Category Archives: Articles – Elderly Emergency Alarm / Fall Prevention

Common injuries due to elderly falls

Falls are the most common cause of injuries among senior people and the top reason for a hospital admission for trauma. Advanced age substantially increases the likelihood of hospitalization after a fall. Falls account for 88% of all fractures among people aged 60 years or older.

As the brain ages, its dura becomes tightly adherent to the skull, which makes epidural (extradural) haematomas uncommon. A progressive loss of brain volume leads to an increase in the space around the brain that is thought to protect it from contusions, but makes subdural haematomas more likely. Patients over the age of 55 years who are anticoagulated have a higher frequency of isolated head trauma, more severe head injury and a higher mortality. Even mild head injuries, particularly in patients with pre-existing cognitive impairment, may lead to permanent neurological damage. If there is a skull fracture and an associated hemiparesis, a traumatic intracranial haematoma should be assumed and not a stroke. Similarly, confusion lasting more than 12 hours after head injury, even in a patient with no skull fracture, is an indication for a CT scan. Any deterioration demands immediate action and a CT scan should be obtained in all patients who are unconsciousness for more than 5 minutes after head injury. The outcome is extremely poor in elderly patients who have sustained head injuries sufficient to cause immediate coma that persists after correction of hypoxia and hypovolaemia. Neurosurgical intervention is not warranted for most of these patients.

Rib fractures often complicate even mild blunt trauma to the chest in old people. The presence of fractured ribs on the chest X-ray is an important indicator of severity of injury and outcome, as mortality increases with increasing number of rib fractures. Because they are poorly tolerated, these patients must be watched carefully and the need for mechanical ventilation frequently reassessed. Those with more severe blunt chest trauma, such as those with penetrating injuries, are managed in the same way as younger patients.

It must be remembered that old people are intolerant of shock and unnecessary laparotomy. Their assessment therefore demands a sense of urgency and a high degree of clinical acumen. Those who have a history or clinical evidence of previous major abdominal surgery should have a CT or ultrasound scan of the abdomen rather than diagnostic peritoneal lavage.

In old people with multiple injuries, fractures must be stabilised to permit optimal positioning and movement, both for immediate management and later rehabilitation. While isolated fractures of the humeral shaft are managed conservatively, there is no logic to such management in a patient with leg injuries who will need to use a walking frame or crutches for mobilisation. The aim of treatment should be to undertake the least invasive, most definitive procedure with a view to early mobilisation as soon as other problems permit. Prolonged inactivity and disuse may seriously limit the eventual functional outcome.

Hip fracture is an increasingly common problem in Europe. In the UK around 70,000 patients suffer a hip fracture each year increasing at approximately 5% per annum and projected to reach 120,000 cases per year by 2015. Seventy-five percent of patients are over 75 years of age and 80% are female. The average length of stay in hospital is 30 days, with a 30-day mortality of about 10%. Hip fractures account for 20% of all orthopaedic bed occupancy. There are now a number of recommendations for ‘best practice’ for the management of this increasing burden on healthcare. The following are based on the Scottish Intercollegiate Guidelines Network.

Elderly patients have a particularly high mortality rate and are extremely vulnerable to less than optimal management. A system of trauma care must be prepared to cope with this group of patients and their special needs. The trauma team must be aware of the anatomical and physiological changes that accompany ageing and how these factors, together with the effects of co-existing illnesses and medications, make special demands on their skills. Oversights and thoughtlessness in initial management of patients may have serious adverse consequences on recovery and eventual hospital discharge. Elderly patients should be informed of what is happening and, where possible, be encouraged to participate in treatment decisions. Not all old people are demented. This does not mean they should necessarily receive identical treatment to younger people; instead, they must be managed in a way that is appropriate to their needs in the light of the likely outcome.

How to safely help an elderly from a fall?

How to safely help an elderly from a fall?

Here, are some of the methods which can help an elderly from a fall –

• According to a research, it has been found that having a little walk after your lunch can save an elderly from a fall. This is followed by the decrease in blood pressure.

Having a little walk after your diet, often leads to the decrease in the dizziness level.

• Having a small glass of water with your diet, avoid various consequences of hypotension.
• Now – a – days various health apps are available, for your smart phones. This will automatically sense unusual conditions and synchronize it with your computer. Moreover, it will automatically calls for help if it finds something amiss.
•  Various capacitive floor sensors and thermal camera systems which will sense any unusual condition and report to your loved ones. This provides greater privacy and works even when your floor is moved.

This technology can also be used for customer tracking, and home security monitoring purposes.

• Best devices are the ones which can automatically sense the fall. And, which calls company’s automatic dispatcher, who will ensure weather everything is all right or not. If not then they will contact emergency services.

This will be helpful if the user is in panic, unconscious and if he / she forget these things at that time.

Therefore, there are a variety of emergency systems available at the marketplace. So which one would you choose from?

Here we have listed some top safety alert systems available at the marketplace.

• Medical Guardian

Medical Guardian alert system is one of the popular medical alert systems. It enables users to move up to 400 meters, from the console while being protected. You can wear it on belt, pocket, wrist, neck … Its battery life is around 32 hours. You can also wear it outside your home, with your GPS enabled. Moreover, it also offers temperature sensitive properties, which means that it can detect extreme temperatures.

Medical guardian is easy to install and the company offers 24*7 helpline. The staff is 911 certified which means that you can call for an ambulance directly.

• Life fone

Life fone is also known for medical alert purposes. Its range is around 146 meters. The pendant used is waterproof. Its battery life is also 32 hours. This is cellular based and you can use this outside your home.

Life fone offers 24*7 customer support. For using this service you have to sign a contract. However, no fee is charged at the time of cancellation of your contract.

• Bay Alarm Medical

Bay Alarm Medical has a range of 305 meters. The pendant is waterproof with the same 32 hours of battery backup.

One of the best features of this device is that it offers carbon monoxide and smoke monitoring.

But on the negative side it does not support GPS which means that you cannot use it outside your home. Its console has a Help button which is easy to press it difficult situations.

“Prepare and prevent, don’t  repair and repent.”

If you find your relatives, family members, friends, or colleagues having falls. Then, contact your doctor as soon as possible, before it becomes severe.How to safely help an elderly from a fall?

Elderly Care: How can we avoid falls?

According to a report from US Centers for disease control and prevention, it has been noted that one – third of the people, in the age group of 65 and above, fall more than once each year.

Falls can lead to following problems:

• Bruising and Sprains
• Abrasions and head injuries
• Shoulder and hip dislocation
• Wrist and hip fractures
• Falling fear which results into restriction of activities and loss of confidence.

It has been noted that, older people have a falling rate of 12 times more as compared to that of pedestrian and motor vehicle accident.

Can we prevent falls?

Yes, falls can be prevented. Falls are evitable. Most of the risk factors can be changed easily. If a person has an injury or has a fall, then it is necessary to consult a doctor for that in order to prevent anything severe.

“Prevention is better than cure.”

How can we avoid falls?

In order to avoid falls, following things must be implemented:

Exercise: To avoid falls, you must keep yourself fit and fine. To become fit and fine, exercise is must. You can join various kinds of exercise programs nearby your house. You can also watch and learn various kinds of yoga, and exercises online, and implement those things in your daily routine.

Wear Shoes: You must wear fit and comfortable shoes. It should be slip resistant.

How can we improve safety inside our house?

• Make sure that the corridors are clear and well lit.
• Remove clutter if any.
• Have a proper lighting in your home. Make sure that all the places of your home have a proper lighting. You can use CFL, plug – in night lights, movement sensitive lights.
• Make sure that the furniture of your home is not having sharp edges / corners.
• Make sure that all the doors of your house can be opened and closed comfortably.
• Wipe up spills.
• Make sure that your house should have proper safety measures. Like having alarm system, fire extinguisher or fire blanket.
• You must have proper medical kit (safety kit) in your home.
• Make sure that the beds and chairs of your home are sturdy.

How to improve safety outside our home?

• Kill lichen, fungi, and mosses that make the path slippery.
• Try to keep the path well slept.
• Wear hat and sunglasses in order to avoid sun glare.
• Repair cracked, broken, and uneven paths.
• Make sure that the outside steps are well lit.
• Clear off the garden tools.

Stay Healthy

• Have eye check up within a month or two.
• In case of foot related problems, meet your podiatrist within regular intervals.
• Consult a doctor or other health professionals about your diet and other related issues.
• “Healthy diet is a key to healthy mind.”

Things to remember in case you fall:

• Do not panic. Stay calm.
• Call for help!
• Dial 911 (emergency services) for help if needed.
• Try to call your neighbors or your doctor.

If you can get up and handle the situation on your own:

• Get into a crawling position.
• Crawl to a safe place.
• Try to get up on your feet. In case you can’t handle the situation:
• Try to move to the safe place.
• Make loud noise so that the people nearby you can hear it, and you can ask them for help.
• If nobody hears you then try to relax yourself, and try to get up again later.

Elderly Falls – Risk Factors & Prevention Tips

Falls can happen anywhere, anytime, to anyone. However, in the older age group number of falls or we can say the severity of the injury increases.

Some of the common injuries caused due to the falls are shoulder dislocation, head injuries, spine, forearm, pelvic and hip fractures.

Falls are one of the major causes which rob elderly independence.

However, it is possible to prevent falls in order to live a happy and comfortable life.

Facts about elderly falls:

• According to CDC (Centers for Disease Control and Prevention), it has been noted that each year one out of three adults in the age group of 65 and above, suffers due to falls.
•  According to a report from NHDS (National Hospital Discharge Survey), more than 90 percent of hip fractures occur due to falls. Moreover, one out of three occurs in women.
• Approx. 40% of hip fracture patients requires nursing at home, 50% of them requires a walker. 25% of the people make a full recovery while 20% people suffering from hip fracture die within a year or two.
• In 2000, it has been noted that falls among the older age group cost more than $19 billion to US health care system according to the CDC.

Causes:

There are certain things which can put you at the higher risk due to falls:

Medical Risk Factors –

• Hearing or vision loss.
• Cancer which affects the bones.
• Bladder and Urinary dysfunction.
• Depression, Senility, Alzheimer’s disease.
• Blood pressure fluctuation
• Irregular heart beat
• Hip, Arthritis imbalance and weakness.
• Side effects of the medication

Personal Risk Factors:

• Diet – An improper diet can lead decrease in the energy and strength.
• Activity – Lack of exercise can lead to decrease in muscle and bone strength. It often leads to imbalance between various body parts.
• Habits – Excessive smoking and alcohol intake can lead to decreasing bone strength. Alcohol intake can lead to unsteadiness and slow response time.
• Age – It has been noted that the risk of falls increases with the age. It affects our strength, eyesight, ability to respond quickly in an environment etc.

Home Risk Factors:

• Home risk factors include slippery wet surfaces, improper lighting, cluttered pathways, inadequate footwear etc.
• Most of the fractures are usually the result of falls in home. It includes fall while walking to bathroom, kitchen, stairs etc.

Prevention of falls:

Staying physically active and maintaining your health can reduce the risk of falling.

Exercise –

• Talk to your physician / doctor for your health.
• Try to participate in the programs that can boost up your confidence and strength like jogging, dancing, weight training, hiking, etc.
• You can also go for gardening and bicycling to improve your health.

Footwear –

• Tie shoelaces.
• Wear properly fit shoes of your size.
• Avoid heals, which increases your risk of falling off.

Maintain your health –

• Have a diet which has the adequate calcium and vitamin D.
• Avoid Alcohol and other Beverages.
• Leave smoking
• Get timely eye and health check – ups.
• Take medications as specified by your doctor.
• Consult your doctor in case you have any queries.

Home Modification:

Bedroom –

• Always keep your mobile phone / telephone nearby you.
• Sleep on your bed which is comfortable and easy to get in and out.
• Install nightlights in your room.

Kitchen –

• Store food, liquid and other necessary items within your reach.
• Avoid standing on chair which can hurt you.
• Keep knife and other sharp equipments at a proper place.

Living Areas –

• Have adequate lighting at your home.
• Clean up the furniture.
• Stay away from the wires / telephone cords, where you can skip easily.
•   Clean – up the spills immediately.
• Have a comfortable chair, bed, or a sofa.

So, here are some of the tips, which you must implement in your daily life in order to avoid any severe effect due to falls.

“It’s your life, live it safely.”

Hospital Services in Singapore

In 2012, there were a total of about 10,756 hospital beds in the 25 hospitals and specialty centres in Singapore, giving a ratio of 2.0 beds per 1,000 total population. About 85% of the beds are in the 15 public hospitals and specialty centres with bed complements between 185 to 2,010 beds. On the other hand, the 10 private hospitals tend to be smaller, with capacity ranging from 20 to 345 beds. The Government’s role as the dominant health care provider allows the Government to influence the supply of hospital beds, the introduction of high-tech/high-cost medicine, and the rate of cost increases in the public sector which sets the bench mark in terms of pricing for the private sector.

The 8 public hospitals comprise 6 acute general hospitals (SGH, NUH, CGH, TTSH, KTPH & AH), a women’s and children’s hospital (KKH) and a psychiatry hospital (IMH). The general hospitals provide multi-disciplinary acute inpatient and specialist outpatient services and a 24-hour emergency department. In addition, there are 6 national specialty centres for cancer, cardiac, eye, skin, neuroscience, dental care and a medical centre for multiple disciplines.

Within the public hospitals, patients have a choice of the different types of ward accommodation on their admission. 81% of the public hospitals’ beds (class B2 and C) are heavily subsidised with the remaining 19% with lower subsidy at 20% for class B1 and no subsidy for A class wards. In 2012, the average length of stay in the public acute care hospitals is about 5.8 days while the average occupancy rate is around 85%.

The Government has restructured all its acute hospitals and specialty centres to be run as private companies wholly-owned by the government. This is to enable the public hospitals to have the management autonomy and flexibility to respond more promptly to the needs of the patients. In the process, commercial accounting systems have been introduced, providing a more accurate picture of the operating costs and instilling greater financial discipline and accountability. The public hospitals are different from the other private hospitals in that they receive an annual government subvention or subsidy for the provision of subsidised medical services to the patients. They are to be managed like not-for-profit organisations. The public hospitals are subject to broad policy guidance by the Government through the Ministry of Health.

The Government has also introduced community hospitals for intermediate healthcare for the convalescent sick and aged who do not require the care of the general hospitals.

What is Alzheimer’s Disease : Dementia

Alzheimer’s disease is characterized by a gradual loss of memory, decline in the ability to perform routine tasks, disorientation, difficulty in learning, loss of language skills, impaired judgment and ability to plan, and personality changes. Over time, these changes become so severe that they interfere with an individual’s daily functioning, resulting eventually in death. Although not a normal part of aging, 1 in 7 persons over 65 and nearly half of those over 85 may have Alzheimer’s disease.
There is no cure for AD. However, there are effective strategies to help maintain cognitive function, reduce behavioral symptoms, prevent acute care crises and excess disability, and delay functional decline as well as nursing home placement.

National Information and Resources

There are great resources available on the Internet for individuals with Alzheimer’s disease and those who care for them. Here are a few key links you may find useful.

Wikipedia: http://en.wikipedia.org/wiki/Alzheimer’s_disease

Alzheimer’s Disease Association, Singapore | Dementia: ADA (Singapore) offers personalised daycare for persons with dementia, as well as support for their caregivers. Call our helpline at 6377 0700 now.

Statistics | Alzheimer’s Disease Association (Singapore): Particularly, the prevalence of dementia in Singapore, those aged 65 years and above in year 2005 was 22,000. By 2020 it is projected the figure will increase to …

MOH Singapore – Hand, Foot & Mouth Disease

Source: http://www.youtube.com/watch?feature=player_embedded&v=HiYt9Izv-24

The Ministry would like to stress the importance of maintaining high standards of personal and environmental hygiene to minimise the risk of HFMD. Parents should ensure that their children adopt the following good practices:

• Wash hands with soap before eating and after going to the toilet;
• Cover mouth and nose with a tissue when coughing or sneezing, and throw the tissue away into a bin immediately;
• Do not share eating utensils.

Parents should also ensure that toys or appliances that are contaminated by nasal or oral secretions should be cleaned before they are used again.

Parents should consult a doctor early if their child has fever, mouth ulcers and rashes on the palms, soles or buttocks. Children with HFMD should remain at home until all the blisters have dried up. During this period, contact with other children should be avoided until the child recovers. The child should not be brought to any public or crowded places. Proper hygiene should also be practised at home so as to prevent transmission to other family members.

