Determinants of Fall Risk and Injury in Hispanic Elderly Living in El Paso Community Guillermina Solis, PhD, RN, F/GNP Vanessa Guerrero, RN Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013

1. Guillermina Solis, PhD, RN, F/GNP
And
Vanessa Guerrero, RN
Determinants of Fall
Risk and Injury in
Hispanic Elderly
Living in El Paso
Community

2. 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

3. Epidemiology of Aging
World
59%, 249 million in developing countries
(WHO, 2011)
United States
13.3% , 41.4 million in 2011
Baby boomers: Started Jan. 2011
• 10,000 new 65 yr. old/ year
Texas
10.9%, 2.9 million
El Paso City
11.2%, 74,000
U.S. Census Bureau, 2010

4. 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)

5. Significance of Falls and Injuries
• Personal Effect
• Family
• Function
• Quality of Life
• Cost: Direct and Indirect

6. Causes of Falls
Intrinsic: within person
• Age
• Physical state
• Illnesses
• Medications
Extrinsic: outside person
• Social support
• Environment
• Assistive devices
• Walking aids

7. Research Study
Purpose: 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

8. Process
• Recruitment
• Coordinating visits
• Challenges
• Data collection
• Home visits
• Informed consent
• Compensation
• Roles of various disciplines
• Benefits
• Challenges
• Perception: participant and professional

9. Demographics (N=30)
Age
Mean 77.4
Range 58-91
Gender
Male: 20% (n=6)
Female: 80% (n=24)
Education
≤6th grade: 30%
12th grade: 20%
Income
Majority below poverty
Family support
Lived alone

10. 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%

11. Medications
• Average number
• Prescription: 10.8
• Non-prescription
• Over the counter: 1.2
• Alternative: 1.5
• Most used
• Anti-hypertensives
• Beer’s Criteria
• Sedatives

12. 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

13. 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%

14. TUG and Reach Test
TUG (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

15. 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

16. 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

17. 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

18. Implications for practice
Need for comprehensive fall risk assessment
• Community
• Admission
• Discharge
Minimize medications
Monitor for adverse effects
Control of chronic illnesses: BMI
Education
• Professionals
• Patients
• Families

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

20. Future Research
Multidisciplinary 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

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