Upper Extremity Fractures and Secondary Fall Prevention: Opportunities to Improve Management and Outcomes Across Disciplines.
|
|
- Alexandrina Simmons
- 6 years ago
- Views:
Transcription
1 Upper Extremity Fractures and Secondary Fall Prevention: Opportunities to Improve Management and Outcomes Across Disciplines Chris,ne McDonough, PhD, PT, CEEAA Health Outcomes Unit Department of Health Law Policy & Management Boston University School of Public Health Acknowledgements The Dartmouth Ins,tute for Health Policy & Clinical Prac,ce Na,onal Ins,tute of Arthri,s and Musculoskeletal and Skin Diseases at the Na,onal Ins,tutes of Health (P60-AR062799; Tosteson A, PI) APTA and the Academy of Geriatric Physical Therapy Boston University, TREAT, NEPDC 1
2 Objec,ves Present current evidence related to UE Fx through the lens of secondary preven,on Selected studies from TDI MCRC Research Fracture Care Project Study 1: Epidemiology of Second Fracture Study 2: Prescrip,on Drug Use Before and A[er Fx Study 3: Evalua,on and Treatment of Balance & Gait a[er UE Fx Study 4: Opioid Use a[er Fx Recommenda,ons based on American Physical Therapy Associa,on Fall Risk Management Guideline Systema,c Review of Measures Sample & Data Sources Fee-for-service Medicare beneficiaries age years old who sustained a hip, shoulder, or wrist fragility fracture Enrolled in Medicare Without managed care enrollment for one year before and one year a[er the index fracture or un,l death Iden,fied fracture types using claims 2
3 Study 1: Fracture Epidemiology Individuals in cohort were followed for one year or un,l occurrence of another fracture or death Cohort Descrip,on 3
4 Results Hip fracture pa,ents: older, had higher comorbidity. Older more likely to die by 1 yr a[er index Fx Hip: 27% Shoulder: 13% Wrist: 7% Women more likely than men to sustain any Fx Gender imbalance > for UE than hip Fx Wrist: 14 % male Shoulder: 19 % male Hip: 26 % male Second Fracture Results Fig. 2 Distribu,on of second fracture type among beneficiaries who sustained a second fracture within 1 year of index hip, shoulder, or wrist fracture 4
5 Second Fracture Results & Conclusions Overall 11,885 people (4.3%) had second within one year Age and comorbidity have strong effects on risk of second fracture Ligle difference in risk by index fracture type or gender (hip: 7.3k; shoulder: 5.8k; wrist: 5.5k per 100k) Results reveal that fracture preven,on is as important a[er humerus and wrist facture as for hip and for men as much as women Study 2: Prescrip,on Drug Use 5
6 Ra,onale: Prescrip,on Drug Use Is Modifiable Risk Factor Fragility Fracture Increased Bone Density Decreased Second Fracture Bisphosphonates Fragility Fracture Deceased Bone Density Increased Second Fracture Proton Pump Inhibitors Fragility Fracture Opiates, SSRIs, seda,ves Increase Fall Risk Increased Second Fracture 6
7 Study 2: Prescrip,on Drug Use Background: Prescrip,on drugs are modifiable risk factor for second fracture Bisphosphonate use a[er fracture low Small study showing high rate of use of drugs associated with fall risk Aim: To characterize prescrip,on drug use and associated fracture risk before and a[er fragility fracture Study 2 Results & Conclusions There was very ligle reduc,on in exposure to prescrip,on drugs associated with fracture risk a[er fragility fracture some pa,ents discon,nued drugs associated with fracture an equal number started new risk-related drugs ~ 25% used bone-building drugs Post-fracture care is an opportunity to medica,on-related risk of second fracture risk 7
8 Study 3 Study 3 Methods Subjects: Fee-for-service beneficiaries age 66 to 99 treated as outpa,ents for proximal humerus or distal radius/ulna ("wrist") fragility fractures Outcomes % evaluated or treated for fall risk up to 6 months a[er proximal humerus or wrist fracture from Predictors of receiving evalua,on or treatment (logis,c regression) 8
9 Percent Receiving Assessment or Treatment for Extremity Fracture Study Results Proximal Humerus Wrist Percent Evalua,on Treatment Evalua,on or Treatment Percent of Medicare Beneficiaries who Received Evalua,on or Treatment up to 6 Months a[er Index Proximal Humerus or Wrist Fracture (n=309,947). Study 3 Results 10.7% received evalua,on or treatment for fall risk or gait issues Using the broader defini,on the percentage increased to 18.5% Higher likelihood of services a[er fracture were: evalua,on or treatment for falls or gait prior to fracture, more comorbidi,es, prior nursing home stay, older age, humerus fracture (versus wrist), female sex and white race 9
