Finding Balance: The Latest in Falls Prevention. Objectives. Geriatric Grand Rounds

Transcription

1 Geriatric Grand Rounds Tuesday, November 18, :00 noon Dr. Bill Black Auditorium Glenrose Rehabilitation Hospital In keeping with Glenrose Rehabilitation Hospital policy, speakers participating in this event have been asked to disclose to the audience any involvement with industry or other organizations that may potentially influence the presentation of the educational material. Disclosure will be done both verbally and using a slide or handout. Visit web sites: for handouts, poster, schedule, subscription: for on-demand archive of previous presentations: Finding Balance: The Latest in Falls Prevention November 18, 2008 Lynda McPhee, Education Coordinator, Alberta Centre for Injury Control & Research Rosalie Freund-Heritage, Falls Prevention Coordinator, Alberta Health Services Objectives Disclosure We have no relationship that could be perceived as placing us in a real or apparent conflict of interest in the context of this presentation. 3 To provide an overview of falls in Alberta and best practices in falls prevention To outline current initiatives in the Greater Edmonton area To consider your role as a health care provider To learn more about Finding Balance 4

2 Seniors Falls Facts Falls are the most common cause of injury for seniors 1 in 3 seniors living in the community fall yearly 40-50% of those living in institutions fall yearly Seniors have 9X more falls injuries compared to those at younger ages More Seniors Falls Facts 50% of falls result in a minor injury 5 25% result in a serious injury Falls cause > 90% of hip fractures; 15-20% of those will die 40% of all nursing home admissions are the result of falls For Alberta Senior s (2006) Falls were the leading cause of injury hospital admissions and emergency department visits Every day: 19 fall-related admissions Every hour: more than 2 fall-related emergency department visits Almost 1/3 of fall-related emergency department visits resulted in an admission to hospital

3 2006 Fall-Related Admissions 2006 Fall-Related Admissions 100% 100% 90% 80% 90% 80% 70% 70% 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% Males Females Age Group (years) Other Injuries Age Group (years) ACICR. Injury Database October Falls ACICR. Injury Database October Deaths Hospitalizations Emergency Dept visits Treated in a physician s office Treated at home or never treated Fall Injuries: the Surface Cost of Falls in Alberta Hospitalization costs = $88,000,000 a year By 2033, costs likely to reach $250,000,000 Costs do not include: Emergency Department visits, payments to physicians and physiotherapists, Home Care, medication or costs to the individual and family Schopflocher, D. On Solid Ground Falls Prevention Conference,

4 Human Cost of Falls What is a fall? Loss of confidence Loss of independence even without injury Fear of falling Spiral effect Unintentionally coming to rest on the ground, floor or other level with or without injury Canadian Falls Prevention Curriculum, What causes a fall? Risk Factors Risks Foot care Blood Pressure Depression A complex interplay of conditions and circumstances lead to a fall Balance Vision Home Safety Leg Strength Attention As number of risk factors increase, so does risk of falling and serious injury Medication Nutrition Dizziness Bathroom Footwear Falls are not a part of normal aging

5 Risk Factors Risk Factors Biological Biological Behavioural Behavioural Social/Economic Environmental Canadian Falls Prevention Curriculum, 2007 Age related changes Mobility Poor health Dementia Chronic illness Fear of falling Risk taking Use of medications Lack of exercise Risk Factors Social/Economic Social isolation Low income Literacy Lack of transportation Environmental Home hazards Community hazards Institutional hazards Falls Risk Assessment Tools Two uses: Checklist to guide interventions Predict risk of falling

6 Falls Risk Assessment Tools Community 5 minute walk, 5 step test, Functional Reach, CTSIB Long-term Care Mobility Fall Chart, MDS Supportive Housing BERG Acute Care STRATIFY Falls Risk Assessment Tools Challenges Limited predictive validity Many seniors already high risk; no added value Do not identify who requires intervention False reassurance; something has been done Interventions Multifactorial = addresses many risk factors BEEACH Prevention Model Education Targeted = tailored to identified, individual risk factors Equipment Behaviour Change Environment Multidisciplinary = team approach Activity Health management 23 Clothing and footwear 24 Canadian Falls Prevention Curriculum, 2007

7 BEEACH Model BEEEACH Model Behaviour change is the goal Need to understand Your target audience Readiness for change Barriers to change Equipment Environment Education BEEEACH Model Falls Hazard or? Activity Clothing and Footwear Health Management

8 Your Role Dietician Challenges to implementation Support Staff Recreation/ Fitness Nurse Client And Family PT OT Pharmacist Competing risks and priorities Time Knowledge Access Buy-in Physician Initiatives in Greater Edmonton Regional Falls Collaborative Established January 2007 Members from public and private sectors educational institutions, public Acute care, continuing care, community steering groups Upcoming falls education booklet, getting up from a fall poster 31 Community Initiatives Million Messages Includes display board and fact sheets SAYGO # 1 Group education for healthy seniors Address risk factors, fitness 32

9 Community Initiatives Syncrude Centre for Balance 1:1 PT led balance and mobility training for 6 weeks at Glenrose Geriatrician referral Better Balance/Fall Prevention Program Group and 1:1 activities for strength, gait, balance led by PT/PTA twice weekly for 8 weeks at Misericordia Physician, OT, PT, home care referral 33 Community Initiatives Wellness with Mobility 6-8 week programs at Grey Nuns Offer a continuum between 3 programs Senior s Balance and Conditioning Program Get Up and Go Walking to Wellness 34 Community Initiatives Home Living Programs Strategy for 2009 for home care, CHOICE, day programs EMS Projects Identify at-risk fallers and refer Reduce 911 calls for falls City of Edmonton Strathcona 35 Community Initiatives Steady As You Go Clinic 1:1 assessment and interventions by OT, PT and nurse practitioner Referral by health care professional Alberta Seniors Falls Prevention Network Electronic network for information sharing Access:

