To Assess the Fall Risk among the Elderly in selected Urban Area Kachery, Thrissur

 

Ann Mariya P.R¹, Delna Mary George¹, Elsamol Francis¹, Thasni R.A¹, Twinkle Joseph¹,

Mrs. Seeja Jacob²*, Dr. Angela Gnanadurai³

¹Fourth Year B.Sc Nursing, Students, Jubilee Mission College of Nursing, Kachery, Thrissur.

²Asst. Professor, Jubilee Mission College of Nursing, Kachery, Thrissur.

³Professor, Jubilee Mission College of Nursing, Kachery, Thrissur.

 

ABSTRACT:

To assess the fall of risk among the elderly in selected urban area of Thrissur. Objectives a) To assess the fall risk among the elderly people in selected urban area of Kachery, Thrissur. b) To associate fall risk score with selected demographic variables. c) To correlate fall risk assessment questionnaire score and modified fall prevention checklist for personal risk factors score among elderly individuals. d) To teach the elderly people about fall prevention exercise. Methodology: Non-experimental descriptive research design is adopted in this study. We selected 60 samples through random sampling technique. Standardized fall risk assessment questionnaire built by national aging research institute and modified fall prevention checklist for personal risk factors built by Hamilton county was used to collect the data. Tool was administered by interview method for assessing fall risk. Fall preventive intervention module developed, validated and administered following data collection. The data collected were analyzed by using descriptive and inferential statistics. Result: The demographic profile of elderly people shows that 46.66% belongs to age group between 60-70 years and most of them 58.33% were females. The majority 73.33% of elderly person are at low risk for fall and 26.66% are at high risk for fall in questionnaire and 81.67% of elderly are low risk for fall, 18.33% are risk and there is no elderly person high risk for fall in checklist. The overall fall risk is high among elderly individual alone in home and low in elderly in nuclear families. The risk for fall among elderly based on previous history of fall shows that elderly with visual impairment those who don’t have previous knowledge about fall prevention and elderly age between 91-100 is high risk for fall. The risk for fall based on ability to perform ADL in elderly shows those who living alone in the home high risk for fall. There is significant association between score with selected variables like age, previous knowledge about fall prevention, elderly residing in their home alone. We found that there is perfect positive correlation r=1 between fall risk assessment, questionnaires and checklist score. Discussion: At the end of the study the investigator found that the risk for fall based on the assessment of fall history among elderly people shows that, there is significant association between age (p=0.0273) that is, age group between 91-100 years are high risk for fall. Previous knowledge about fall prevention shows that, elderly without previous knowledge about fall prevention is at high risk for fall (p= 0.03074). In sensory impairment that is, elderly having visual impairment (p=0.998) having risk for fall. The risk for fall among elderly people based on their ability to perform activities of daily living shows that, elderly residing in their home alone shows more risk for fall.

 

 

 

INTRODUCTION:

The number of persons above the age of 60 years is fast growing, especially in India. India as the second most popular country in the world has 76.6 million people at over the age of 60, constituting above 77% of total population. According to US Centre for disease control and prevention every 11 seconds an older adult is treated in the emergency room for fall, every 19 minute an older adult dies from fall. Falls result in more than 2.8 million injuries treated in the emergency department annually.¹

 

The major area of concern is the health of the elderly in the medical and psychological problems. Falls are one of the major problems in the elderly and are considered one of the ‘GERIATRIC GAINTS’. Recurrent falls are important cause of morbidity and mortality in the elderly and are a marker of poor physical and cognitive status.

 

India as the second most populous country in the world has 76.6 million people at or over the age of 60, constituting above 7.7% of total population. The problems faced by this population are numerous owing to the social and cultural changes that are taking place within the Indian society. Falls are one of the major problems in the elderly. Recurrent falls are an important cause of morbidity and mortality in the elderly and are a marker of poor physical and cognitive status.²

 

Falls are one of the most common problems in elderly around the world. Most falls occur at home (72.8%). Women represented 80.2% of fall injury victims. The most common location for fall injuries in the home is bathroom. Other environment hazards include poor stairway design and disrepair, inadequate lighting, clutter, slippery floors, unsecured mats and the lack of non skid surface in the bathroom. Assessment of prevalence of falls and associated factors can lead to the identification of corrective measures, which can help in preventing falls and their consequent effect on health and well being of elderly.³

 

A study of “Falls in elderly persons: evaluation of risk and prevention” conducted by Pepersack T in France in September 1997.The sample size was 958 and the result of the study was efforts to prevent falls in elderly have involved education, strengthening exercises, medication evaluation, and environmental improvements.⁴

 

Our own personal experience of conducting survey in selected area of Kachery, we found that 17% of total population is elderly, who need special care. So we decided to conduct a study to assess the risk for fall among elderly population and to provide a brochure with measures to prevent fall in selected areas of Thrissur.