10 Study 3 Conclusions/Next Steps This low rate of assessment and treatment a[er an upper extremity fracture is the most important finding of this study, marking a large missed opportunity to reduce future falls and associated func,onal loss Next step Rerun the analysis from to address more recent incen,ves and policies (AGS/BGS CPG, APTA CGS, PQRS, Medicare annual wellness visit, etc.) Opportuni,es to Improve Management and Outcomes Across Disciplines Fragility fractures should be sen,nel events triggering Assessment of medica,on-based risk & reduc,on Evalua,on & treatment of balance and mobility deficits Consider humerus, wrist, and hip fracture as equally predic,ve of second fracture Take appropriate ac,on as soon as possible a[er fracture 10
11 Methods: Iden,fica,on of Clinical Prac,ce Guidelines (CPGs) Systema,cally search (11 databases) Search terms: falls, geriatric, older adult Inclusion Published between 2000 and 2013 English and Adults over the age of 65 living in the community or in assisted-living seongs Exclusion Specific to a neurological condi,on (e.g., stroke, Parkinson disease, mul,ple sclerosis) Fracture management Clinical prac,ce statements excluded 11
12 Methods 4028 CPGs iden,fied 5 met inclusion criteria Cri,cally appraised by >=3 reviewers: AGREE II AGS/BGS (American & Bri,sh Geriatrics Socie,es) NICE (Na,onal Ins,tute for Health & Care Excellence) FSGG (French Society of Geriatrics & Gerontology ) AGILE (UK Society for PTs working with older adults) Moreland J et al Recommenda,ons The recommenda,ons were wrigen for physical therapists Based on mul,-disciplinary CPGs, therefore may be relevant for other disciplines Levels of Evidence Level I: Strong (RCTs, SR) Level II: Moderate (small RCTS, quasiexperimental) Level III: Weak (observa,onal studies) 12
13 Screening [Physical therapists] should rou,nely ask older adult pa,ents if they have fallen in the previous 12 months (Strong Recommenda,on based on Level III evidence). Screening should include: History and context of falls over previous 12 months At least one ques,on about the pa,ent s percep,on of difficulty with balance or walking Screening For each pa,ent who reports a fall or falls or reports difficulty with balance or walking, [the physical therapist] should screen by observing for gait or balance disturbance (Strong Recommenda,on based on Level III Evidence). Posi,ve screening result is when either is found: Mul,ple falls One fall + balance or gait impairment 13
14 Assessment Evidence: Health Condi,ons Cardiac condi,ons Cardiac exam (NICE, AGS/BGS) HR, rhythm, postural pulse, BP, hypotension (AGS/ BGS) An,-arrhythmia medica,on (NICE) Cardiac drugs and postural hypotension (Moreland) Osteoporosis (NICE, AGS/BGS) Risk assessment or diagnosis Assessment Evidence: Health Condi,ons Depression (Moreland) Assess for risk Geriatric Depression Scale Medica,on review Number of meds with dosage Cardiac Psychotropic (benzodiazepines, hypno,cs, an,depressants, tranquilizers) 14
15 Assessment Evidence: Body Func,ons and Structures Strength of the extremi,es Lower extremity strength (AGS/BGS) Balance No specific procedures or methods for balance assessment are provided within the CPGs Frequently used tests: BBS, TUG, POMA Assessment Evidence: Body Func,ons and Structures Vision Visual acuity (AGS/BGS) Urinary func,on/ incon,nence Cogni,ve assessment/ neurologic func,on Cogni,ve evalua,on (AGS/BGS, NICE) Peripheral nerve func,on, propriocep,on, reflex tes,ng, and cor,cal, extrapyramidal, cerebellar func,on (AGS/BGS) 15
16 Assessment Evidence: Ac,vity and Par,cipa,on Gait (thorough and detailed) Gait deficits or abnormali,es are a risk factor for falls No specific procedures or methods were recommended Individual professional should iden,fy appropriate measures for the assessment of gait for each older adult (NICE) Use of walking aids (Moreland) Assessment Evidence: Ac,vity and Par,cipa,on Ac,vi,es of daily living and mobility ADL skill including use of adap,ve equipment Mobility aids (AGS/BGS) Transfers (Moreland) Physical ac,vity Given that moderate ac,vity levels may be protec,ve to balance and falls, assess levels of physical ac,vity (Moreland) 16
17 Assessment Evidence: Environmental and Personal Factors Since home safety and hazards are risk factors, assess the home for hazards Example: Tripping hazards: agen,on to loose rugs and mats Fear and health percep,on Assess perceived func,onal ability and fear of falling Assessment: Environmental and Personal Factors Social support Iden,fica,on of the older adult s social support network (Moreland) Alcohol use Assessment of consump,on and inappropriate alcohol use (Moreland) Feet and footwear Assess feet and footwear (AGS/BGS) 17
18 Interven,on Evidence: Health Condi,ons Conduct medica,on review; modify/ withdraw psychotropic meds if possible Treat cardioinhibitory caro,d sinus hypersensi,vity (NICE, AGS/BGS) Treat postural hypotension (AGS/BGS, Moreland) Treat vitamin D insufficiency (AGS/BGS) Treat impaired cogni,ve status (Moreland) Treat depression (Moreland) Interven,on Evidence: Body Func,ons and Structure Individualized balance training Individualized strength exercises (NICE, AGS/BGS) Monitored by appropriately trained health care professional (NICE, AGS/BGS) Coordina,on training (AGS/BGS) Flexibility and endurance should be offered; not as stand alone interven,on (AGS/BGS) 18
19 Interven,on Evidence: Body Func,ons and Structure For persons who have fallen, but with no specific findings on assessment Tai chi or other balance control ex (e.g. on foam surfaces) (Moreland) For women over 80 yrs, individualized home physical therapy program for strengthening, balance, and flexibility (Moreland) Interven,on Evidence: Body Func,ons and Structure Delivery Referral to physical therapy (Moreland) Tai chi or physical therapy (AGS/BGS) Group exercise or individual (AGS/BGS) 19
20 Interven,on Evidence: Body Func,ons and Structure Expedite first cataract surgery when indicated (AGS/BGS) χ Advise against mul,focal lenses for walking on level and stairs (AGS/BGS) Treat vision and hearing impairment (Moreland) Insufficient evidence to recommend vision correc,on as stand-alone falls interven,on (NICE, AGS/BGS) Interven,on Evidence: Ac,vity & Par,cipa,on Individualized gait training combined with balance and strength training (AGS/BGS, Moreland was specific to older women) χ Advise against brisk walking for postmenopausal women with fracture history (Moreland) Insufficient evidence for brisk walking (NICE) 20
21 Interven,on Evidence: Ac,vity & Par,cipa,on ADL training for those with difficulty performing ADL ac,vi,es. (AGS/BGS, Moreland) Interven,on Evidence: Educa,on Educa,on and informa,on giving Verbal and wrigen re: preven,on, effec,ve measures, mo,va,on to exercise, benefits of engagement in risk reduc,on ac,vi,es (NICE) Tailored educa,on within mul,-factorial interven,on (AGS/BGS) Insufficient evidence for targeted or untargeted educa,onal programs as stand-alone interven,ons (AGS/BGS) 21
22 Interven,on Evidence: Alcohol and Physical Ac,vity For those with inappropriate alcohol use Educate and refer for treatment (Moreland) For those with risky ac,vity level Educate and refer for treatment (Moreland) Interven,on Evidence: Environmental Factors Home hazard modifica,on Home hazard assessment combined with modifica,ons. Home hazard assessment should not be conducted without follow-up and modifica,ons 22
23 Interven,on Evidence: Personal Factors Footwear Treatment of foot and footwear problems iden,fied in mul,-factorial assessment (AGS/BGS) Advise low heels and high surface contact area (AGS/BGS) Interven,on Evidence: Personal Factors Hip protectors Insufficient evidence to recommend hip protectors for fall preven,on (NICE) ** Note that hip protectors may be effec,ve in preven,ng fractures associated with falls 23
24 Assessment Recommenda,ons [Physical therapists] should provide individualized assessment within scope of prac,ce that contributes to mul,-factorial assessment of falls and fall risk. Addi,onal risk factors may need to be addressed by the appropriate provider (Strong Recommenda,on based on Level II evidence). This assessment should include: Medica,on review Polypharmacy & psychoac,ve drugs Assessment Recommenda,ons Medical History Osteoporosis Depression Cardiac disease Signs & symptoms of cardioinhibitory caro,d sinus hypersensi,vity 24
25 Assessment Recommenda,ons Body func,ons and structure, ac,vity and par,cipa,on, environmental & personal factors Strength Balance Gait Ac,vi,es of Daily Living Footwear Environmental Hazards Cogni,on Neurological Func,on Cardiac func,on, including postural hypotension Vision Urinary incon,nence Interven,on Recommenda,ons Broadly, recommenda,ons were similar for older adults at risk of falls Individualized exercise program including: Balance training Strength training Referral to physical therapy (Moreland) There were differences 25
26 Interven,on Recommenda,ons [Physical therapists] should provide individualized interven,ons within the scope of prac,ce (Strong Recommenda,on based on Level I evidence). Components of the interven,on should include: Strength training that is individually prescribed, monitored, and adjusted (Strong recommenda,on based on Level I evidence) Interven,on Recommenda,ons Balance training that is individually prescribed, monitored, and adjusted (Strong recommenda,on based on Level I evidence) 26
27 Interven,on Recommenda,ons Gait training (Strong recommenda,on based on Level I evidence) Interven,on Recommenda,ons Correc,on of environmental hazards (Strong recommenda,on based on Level I evidence) 27
28 Interven,on Recommenda,ons Correc,on of footwear or structural impairments of the feet (Recommenda,on based on Level II evidence) Which tests to Use to Determine Fall Risk 28
29 Summary of Clinically Useful Indicators of Fall Risk Category Measure Medical History Ques,ons Any previous falls Psychoac,ve medica,on Requiring any ADL assistance Ambulatory assis,ve device use Self-report Measures Geriatric Depression Scale-15 Falls Efficacy Scale Interna,onal Performance-based Measures Timed Up & Go Test Single-limb stance eyes open Five Times Sit-to-Stand Test Self-selected walking speed More details Gillespie LD, Robertson MC, Gillespie WJ, et al. Interven,ons for preven,ng falls in older people living in the community. Cochrane Database of Systema,c Reviews 2012, Issue 9. Sherrington C, Whitney JC, Lord SR, et al. Effec,ve exercise for the preven,on of falls: A systema,c review and meta-analysis. J Amer Geriatr Soc. 2008; 56(12): Power V, Clifford AM. Characteris,cs of op,mum falls preven,on exercise programmes for community-dwelling older adults. Eur Rev Aging Phys Act 2013; 10:
30 Mode Must include balance training Strength training only has small effect Mul,factorial home or community-based interven,ons Walking programs alone have small effect Intensity of training Balance training demanding Intensity challenging appropriate and increasing levels of difficulty Highest possible level of difficulty without falling or near-falling Mastery of each exercise before progressing 30
31 Frequency Minimum effec,ve frequency twice per week Most consistently effec,ve frequency three,mes per week Higher frequencies reduce fall risk, but adherence was poor adherence frequency Time Total exercise volume? At least 40* or 50** hours over the course of the interven,on *Power et al ** Sherrington et al 31
32 Exercise components What works Leaning beyond BOS Shi[ing the COM Minimizing UE support Narrowing base of support Dual-task movement Altering sensory feedback Func,onal ac,vi,es TJQMBB What doesn t work Lack of balance training component Lack of func,onal relevance Lack of exercise progression Ques,ons? 32
33 Thank You! 33
Upper Extremity Fractures and Secondary Fall Prevention: Opportunities to Improve Management and Outcomes Across Disciplines
Upper Extremity Fractures and Secondary Fall Prevention: Opportunities to Improve Management and Outcomes Across Disciplines Christine McDonough, PhD, PT, CEEAA Health Outcomes Unit Department of Health
More informationFall Prevention and hip protectors
Presenter Disclosure Information Edgar Pierluissi Division of Geriatrics Edgar Pierluissi, MD Medical Director, Acute Care for Elders Unit, San Francisco General Hospital and Trauma Center Fall Prevention
More informationFalls. Key Points. The highest proportions of community-dwelling older adults who fall are in the 80+ age cohort (de Negreiros Carbral et al., 2013).
