bearing exercise.
  • Get screened and, if needed, treated for osteoporosis.

Watch your step

Screening Options/Resources:

One out of three older adults (those aged 65 or older) falls each year, but less than half talk to their healthcare providers about it. Among older adults, falls are the leading cause of both fatal and nonfatal injuries.

Falls don’t ‘just happen’ and people don’t fall just because they get older. Falls are more likely with:

  • Muscle weakness, especially in the legs,
  • Problems with balance and/or gait – how someone walks, or
  • Certain medications.

There are many other reasons as well!  Use this excellent checklist and screening tools created by the Alaskan Department of health to assess your risk. Information about Falls Risk Factor Assessments and Tests

Resource: http://dhss.alaska.gov/dph/chronic/Pages/SafeandHealthyMe/Screening/default.aspx

Safety First

Falls are serious at any age, but especially for older people who are more likely to break a bone when they fall.

If you have a disease called osteoporosis, you are more likely to break a bone if you fall. Osteoporosis is called the “silent disease” because bones become weak with no symptoms. You may not know that you have it until a strain, bump, or fall causes a bone to break.

Falls are especially dangerous for people with osteoporosis. If you break a bone, you might need a long time to recover. Learning how to prevent falls can help you avoid broken bones and the problems they can cause.

Why Do People Fall?

Some of the reasons people fall are:

  • Tripping or slipping due to loss of footing or traction
  • Slow reflexes, which make it hard to keep your balance or move out of the way of a hazard
  • Balance problems
  • Reduced muscle strength
  • Poor vision
  • Illness
  • Taking medicines
  • Drinking alcohol.

Illness and some medicines can make you feel dizzy, confused, or slow. Medicines that may increase the risk of falls are:

  • Blood pressure pills
  • Heart medicines
  • Diuretics (water pills)
  • Muscle relaxants
  • Sleeping pills.

Drinking alcohol can lead to a fall because it can:

  • Slow your reflexes
  • Cause you to feel dizzy or sleepy
  • Alter your balance
  • Cause you to take risks that can lead to falls.

 

No Falling

How Can I Prevent Falling?

At any age, people can make changes to lower their risk of falling. Some tips to help prevent falls outdoors are:

  • Use a cane or walker
  • Wear rubber-soled shoes so you don’t slip
  • Walk on grass when sidewalks are slick
  • Put salt or kitty litter on icy sidewalks.

Some ways to help prevent falls indoors are:

  • Keep rooms free of clutter, especially on floors
  • Use plastic or carpet runners
  • Wear low-heeled shoes
  • Do not walk in socks, stockings, or slippers
  • Be sure rugs have skid-proof backs or are tacked to the floor
  • Be sure stairs are well lit and have rails on both sides
  • Put grab bars on bathroom walls near tub, shower, and toilet
  • Use a nonskid bath mat in the shower or tub
  • Keep a flashlight next to your bed
  • Use a sturdy stepstool with a handrail and wide steps
  • Add more lights in rooms
  • Buy a cordless phone so that you don’t have to rush to the phone when it rings and so that you can call for help if you fall.

You can also do exercises to improve your balance. While holding the back of a chair, sink, or counter:

  • Stand on one leg at a time for a minute and then slowly increase the time. Try to balance with your eyes closed or without holding on.
  • Stand on your toes for a count of 10, and then rock back on your heels for a count of 10.
  • Make a big circle to the left with your hips, and then to the right. Do not move your shoulders or feet. Repeat five times.

Fall trip hazard

How Can I Prevent Broken Bones if I Fall?

Sometimes you cannot prevent a fall. If you do fall, you can try to prevent breaking a bone. Try to fall forwards or backwards (on your buttocks), because if you fall to the side you may break your hip. You can also use your hands or grab things around you to break a fall. Some people wear extra clothes to pad their hips or use special hip pads.

How Can I Keep My Bones Healthy?

Some ways to protect your bones are:

  • Get enough calcium and vitamin D each day.
  • Walk, climb stairs, lift weights, or dance each day.
  • Talk with your doctor about having a bone mineral density (BMD) test.
  • Talk with your doctor about taking medicine to make your bones stronger.