 

MATERIAL AND METHODS:

Research approach:

Quantitative approach was used in study. It is used to evaluate risk of fall in elderly people in urban area Kachery, Thrissur.

 

Research design:

Non experimental descriptive research design.

 

Setting:

Study conducted in urban areas of Kachery, Thrissur.

 

Population:

Elderly people above 60 years, in urban areas of Thrissur.

 

Sample and sample size:

Samples are the elderly people above 60 years, who met inclusion criteria.

 

In this study sample size is 60.

 

Sampling technique:

Random sampling technique is used to collect data.

 

Description and Scoring of Data Collection Tools:

Section A: Socio-demographic and clinical data variables of elderly person:

It includes age, sex, educational status, religion, occupations, type of family, physiological impairment, sensory impairment and previous knowledge regarding fall prevention. Coding will be done to determine the sample characteristics and association between socio demographic and clinical data variables.

 

Section B: Standardized fall risk assessment questionnaire by NARI:

This is a standardized tool for assessing Falls Risk for Older People in the Community (FROP) built by National Aging Research Institute. The domains assessing in the tool are Fall history, Functional ADL status, and Balance (testing by tired up and go (TUG) test). The total score of each domain is 3. If the score is in between 0 to 1 it is considered as low risk and if it is 2 to 3 it is considered as high risk. The total scoring of the tool is 9. It is categorized as low risk (0-3) score or low risk of being faller (0.25,0.7) and high risk (4-9) score or high risk of being faller (1.4,4.0,7.7).⁵.

 

Section C: Modified fall prevention checklist for personal risk factors by Hamilton County:

Standardized checklist is used for assessing personal risk factors. It include total of 10 statements. They are previous fall and injury, whether doing exercise, incontinence, hand strength, dizziness in standing position etc.⁶ The score is based on number of responses to yes or no. All are negative questions in the checklist and response to yes is considered as there is a chance for fall. If the number of yes response is 1 to 4 then it is considered as low risk for fall and more than 5 yes response is considered as high risk for fall.

 

Section D: Fall prevention exercise module:

It is developed by the researcher and it is validated. It is then taught to the sample group. Prevention of fall among the elderly can be reduced by fall prevention exercises, mainly it include 3 exercises. Such as range of motion exercise, strengthening exercises, and balance retaining exercise.⁷

 

Data Analysis and Interpretation:

Table:1 Demographic profile of elderly people (>60yrs)      n=60

Variables	Frequency (f)	(%)
Socio demographic variables
Age
a)   60-70yrs	28	46.66
b)   71-80yrs	23	38.33
c)   81-90yrs	7	11.66
d)   91-100yrs	2	3.33
Sex
a) male	25	41.66
b) female	35	58.33
Educational status
a) primary	33	55
b) secondary	18	30
c) higher secondary	2	3.33
d) graduate	0	0
e) uneducated	7	11.66
Variables	Frequency(f)	(%)
Religion
a) Christian	51	85
b) hindu	9	15
c) muslim	0	0
Occupation
a) govt. employee	0	0
b) private employee	7	11.66
c) self employee	5	8.33
d) nill	48	80
Economic status
a) APL	21	35
b) BPL	38	63.33
c) Anthyodhayaannayogana beneficiaris	1	1.66
Type of family
a) nuclear family	44	73.33
b) joint family	15	25
c) living along	1	1.66
Spouse
a) present	27	45
b) absent	33	55
Clinical data variables
Physiological impairement
a) musculoskeletal	29	48.33
b) neurological	8	13.33
c) other physiological impairements	16	26.66
d) nil	7	11.66
Sensory impairements
a) visual	38	63.33
b) hearing	2	3.33
c) speech	0	0
d) other sensory impairements	6	10
e) nil	10	16.66
f) visual and hearing(both)	4	6.66
Previous –knowledge regarding fall prevention
a) no	39	65
Variables	Frequency	(%)
b) yes	21	35
If yes
a) magazine	4	19.04
b) media	11	52.38
c) friends	2	9.5
d) relatives	4	19.04
ADL activities which need assistance
a) bathing	5	8.33
b) dressing	2	3.33
c) eating	1	1.66
d) mobility	7	11.66
e) nil	45	75

 

The socio demographic profile of elderly people shows that 28 of them (46.66%) belongs to age group 60-70 yrs. And 35 of them (58.33%) are females. In economic status38 of the elderly (63.33%) belongs to BPL category. The clinical data shows that 29 (48.33%) of the elderly people are having musculoskeletal impairment and 38 (63.33%) of them are having visual impairment.

 

Table:2Distribution of elderly people based on their fall risk using sstandardized fall risk assessment questionnaire.                   n=60

Risk	Frequency (f)	Percentage (%)
Low risk	44	73.33
High risk	16	26.66
Total	60	100

 

Table 2shows that majority of the percentage (73.33%) of elderly person are at low risk for fall and 26.66% are at high risk for fall.