10 Acute Care Initiatives Pilots in Grey Nuns and Misericordia Upcoming education on selected units across Edmonton and area Come on! Tell him you re sorry for stepping on him at the top of the stairs Continuing Care Initiatives Continuing Care Steering Group Safer Health Care Now Finding Balance Multiyear campaign Partnership between ACICR, AMA and AHW

11 Advisory Committee Representatives from 9 Health Regions AB Pharmacists Association AB Physiotherapy Association College & Association of RN of Alberta AB Centre for Active Living AB College of Occupational Therapists AB Therapeutic Recreation Association AB Chapter Dieticians of Canada Osteoporosis Centres and AB Chapter Seniors Association of Greater Edmonton Health Link Alberta 41 Finding Balance 5 Key Components Evidence-based consistent messaging Connect seniors to local supports/programs Strategic provincial media plan Stakeholder support and participation Evaluation 42 Finding Balance Finding Balance Website:

12 Conclusion It takes a village of stakeholders working together to prevent falls and fall risk, tasks that no one stakeholder cam accomplish alone. Ganz, Alkema & Wu, Contacts Rosalie Freund-Heritage Regional Falls Prevention Coordinator, AHS rosalie.freund@capitalhealth.ca Lynda McPhee Education Coordinator Alberta Centre for Injury Control & Research lynda.mcphee@ualberta.ca 47 Resources Report on Senior s Falls in Canada. Minister of Public Works and Government Services Canada. Health Canada WHO Global Report on Falls Prevention in Older Age, Falls: NICE Guideline. New Zealand Falls Prevention Prevention of Falls Network Europe (ProFaNE)

13 Resources Stay on Your Feet Falls Prevention Center of Excellence National Council on Aging: falls free coalition Queensland Health: Falls prevention in older people References Elley, C.R., Robertson, M.C., Garrett, S., Kerse, N.M., McKinlay, E., Lawton, B., Moriarty, H., Moyes, S.A., Campbell, A.J. Effectiveness of a falls-and-fracture nurse coordinator to reduce falls: A randomized, controlled trial of at-risk older adults. Journal of the American Geriatrics Society. 2008;56: Fortinsky, R.H., Baker, D., Gottschalk, M., King, M., Trella, P., Tinetti, M.E. Extent of implementation of evidence-based fall prevention practices for older patients in home health care. Journal of the American Geriatrics Society. 2008;56: Ganz, D.A., Alkema, G.E., Wu, S. It takes a village to prevent falls: Reconceptualizing fall prevention and management for older adults. Injury Prevention. 2008;14: Hendriks, M.R.C., Bleijlevens, M.H.C., van Haastregt, J.C.M., Crebolder, H.F.J.M., Diederiks, J.P.M., Evers, S.M.A.A., Mulder, W.J., Kempen, G.I.J.M., van Rossum.E., Ruijgrok, J.M., Stalenhoef, P.A., van Eijk, J.T.M. Lack of effectiveness of a multidisciplinary fall-prevention program in elderly people at risk: A randomized, 50 controlled trial. Journal of the American Geriatrics Society. 2008;56: References References Lord, S., Sherrington, C., Menz, H., Close, J. Falls in Older People. Risk factors and strategies for prevention. (2nd edition) Cambridge University Press. Cambridge: Newitt, M.C., Cummings, S.R., Kidd, S., Black, D. Risk factors for recurrent nonsyncopal falls. A prospective study. Journal of the American Medical Association, 1989;261: Norris, M.A., Walton, R.E., Patterson, C,J,S., Feightner, J.W. Reducing falls in long-term care: A systematic review of the evidence. Canadian Journal of Geriatrics. 2008; 11: Oliver, D. Falls risk-prediction tools for hospital inpatients. Time to put them to bed? Age and Aging. 2008;35: Shorr, R.I., Mion, L.C. Chandler, A.M., Rosenblatt, L.C., Lynch, D., Kessler, L.A. Improving the capture of fall events in hospitals: Combining a service for evaluating inpatient falls with an incident report system. Journal of the American Geriatrics Society. 2008:56; Scott V, Lockhart S, Gallagher E, Smith D, Asselin G, Belton K, Duncan B. (2007). Canadian Falls Prevention Curriculum. Vancouver BC. BC Injury Research and Prevention Unit. Scott, V., Votova, K., Scanlan, A., Close, J. Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, longterm and acute care settings. Age and Ageing. 2007;35: Tinetti, M.E. Multifactorial fall-prevention strategies: Time to retreat or advance. Response to Hendriks et al and Elley et al in JAGS Journal of the American Geriatrics Society. 2008;56:

14 References Tinetti, M.E., Baker, D.I., McAvay, G. et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. New England Journal of Medicine. 1994;331: Tinetti, M.E., Gordon, C., Sogolow, E., Lapin, P., Bradley, E.H. Fall-risk evaluation and management: Challenges in adopting geriatric care practices. The Gerontologist. 2006;46: Tinetti, M.E., Speechley, M., Ginter, S.F. Risk factors for falls among elderly persons living in the community. New England Journal of Medicine, 1988;319: