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Balance and Falls
in the Elderly
Heidi Piccione, DPT, GCS Jeannie Stephenson, PT, PhD, NCS USF Morsani College of Medicine School of Physical Therapy and Rehabilitation Sciences
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Healthcare Costs
- 3 Trillion for Healthcare in 2015
- Medicare - 20% of all Healthcare costs
- Cancer 36.8 Billion
- Falls 31.3 Billion
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Fall Statistics
- Fall related deaths in those >65 have steadily increased from 2005 to 2011.
- 2012 - 25,000 fatal falls cost 616.5 million
- 3.2 million non-fatal falls cost 30.3 billion
- Women fall more > men
- Avg. cost of fall $9400.
- 85 and older - 1/3 of 30.3 billion
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Who Falls?
- 30% of community dwellers > 65
- 50 %+ of nursing home patients
- 75% of slips/trips/falls unreported
- 25 - 89 % of hospital adverse events
- 10 - 20% of fallers fall repeatedly
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Risk Factors
INTRINSIC
- Increasing age
- Previous fall in past 6 months
- Neurologic/Cardiovascular Dz.
- Osteoporosis/Osteopenia
- Motor or sensory impairment
- Gait and balance impairment
- Incontinence
- Cognitive Deficit/Depression
- Visual Impairment
- Orthostatic Hypotension EXTRINSIC
- Medications: Psychotropics, Benzodiazepines, Diuretics, Cardiovascular
- Fall Risk Increasing Drugs – FRID (Polypharmacy)
- Environmental Factors
- Footwear
- Inappropriate Assistive Device or no assistive device
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Fall Related Injuries
- Hip Fracture – 90% fall related
- Occur in 65 and older population
- Poor Outcomes
- 25% mortality rate within one year
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Intervention for Falls
- Special Report from CDC - Sept 2016
- Stopping Elderly Accidents Death and Injury (STEADI)
- CDC Website – www.cdc.gov
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Prevention Management
- Fall related injury prevention versus fall prevention. - Individualized assessment
- May require multi-disciplinary approach and input
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Fall Risk Assessment
- Gait Speed (10 Meter Walk Test)
- Timed Up and Go
- 30 Second Sit to Stand
- 4 Stage Balance Test
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10 Meter Walk Test
- Walking speed – the 6 th Vital Sign (Fritz and Lusardi, 2008)
- 2.2 mph= 1.0m/sec – community ambulator
- Less than (1.0 mph=0.447 m/sec.) fall risk rises exponentially
- Gait velocity strong predictor of fall risk
- Faster to administer than TUGT
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Test Cut-off Scores for Fall Risk
- Timed up and Go (TUG) - >13.5 sec
- 30 Sec Sit to Stand – 15x
- 4 Stage Balance Test – 10 sec for each position