Falls Key Points Reducing falls and fall-associated deaths and serious injuries is one of the major goals of Healthy People 2020 (U.S. Department of Health and Human Services, 2010). Twenty-eight to thirty-five
More informationMultifactorial risk assessments and evidence-based interventions to address falls in primary care. Objectives. Importance
Multifactorial risk assessments and evidence-based interventions to address falls in primary care Sarah Ross, DO, MS Assistant Professor Internal Medicine, Geriatrics Nicoleta Bugnariu, PT, PhD Associate
More information7/12/2016. Presenter Disclosure Information. The Other Half of the Fracture Equation: Fall Prevention and Management. Presentation Outline
Presenter Disclosure Information Edgar Pierluissi Division of Geriatrics Edgar Pierluissi, MD Acute Care for Elders Unit Zuckerberg San Francisco General Hospital July 21, 2016 OSTEOPOROSIS NEW INSIGHTS
More informationObjectives. Definition: Screen. Definition: Assessment 10/30/2013. Falls: Screens vs. Assessments vs. Outcome Measures
Objectives Falls: Screens vs. Balance and Falls SIG: Neurology & Health Policy and Administration Sections of the APTA Jacqueline Osborne PT, DPT, GCS, CEEAA Geriatric Residency Coordinator Brooks Institute
More informationHelpful Tips for the Unsteady Patient. Mairead Collins Senior Physiotherapist Bon Secours Hospital 20/09/14
Helpful Tips for the Unsteady Patient Mairead Collins Senior Physiotherapist Bon Secours Hospital 20/09/14 AIMS Brief discussion of Causes & Implications of Unsteady Gait/Imbalance Falls & Falls Prevention
More informationIndependence Well- being and Choice 2005, Our health, our care, our say 2006, Strong and Prosperous 2006
Medicines Op+misa+on Outcome focused approach to safe and effec+ve use of medicines that takes into account the pa+ent s values, percep+on and experience of taking their medicines Important Outcomes for
More informationPREVENTIVE CARE GUIDELINE. Quality Management Committee Chair
PREVENTIVE CARE GUIDELINE Guideline Number: DHMP_DHMC_PG1008 Effective Date: 11/2016 Guideline Subject: Fall Prevention Guideline for 65+ & Above Revision Date: 11/2017 Page 2 of 4 Quality Management Committee
More informationOncology Care Model Overview
Oncology Care Model Overview Centers for Medicare & Medicaid Services Innova3on Center (CMMI) September 2017 Innova3on at CMS Center for Medicare & Medicaid Innova3on (Innova3on Center) Established by
More informationStaying on Your Feet. Taking Steps to Prevent Falls
Staying on Your Feet Taking Steps to Prevent Falls 1 Why falls prevention? 1 out of 3 Canadians over the age of 65 and 1 out of 2 Canadians over the age of 80 will fall at least once a year older adults
More informationFall Risk Management. Is Everybody s Business
Fall Risk Management Is Everybody s Business A fall is An unintentional change in position, resulting in an individual coming to rest on the floor or a lower surface Risk Factors for Falls Over age 65
More informationEngage and Empower Pa.ents with Interac.ve Technology. Northeast NAHAM Regional Conference Pa.ent Access: GeBng It Right Upfront October 22-23, 2012
Engage and Empower Pa.ents with Interac.ve Technology Northeast NAHAM Regional Conference Pa.ent Access: GeBng It Right Upfront October 22-23, 2012 NAHAM - Pa.ent Access Services 2 Pa%ent Access Services
More informationFALLS PREVENTION. S H I R L E Y H U A N G, M S c, M D, F R C P C
FALLS PREVENTION S H I R L E Y H U A N G, M S c, M D, F R C P C S T A F F G E R I A T R I C I A N T H E O T T A W A H O S P I T A L B R U Y E R E C O N T I N U I N G C A R E W I N C H E S T E R D I S T
More informationPrimary Care Approach for Evaluating the Risk of Falls with Elderly Patients. Danielle Hansen, DO, MS (Med Ed), MHSA
Primary Care Approach for Evaluating the Risk of Falls with Elderly Patients Danielle Hansen, DO, MS (Med Ed), MHSA Clinical Assistant Professor, LECOM Associate Director, LECOM Institute for Successful
More informationDraft. Case Study. Otago Exercise Program. Tiffany E. Shubert, PhD, PT
Case Study for Otago Exercise Program Tiffany E. Shubert, PhD, PT tshubert@med.unc.edu Funding A portion of this work was supported by the Bureau of Health Professions (BHPr), Health Resources and Services
More informationEvery year, a third of Americans over age 65
Falls and mobility problems are not just part of getting old! Every year, a third of Americans over age 65 living in the community suffer a fall, and 50% over the age of 80 fall at least once per year.
More informationNeurocogni*ve tes*ng and cochlear implanta*on: insights into performance in older adults
Neurocogni*ve tes*ng and cochlear implanta*on: insights into performance in older adults Maura K Cosetti 1 MD James B. Pinkston, PhD 1 ; Jose M. Flores, MPH, PhD 3 ; David R. Friedmann, MD 2 ; Callie B.
More informationOutcome Measures for the Clinician
Outcome Measures for the Clinician Timed up and Go (TUG) Special contribu=ons made by: Jason Kahle - Jason Highsmith Brian Kaluf - Tyler Klenow 1 Introduc=on Outcome measures are clinical tests that are
More informationFall Risk Assessment and Management. Elizabeth A. Phelan, MD, MS Assistant Professor, Medicine/Gerontology October 24, 2007
Fall Risk Assessment and Management Elizabeth A. Phelan, MD, MS Assistant Professor, Medicine/Gerontology October 24, 2007 Slide 2 OBJECTIVES Know and understand: The importance of falls by older persons
More informationPreven+ng Carpal Tunnel & Other Work Related Injuries
Objec+ves At the end of this session, par+cipants will be able to: Preven+ng Carpal Tunnel & Other Work Related Injuries Anne M. Haskins, PhD, OTR/L Department of Occupa+onal Therapy 1. Iden+fy physical
More informationSlide 1. Slide 2 Overview of Course. Slide 3 Overview of Course. Gait and Balance Standardized Assessment in Geriatric Fallers
Slide 1 Gait and Balance Standardized Assessment in Geriatric Fallers Dianna Saunders, MS, PT Nicole Prieto, MSPT NF/SG Veterans Health System Gait and Balance Clinic Gainesville, FL Lenni Jo Yarchin,
More informationUpdate on Falls Prevention Research
Update on Falls Prevention Research Jasmine Menant NSW Falls Prevention Network Rural Forum 26 th March 2015 Acknowledgments: Prof Stephen Lord Recent falls risk factor studies Vascular disease 38.6% of
More informationFrailty in Geriatric Trauma Pa1ents
Division of Trauma, Burn, Surgical Critical Care, & Emergency General Surgery Frailty in Geriatric Trauma Pa1ents Zara Cooper, MD, MSc, FACS Elizabeth Bryant, MPH Disclosures NIA R01AG044518 NCI R35CA197730
More informationChemo Brain and Fa.gue Chemotherapy Related Cogni:ve Impairment Chemotherapy Related Fa:gue. Alok Pant, MD Northwestern Medicine
Chemo Brain and Fa.gue Chemotherapy Related Cogni:ve Impairment Chemotherapy Related Fa:gue Alok Pant, MD Northwestern Medicine Chemotherapy Related Cogni.ve Changes Agen:on Concentra:on Learning Memory
More informationPre-habilitation: Planning for Best Outcomes After Surgery
Optimizing Aging Collaborative Pre-habilitation: Planning for Best Outcomes After Surgery Kaitlin Willham, MD San Francisco VA Medical Center Division of Geriatrics, UCSF The Optimizing Aging Collaborative
