Determinants of Fall Risk and Injury in Hispanic Elderly Living in El Paso Community

Guillermina Solis, PhD, RN, F/GNPAnd

Vanessa Guerrero, RN

Determinants of Fall Risk and

Injury in Hispanic

Elderly Living in El Paso

Community

Objectives• Describe the prevalence of falls & injuries in elderly

• Explore effects and consequences of falls injuries and its relation to quality of life

• Analyze results of fall risk factors and reported causes of fall injuries

• Identify clinical implications of study and value of multidisciplinary research

Epidemiology of Aging

World59%, 249 million in developing countries (WHO, 2011)

United States 13.3% , 41.4 million in 2011Baby boomers: Started Jan. 2011

• 10,000 new 65 yr. old/ year

Texas10.9%, 2.9 million

El Paso City11.2%, 74,000

U.S. Census Bureau, 2010

Prevalence of Falls

• Fourth leading cause of death in U.S. • 1 of every 3 elderly fall yearly• Increase number of fall increase risk of injury• 20-30% sustain injury• Major cause of ER visits and hospital admissions• Common injuries: fractures & TBI• Fear of falling: limit physical activity, isolation• Influences level of independence

(CDC, 2012)

Significance of Falls and Injuries

• Personal Effect

• Family

• Function

• Quality of Life

• Cost: Direct and Indirect

Causes of FallsIntrinsic: within person• Age• Physical state• Illnesses• Medications

Extrinsic: outside person• Social support• Environment• Assistive devices• Walking aids

Research StudyPurpose: to evaluate the risks for falls in home bound elderly residing in El Paso county utilizing a multidisciplinary approach to evaluate the physical, medical, and environmental components of the participant . Limited studies in Hispanics

Methodology: Descriptive study • Inclusion: • Hispanic • 55 years and older• Self-report fall within the last 3months, • Lives in a non-institutionalized setting• Receiving services from a home health agency• Willingness to participate

IRB approval: UTEP

Process• Recruitment• Coordinating visits• Challenges

• Data collection• Home visits• Informed consent• Compensation

• Roles of various disciplines• Benefits• Challenges• Perception: participant and professional

Demographics (N=30)AgeMean 77.4

Range 58-91

GenderMale: 20% (n=6)

Female: 80% (n=24)

Education

≤6th grade: 30%

12th grade: 20%

Income

Majority below poverty

Family support

Lived alone

Chronic Illness• Arthritis 23 78%• Hypertension 21 70%• Diabetes 18 60%• High Chol. 15 50%• Anxiety 13 43%• Heart disease 12 40%• Depression 8 27%• Renal Disease 4 13%

Medications• Average number• Prescription: 10.8• Non-prescription• Over the counter: 1.2• Alternative: 1.5

•Most used• Anti-hypertensives

• Beer’s Criteria• Sedatives

BMI

BMI (n=30) Range (16-39) Weight Status

Below 18.5 (1) Underweight

18.5 – 24.9 (7) Normal

25.0 – 29.9 (11) Overweight

30.0 and Above (11) Obese

The fall story:Where did they fall?• 53% Indoor• 47% Outdoor: yard and outside activities like stores,

restaurant

What were they doing?• Activities: while doing something such as walking,

picking up objects, slid off furniture• Tripped with objects

When did they fall?• AM: 48%• PM: 37%• Night: 13%

TUG and Reach TestTUG (measure of function/balance)• 11 fell outside cut off = 13 seconds • 5 considered high risk = ≥20 seconds

Reach test (measure of flexibility)• No deficits identified• All able to extend beyond 6” from baseline

Uncorrected Vision• OD (n=29)

≥40 but < 200 = 23

≥200 = 7• OS

≥40 but < 200 = 20

≥200 = 5• OU

≥40 but < 200 = 20

≥200 = 2

Corrected Vision• OD (n=29)

≥40 but < 200 = 16

≥200 = 3• OS

≥40 but < 200 = 14

≥200 = 3• OU

≥40 but < 200 = 11

≥200 = 0

SUMMARY• Over 75 greater prevalence•Women a majority • High number of chronic illness• High prevalence Hypertension and Hypoglycemia

• Most fall occurred during activity• Resulted in fractures• Vision: unilateral impairment• High Obesity rate• TUG test: lower function

Implications for practiceNeed for comprehensive fall risk assessment• Community• Admission• Discharge

Minimize medications

Monitor for adverse effects

Control of chronic illnesses: BMI

Education• Professionals• Patients • Families

Prevention• Physical activity• Environment modification• Awareness of medication adverse effect• Control of chronic illness• Communication among health care provideres

Future ResearchMultidisciplinary intervention studies of various age groups Incorporate EBP programs• Experimental studies to evaluate various groups• Longitudinal prevention studies

Evaluate various psychological and physical components that affect balance• Sensory• Strength• Mobility• Learning styles• Fear of falling

Conclusion

Fall risk is multifactorial and requires careful individual evaluation BUT may be lessened by taking a proactive approach …