What is Hand, Foot & Mouth Disease?

Hand, foot and mouth disease (HFMD) is a human syndrome caused by intestinal viruses of the picornaviridae family. The most common strains causing HFMD are coxsackie A virus A16 and enterovirus 71 (EV-71), but may be caused by various strains of coxsackievirus or enterovirus.

HFMD is a common and highly contagious viral infection that typically causes a mild, self-limited febrile illness followed by a maculopapular rash that may involve the skin of the hands, feet, and oral cavity. HFMD is fairly common and typically affects infants and children, but may affect immunocompetent adults on occasion. The viruses that cause HFMD are spread through direct contact with the mucus, saliva, or feces of an infected person. HFMD typically occurs in small epidemics in nursery schools or kindergartens, usually during the summer and autumn months. The usual incubation period is 3–6 days.

HFMD should not be confused with foot-and-mouth disease (also known as hoof-and-mouth disease), a distinct viral disease known to affect sheep, cattle, and swine (both diseases are caused by members of the picornaviridae family) but is not transmitted between animals and humans.

Signs and symptoms
Early prodromal symptoms are likely to be fever often followed by a sore throat. Loss of appetite and general malaise may also occur. Between one and two days after the onset of fever, painful sores (lesions) may appear in the mouth, throat, or both. A rash (vesicle) may become evident on the hands, feet, mouth, tongue, inside of the cheeks, and occasionally the buttocks (but generally, the rash on the buttocks will be caused by the diarrhea). HFMD usually resolves on its own after 7-10 days.

Symptoms of HFMD may include

• Fever
• Fatigue
• Malaise
• Sore throat
• Painful perioral, intraoral, nasal, or facial lesions, ulcers or blisters
• Maculopapular rash, followed by vesicular sores with blisters on palms of hand, soles of feet, buttocks, and sometimes on the lips. The rash is rarely itchy for children, but can be extremely itchy for adults
• Sores or blisters may be present on the buttocks of small children and infants
• Irritability in infants and toddlers
• Loss of appetite
• Diarrhea
• Diagnosis

A diagnosis usually can be made by the presenting signs and symptoms alone. If the diagnosis is unclear, a throat swab or stool specimen may be taken to identify the virus by culture.The common incubation period (the time between infection and onset of symptoms) ranges from three to six days.

How HFMD Spreads
HFMD is spread from person to person by direct contact with the nasal discharge, saliva, faeces, and fluids from the rash of an infected person.

A person infected with HFMD is most contagious during the duration of the illness. Although the virus may continue to persist in the stool for several weeks after infection, the person generally becomes much less contagious when the illness resolves. Nonetheless, good personal and environmental hygiene must continue to be maintained.

Treatment
There is no specific treatment besides relief of symptoms. Treatment with antibiotics is not effective and is not indicated.
There is no HFMD vaccine currently available.

For more information on HFMD, please see the FAQs on MOH website at http://www.pqms.moh.gov.sg/apps/fcd_faqmain.aspx, or the Infection Control Guidelines for Schools and Childcare Centres.

MOH also publishes a weekly bulletin on the local infectious disease situation here.

Measles Virus

Causative agent: measles virus.

Signs and symptoms

The onset of measles is marked by fever followed by the “three C’s” – coryza, conjunctivitis and cough. These signs will peak at about 3 to 4 days around the time the rash appears. The rash starts on the face and progresses to the feet over 3 days changing from a discrete to a confluent rash. Once the rash appears, the fever and respiratory signs tend to improve. The rash fades over the next few days to leave a brown stain with generalised peeling of the skin. The course of measles generally resolves over a 10-day period. Incubation period is 10-12 days.

Mode of spread

Measles is spread by contact with secretions of infected persons by large-particle droplets requiring close contact or small-particle aerosols which allow distant mode of spread. Direct contact may also occur via contact with contaminated surface or objects. Measles is considered contagious from onset of symptoms through the first day of rash.

Diagnosis is often made clinically. Confirmation may be made by rapid antigen tests or measles IgM antibody.

Treatment

Measles is a self-limiting disease and treatment is mainly supportive. Antibiotics should be given only for proven bacterial complications such as otitis media.

Complications can include pneumonia and encephalitis (brain infection).