 

Recommended Calcium and Vitamin D Intakes

Life-stage group Calcium mg/day Vitamin D (IU/day)
Infants 0 to 6 months 200 400
Infants 6 to 12 months 260 400
1 to 3 years old 700 600
4 to 8 years old 1,000 600
9 to 13 years old 1,300 600
14 to 18 years old 1,300 600
19 to 30 years old 1,000 600
31 to 50 years old 1,000 600
51- to 70-year-old males 1,000 600
51- to 70-year-old females 1,200 600
>70 years old 1,200 800
14 to 18 years old, pregnant/lactating 1,300 600
19 to 50 years old, pregnant/lactating 1,000 600

Definitions: mg = milligrams; IU = International Units
Source: Food and Nutrition Board, Institute of Medicine, National Academy of Sciences, 2010.

 

For More Information About Osteoporosis and Other Related Conditions:

The NIH Osteoporosis and Related Bone Diseases~National Resource Center acknowledges the assistance of the National Osteoporosis Foundation in the preparation of this publication.

For Your Information

This publication may contain information about medications used to treat the health condition discussed here. When this publication was printed, we included the most up-to-date (accurate) information available. Occasionally, new information on medication is released.

For updates and for any questions about any medications you are taking, please contact the U.S. Food and Drug Administration at:

U.S. Food and Drug Administration

Toll Free: 888–INFO–FDA (888–463–6332)
Website: http://www.fda.gov

NIH Osteoporosis and Related Bone Diseases ~ National Resource Center

2 AMS Circle
Bethesda, MD 20892-3676
Phone: 202-223-0344
Toll Free: 800-624-BONE (2663)
TTY: 202-466-4315
Fax: 202-293-2356
Email: NIHBoneInfo@mail.nih.gov
Website: http://www.bones.nih.gov

The NIH Osteoporosis and Related Bone Diseases ~ National Resource Center provides patients, health professionals, and the public with an important link to resources and information on metabolic bone diseases. The mission of NIH ORBD~NRC is to expand awareness and enhance knowledge and understanding of the prevention, early detection, and treatment of these diseases as well as strategies for coping with them.

The NIH Osteoporosis and Related Bone Diseases ~ National Resource Center is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases with contributions from:

The National Institutes of Health (NIH) is a component of the U.S. Department of Health and Human Services (HHS).

http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/Fracture/prevent_falls_ff.asp

Teddy Bear Falls

Falls: Children

We all want to keep our children safe and secure and help them live to their full potential. Knowing how to prevent leading causes of child injury, like falls, is a step toward this goal.

Falls are the leading cause of non-fatal injuries for all children ages 0 to 19. Every day, approximately 8,000 children are treated in U.S. emergency rooms for fall-related injuries. This adds up to almost 2.8 million children each year.

Thankfully, many falls can be prevented, and parents and caregivers can play a key role in protecting children.

Play safely. Falls on the playground are a common cause of injury. Check to make sure that the surfaces under playground equipment are safe, soft, and well- maintained (such as wood chips or sand, not dirt or grass).

Make your home safer. Use home safety devices, such as guards on windows that are above ground level, stair gates, and guard rails. These devices can help keep a busy, active child from taking a dangerous tumble.

Keep sports safe. Make sure your child wears protective gear during sports and recreation. For example, when in-line skating,  use wrist guards, knee and elbow pads, and a helmet.

Supervision is key. Supervise young children at all times around fall hazards, such as stairs and playground equipment, whether you’re at home or out to play.

Resource: http://www.cdc.gov/safechild/Falls/index.html

Falls: Playground Safety

Each year in the United States, emergency departments treat more than 200,000 children ages 14 and younger for playground-related injuries (Tinsworth 2001).

Occurrence and Consequences

  • About 45% of playground-related injuries are severe–fractures, internal injuries, concussions, dislocations, and amputations (Tinsworth 2001).
  • About 75% of nonfatal injuries related to playground equipment occur on public playgrounds (Tinsworth 2001). Most occur at schools and daycare centers (Phelan 2001).
  • Between 1990 and 2000, 147 children ages 14 and younger died from playground-related injuries. Of them, 82 (56%) died from strangulation and 31 (20%) died from falls to the playground surface. Most of these deaths (70%) occurred on home playgrounds (Tinsworth 2001).

