www.company.com
www.fallcam.be
Falls in ho me-dwellin g Falls in ho me-dwellin g
elderly elderly
Mieke Deschodt
Center for Health Services and Nursing Sciences Katholiek Universiteit Leuven
www.fallcam.be
2
Falls incidence
In home-dwelling elderly
28% - 35% of people aged 65 or older fall at least ones a year
32% - 42% of people aged 75 or older
15% - 50% with two or more fall incidents per year
(Masud & Morris, Age Ageing 2001; Tinetti, NEJM 2003; Milisen et al., Tijdschr Gerontol Geriatr 2004)
www.fallcam.be
3
Falls incidence
In institutionalized elderly (e.g. nursing home)
30-70% at least one fall incident a year
15-40% with 2 or more fall incidents
Average number of falls per bed
1,4 in somatic institutions
2,2 in psychogeriatric institutions
(NVKG & CBO richtlijn, 2004)
www.fallcam.be
4
Fall incidents per season
www.fallcam.be
5
Fall incidents per daily period
www.fallcam.be
6
Indoor versus outdoor
www.fallcam.be
7
At home versus not at home
www.fallcam.be
8
Locations indoor
www.fallcam.be
9
Impact on the older person
Physical impact (40% - 60%)
Minor injury: 30% - 50%
Bruises, cuts, tissue damage
Major injury: 10% - 15%
Fracture: 5% - 10%;
Hip fracture: 1% - 2%;
Soft tissue injury and head injury: 5%
(AGS panel on falls prevention et al., JAGS 2001; Masud & Morris, Age Ageing 2001; Milisen et al., Tijdschr Gerontol Geriatr 2004; Tinetti, NEJM 2003)
www.fallcam.be
10
Impact on the older person
Psychological impact:
Fear of falling again: 32% - 63%
Loss of self-confidence, loss of independency, social isolation, depression,… causes an increased risk of falling and a longer hospitalisation
(AGS panel on falls prevention et al., JAGS 2001; Masud & Morris, Age Ageing 2001; Milisen et al., Tijdschr Gerontol Geriatr 2004; Tinetti, NEJM 2003)
www.fallcam.be
11
Impact on the older person
Increased risk of mortalilty
Involuntary injury = 5th cause of death in people aged 70 years or older
Fall accidents = most important cause of involuntary injuries
Most important risk factor in older persons with osteoporosis for having a hip fracture
Hip fracture
20% becomes immobile
only 14% - 21% regains full ADL-independency
25% - 33% mortality risk in the first year
(AGS panel on falls prevention et al., JAGS 2001; Masud & Morris, Age Ageing 2001; NVKG richtlijn & CBO, 2004)
www.fallcam.be
12
Financial consequences
Increases use of sources
Institutionalisation = 3 x more ofter in fallers
Hospital admission as a result of falling increases 6 times from the age of 65
Fall injury = most expensive category of all traumata in elderly
(Englander et al., J Forensic Sciences 1996; Masud & Morris, Age Ageing 2001)
www.fallcam.be
13
Increased age and institutionalisation before the fracture are the most important decisive factors for the additional cost (Haentjens et al. Disabil Rehabil 2005)
(Kneuzing, schaafwonde, …)
€10.528
www.fallcam.be
14
Falls
Fall incident =
result of a combination of
Intrinsic risk factors
Extrinsic risk factors
Multifactorial problem
multidisciplinary solution
www.fallcam.be
15
Effectivity
Multifactorial evaluation followed by multifactorial interventions targeting on identified risk factors
In older persons with increased risk
= most effective
25% to 39% reduction of fall incidents
Little/no proven effect on incidence of severe injuries
the risk profile of the older person has no influence on the effectivity
cave older persons with severe cognitive problems (e.g. dementia)
(Gillespie et al., Cochrane 2003; Tinetti, NEJM 2003; Chang et al., BMJ 2004; Kannus et al., Lancet 2005)
www.fallcam.be
16
Inability to get up after a fall incident
1 year follow-up of 90 women en 20 men (90+) at home and in an institution
60% fell at least 1x/year
82% of falls occured when the person was alone
80% were unable to get up without help
> 95% has a personal alarm system, +/- 80% does not use the alarm system
30% had lain on the floor for an hour or more
Pressure ulcers, dehydration, hypothermia, pneumonia, hospital admission, moving into long term care, death
Older persons need training in strategies to get up from the floor after a fall incident
(Fleming et al. BMJ 2008)
www.fallcam.be
17
Inability to get up after a fall incident
Cognitive impairment is the only characteristic that predicted lying on the floor for a long time
Need for developing an automatic fall detection system that is not depending on the (cognitive) capacities of the older person
(Fleming et al. BMJ 2008)
Building and validating a camera system for fall detection in home-dwelling elderly
www.fallcam.be
18
Camera system
Alarm can be generated independently
No action needed of the person in contrast to the personal alarm system
In cases where the person is not fully conscious after the fall, there will still be an alarm
Because of the alarm a care provider can quickly come to help
Preventing that the faller lies on the floor for a long time
The system can reduce the fear of falling and enables for older people to live longer independently at home.
www.fallcam.be
19
Camera system
Unlike accelerometers, gyroscopes, or alarm buttons, a camera system is fully contactless
elderly people do not have to take along or wear the alarm button and so they can't forget it
The system is not battery-operated
After a fall incident the circumstances can be studied carefully with the camera images, so that preventive steps could be taken to prevent similar falls
