Articles Posted in Falls

As our population ages, there has been an increase in the number of elderly patients that undergo neurosurgical interventions. This increase is accompanied by aging risk factors, such as frailty, that increase the risk of complications post-surgery. A recent study undertook the task of surveying how recent falls affected patients who underwent a neurosurgical operation, focusing on a patient’s outcome relative to their fall history in the six months prior to their surgery.

The study’s overall findings were that patients with at least one fall six months prior to a neurosurgical procedure, had an increased risk of complications following their discharge. It specifically focused on the number of those discharged to a facility post-surgery, re-admittance rate, and the rate of complications. 18 % of those studied were discharged to a long term care facility after the operation, 17% were readmitted within thirty days, and 28% also had a complication arise within thirty days of their discharge date.

The results of this study give reasons to include fall history in preoperative risk assessments prior to any neurosurgery. While the frailty of an elderly patient is already considered in these assessments, it is important to include patients fall history since there reason to believe that these falls affect patients’ recovery. Neurosurgical procedures  As shown in the study there is a higher risk of complications that arise when a patient has suffered a fall.

It is well known that the older adult population around the world is rapidly increasing. This fact implies that health care systems must make readjustments to better meet the needs of elderly people, no matter their socioeconomic background.  Multimorbidity and needing social support increase as one grows older.  Health issues and disabilities due to age create burden for the older adult, his or her loved ones, and public health care systems.  A strong association exists between the number of older adults in the population and health care costs in developed countries. Health care costs for the elderly population have grown at a faster rate than those for younger adults, primarily because of inadequate systems that are unable to meet the varied and complex needs of vulnerable, frail, and impaired older adults.  Such situations clearly pose a threat to the sustainability of social and health care frameworks.  Due to these reasons, in the past few years, the calls for the implementation of preventative measures against age-related and debilitating conditions in older adults have increased.

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It is well known that the older adult population residing in long-term care settings are highly heterogeneous, characterized by high rates of dependency in the performance of activities of daily living, multiple diseases, and polypharmacy.  Although it may be challenging, nursing home and assisted living facility staff must provide the best possible care to their residents, striving to meet their needs and staying vigilant for any risk factors that may cause residents to experience adverse outcomes.  According to a recent report from the United Nations, the number of older adults ages 60 and above is predicted to increase by more than double by 2050, with elderly people ages 80 and above constituting the age group with the greatest increase in growth.  The number of older adults residing in long-term care facilities is also predicted to increase, resulting in a critical increase in health care expenses.

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Research indicates that most falls experienced by older adults happen during the daytime and are often caused by slippery floors and irregular surfaces.  An estimated 20% of falls occur during the night and are most commonly experienced by the elderly, with about 30% experiencing a fall incidence once every year.  It is well known that when an older adult experiences a fall, their likelihood of getting injured, having a hip-fracture, and even dying are higher than those of younger adults.

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Hip fractures are highly prevalent among the elderly population in the United States. An estimated 1.6 million older adults (those over 50 years of age) experience a hip fracture every year.  This type of injury causes severe debilitation and significantly hinders an individual’s ability to carry out activities of daily living (i.e. bathing, dressing). According to an article published in the Journal of the American Medical Directors Association, hip fractures occur at least twice as often in elderly women than in elderly men, which have traditionally been attributed to women having lower bone density. However, new studies show that difference in bone density, and therefore osteoporosis, is not enough to explain the higher incidence of fractures in women than their male counterparts.  Researchers sought to investigate other underlying factors that contribute to fracture, such as vulnerability of falling, especially due to the fact that 90% of hip fractures result from falls.

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As the older adult population in the United States continues to grow, falls continue to be a major concern in the healthcare industry. Frail elderly patients in nursing homes and assisted living facilities are especially vulnerable to fall events, which can greatly increase the risk of morbidity and mortality. Decline in functional status, the amount and kinds of medications, health conditions, impairments in vision and hearing, cognitive status, the reliance on adaptive equipment (such as canes, walkers, and wheelchairs), and restraints are all significant risk factors for falls in the care facility. Patients who are newly admitted into a nursing home are especially vulnerable to falls—an unfamiliar environment coupled with unfamiliar staff makes fall risk identification and management more difficult in this patient population. Moreover, these newly admitted patients have often suffered from a recent acute care event, thus increasing their risk of falls due to debilitated functional ability.

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Osteoporosis is a bone disease that is highly prevalent within the older adult population.  Often referred to as a silent disease due to its lack of clear outward symptoms, osteroporosis weakens bone structure and durability, increasing the risk of fractures.  The areas of the hip, spine, and wrists are the most vulnerable to bone fracture.  Some risk factors for osteoporosis are modifiable, such as poor diet and smoking, but others are non-modifiable, such as age.  The risk of the disease increases as one grows older, starting in the late-30s.

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Falling is a serious issue in nursing homes and leads to deleterious consequences. Every year, 4% of falls result in fractures and 11% result in soft tissue damage. Patients who fall experience functional loss, self-imposed functional limitations due to fear of falling, and restraint from activity imposed by care givers.

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Many older adults are at high risk of falls that can cause serious injury and debilitation.  Impaired lower extremity function increases the likelihood for falls, hip fractures, sarcopenia, and loss of independence.  Given that the elderly population has been experiencing major growth worldwide, interventions to prevent functional decline and the impending undesirable and costly consequences are in critical need.

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The older population is highly heterogeneous. Although the general development of diseases and disabilities is similar as they age, the trajectory and rate of change in health and functional ability is widely varied in each individual and those with the same chronological age can have extremely different biological ages. Thus, it is difficult to measure the heterogeneity of the aging process in older people.

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