Cost

In 1995, playground-related injuries among children ages 14 and younger cost an estimated $1.2 billion (Office of Technology Assessment 1995).

Groups at Risk

  • While all children who use playgrounds are at risk for injury, girls sustain injuries (55%) slightly more often than boys (45%) (Tinsworth 2001).
  • Children ages 5 to 9 have higher rates of emergency department visits for playground injuries than any other age group. Most of these injuries occur at school (Phelan 2001).

Risk Factors

  • On public playgrounds, more injuries occur on climbers than on any other equipment (Tinsworth 2001).
  • On home playgrounds, swings are responsible for most injuries (Tinsworth 2001).
  • A study in New York City found that playgrounds in low-income areas had more maintenance-related hazards than playgrounds in high-income areas. For example, playgrounds in low-income areas had significantly more trash, rusty play equipment, and damaged fall surfaces (Suecoff 1999).

Reference: http://www.cdc.gov/homeandrecreationalsafety/Playground-Injuries/playgroundinjuries-factsheet.htm

Falling Prevention  Library http://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/

References

  1. Tromp AM, Pluijm SMF, Smit JH, et al. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol 2001;54(8):837–844.
  2. Stevens JA, Ballesteros MF, Mack KA, Rudd RA, DeCaro E, Adler G. Gender differences in seeking care for falls in the aged Medicare Population. American Journal of Preventive Medicine 2012;43:59–62.
  3. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed August 15, 2013.
  4. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006a;12:290–5.
  5. Sterling DA, O’Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. Journal of Trauma–Injury, Infection and Critical Care 2001;50(1):116–9.
  6. Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall–related injuries in older adults. American Journal of Public Health 1992;82(7):1020–3.
  7. Stevens JA. Fatalities and injuries from falls among older adults – United States, 1993–2003 and 2001–2005. MMWR 2006b;55.45:1222–24.
  8. Jager TE, Weiss HB, Coben JH, Pepe PE. Traumatic brain injuries evaluated in U.S. emergency departments, 1992–1994. Academic Emergency Medicine 2000;7(2):134–40.
  9. Scheffer AC, Schuurmans MJ, Van Dijk N, Van Der Hoof T. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age and Ageing 2008;37:19–24.
  10. Bell AJ, Talbot-Stern JK, Hennessy A. Characteristics and outcomes of older patients presenting to the emergency department after a fall: a retrospective analysis. Medical Journal of Australia 2000;173(4):176–7.
  11. Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age and Ageing 1997;26:189–193.
  12. Stevens JA, Dellinger AM. Motor vehicle and fall related deaths among older Americans 1990–98: sex, race, and ethnic disparities. Injury Prevention 2002;8:272–5.
  13. Scott JC. Osteoporosis and hip fractures. Rheumatic Diseases Clinics of North America 1990;16(3):717–40.
  14. Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age and Ageing 1999;28:121–5.
  15. Hayes WC, Myers ER, Morris JN, et al. Impact near the hip dominates fracture risk in elderly nursing home residents who fall. Calcified Tissue International 1993; 52:192–198.
  16. Stevens JA, Sogolow ED. Gender differences for non-fatal unintentional fall related injuries among older adults. Injury Prevention 2005b;11:115–9.
  17. National Hospital Discharge Survey (NHDS), National Center for Health Statistics. Available at:www.cdc.gov/nchs/hdi.htm. Assessed September 14, 2011.
  18. Gillespie, LD, Robertson, MC, Gillespie, WH, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community.  Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD007146. DOI: 10.1002/14651858.CD007146.pub3.
  19. Moyer VA. Prevention of Falls in Community-Dwelling Older Adults: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine 2012;157(3):197–204.

Band fall risk

 

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Recommendations for you: Visit our Preventing Medication Errors Class (http://cecourses.org/preventive-care/preventing-medical-errors-2/), to learn how to distinguish the common types of medical errors and how they can be prevented, improve patient safety through various procedures, learn protocols and policies that impact patients, list the common medication errors that can make a medical setting unsafe for patients, discuss the prevention of medication errors in various settings for different populations, and evaluate the various reporting systems and approaches that deal with medication errors.

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