 

Table 3: Percentage distribution of fall risk based on domain (fall history, ADL status level and balance of elderly person)         n=60

Sl. no	Risk grade	Fall history		Fun-ADL status		Balance
		f	%	f	%	F	%
1.	Low risk	51	85	50	83.33	42	70
2.	High risk	9	15	10	16.66	18	30
Total		60	100	60	100	60	100

 

Table 3 shows that 85% of elderly are at low risk in fall history. 83.33% of elderly are at low risk for fall in functional ADL status and and 70% of elderly are at low risk for fall in balance domain of fall risk assessment questionnaire.

 

Table 4: Distribution of elderly persons based on their fall risk using modified fall prevention checklist for personal riskfactors.                                                                                            n=60

Risk	Frequency (f)	Percentage (%)
Low risk	49	81.66
High risk	11	18.33
Total	60	100

 

Table 4 shows that majority of the percentage (81.67%) of elderly are of low risk for fall and 18.33% are high risk for fall.

 

Table 5: Correlation between the Standardized fall risk assessment questionnaire score and Modified fall prevention checklists for personal risk factors score among elderly people.                                                                                                                                n=60

Sl. No	Variables	Fall risk		Mean	Standard deviation	Coefficient of correlation	P value
		Low risk	High risk
1.	Fall risk questionnaire score	44	16	30	14	1	0.001
2.	Fall prevention checklist score	49	11	30	19

r= 1 (perfect positive correlation)

significant p < 0.05

 

Table 5 shows that the correlation between standardized fall risk assessment questionnaire score and modified fall prevention checklist for personal risk factors, score are significant. Karl Pearson’s correlation coefficient was 1 (p=0.001). So there is a perfect correlation exist between the standardized fall risk assessment questionnaire score and modified fall prevention checklist for personal risk factors, score among elderly people.

 

RESULTS:

The demographic profile of elderly people shows that 46.66% belongs to age group between 60-70 years and most of them 58.33% were females.

 

The majority73.33%of elderly person are at low risk for fall and 26.66% are at high risk for fall in questionnaire and 81.67% of elderly are low risk for fall, 18.33% are high risk for fall in checklist.

 

The overall fall risk is high among elderly individual alone in home and low in elderly in nuclear families.

 

The risk for fall among elderly based on previous history of fall shows that elderly with visual impairment those who don’t have previous knowledge about fall prevention and elderly inbetween age group of 91-100 is high risk for fall.

 

The risk for fall based on ability to perform ADL in elderly shows those who living alone in the home high risk for fall.

 

There is significant association between score with selected variables like age, previous knowledge about fall prevention, elderly residing in their home alone.

 

We found that there is perfect positive correlation r=1 between fall risk assessment, questionnaires and checklist score. Which means elderly people belongs to high risk for fall in Standardized questionnaire also belongs to high risk assessed in Modified fall prevention checklist for personal risk factors.

 

CONCLUSION:

The major conclusion drawn from the study are:

a)     The study findings reveals that there was significant relationship between age (p=0.0273), sensory impairment (p=0.0098), previous knowledge regarding fall prevention (0.03074), and family type of elderly individual (P=0.00306) with risk for fall.

b)    The study shows that there is perfect positive correlation exist between the standardized fall risk assessment questionnaire score and modified fall prevention check list for personal risk factors, score among elderly people. That is the elderly people belongs to high risk for fall in questionnaire also belongs to high risk assessed in checklist.

 

REFERENCE:

1       Moiz JA, Bansal V, Noochu MM, Gaur SN, Hussain ME, Anwer S, Alghadir A. Activities specific balance confidence scale for predicting future falls in Indian older aduls. Clinical Interventions in Ageing. 2017; 12: 645.

2       AlshammaniSA, Alhassan A M, Aldawsari MA, Bazuhair F and Alobaibi FK, Aldakhi AA, Abdultatah FW. Falls among elderly and its relation with their health problems and surrounding environmental factors in Riyadh. Journal of Family and Community Medicine. 2018 January 25 (1): 29

3       Frieson CW, Tan M P, Ory M G, Smith M L. Evidence based practice to reduces falls and fall related injuries among elder adults. Frontiers in Public Health.2018 August; 6; 222

4       Karlsson MK. Magnusson H, von schewelov T, Rosengren BE, prevention of falls in the elderly---a review. Osteoporosis International.2013 mar 1: 24(3): 747-62

5       National Ageing Research Institute. Narci.unimerh.FROP.com Publication.Geriatrics.2009. January 38(1).

6       Hamilton country general health district fall prevention checklist. Personal risk factors. Hamilton Publications for Geriatrics. 2006 April 2, 112 (6): 20.30.

7       World health organization WHO global report on fall prevention in old age. Geneva. WHO Publication 2007, 22(3-4): 78-83

 

 

Received on 15.02.2021         Modified on 08.03.2021

Accepted on 30.03.2021       ©A&V Publications All right reserved