More informationUpdate on Falls Prevention Research
Update on Falls Prevention Research Jasmine Menant NSW Falls Prevention Network Rural Forum 24 th August 2018 Acknowledgements: Prof Stephen Lord, Dr Daina Sturnieks Recent falls risk factor studies Lubaszy
More informationManaging falls in the elderly: real world approach DR PRISCILLA NG
Managing falls in the elderly: real world approach DR PRISCILLA NG A fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or other lower level. FALL:
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationTai Chi for Prevention of Falls in Older Adults. Yolanda Suarez, DO Geriatrics Fellow University of Reno School of Medicine June 20, 2018
Tai Chi for Prevention of Falls in Older Adults Yolanda Suarez, DO Geriatrics Fellow University of Reno School of Medicine June 20, 2018 Through this interactive presentation you will learn to Identify
More informationIdentifying Engineering, Clinical and Patient's Metrics for Evaluating and Quantifying Performance of Brain- Machine Interface Systems
Identifying Engineering, Clinical and Patient's Metrics for Evaluating and Quantifying Performance of Brain- Machine Interface Systems Jose Pepe L. Contreras-Vidal, Ph.D. Department of Electrical & Computer
More informationFalls in the Elderly. Causes and solutions.
Falls in the Elderly. Causes and solutions. Brent Tipping Sub-specialist Geriatrician and Specialist Physician Division of Geriatric Medicine University of the Witwatersrand 6 th Annual congress of the
More informationUpdate on Falls Prevention Research
Update on Falls Prevention Research Professor Stephen Lord Coffs Harbour Falls Prevention Network Rural Forum 28 th February 2014 Acknowledgments: Dr Jasmine Menant, Mr. Daniel Schoene Recent falls risk
More informationFalls and Mobility. Katherine Berg, PhD, PT and Arielle Berger, MD. Presented by: Ontario s Geriatric Steering Committee
Falls and Mobility Katherine Berg, PhD, PT and Arielle Berger, MD Key Learnings Arielle Berger, MD Key Learnings Learn approaches to falls assessment Understand inter-relationship between promoting safe
More informationCreated in January 2005 Duration: approx. 20 minutes
1 1 The Timed Up and Go Test Created in January 2005 Duration: approx. 20 minutes 2 Credits 2005 Stein Gerontological Institute. All rights reserved. Principal medical contributors: Alan Katz, MD Francois
More informationAssisted Living s Whole Brain Fitness: Can It Prevent Re-hospitalization?
Assisted Living s Whole Brain Fitness: Can It Prevent Re-hospitalization? Health Care Environment Is Changing, Opening Up New Opportuni:es for Assisted Living Center for Medicaid & Medicare Services (CMS)
More informationDiabetes Self- management Educa4on and Support (DSME/S)
Improving Patient Care Through Diabetes Self- management Education Davida F. Kruger, MSN, APN-BC, BC-ADM Certified Nurse Practitioner Henry Ford Health System Division of Endocrinology, Diabetes, Bone
More informationPrimary Hyperparathyroidism
Primary Hyperparathyroidism Copyright Copyright 2019 2019 American American Associa7on Associa7on of Clinical of Clinical Endocrinologists Endocrinologists 1 Primary Hyperparathyroidism In primary hyperparathyroidism
More informationPrimary Screening and Ongoing Assessment, Diagnosis and Interventions
Primary Screening and Ongoing Assessment, Diagnosis and Interventions Vicky Scott, RN, PhD Clinical Professor, School of Population and Public Health Faculty of Medicine, University of British Columbia
More informationUpdate on Falls Prevention Research
Update on Falls Prevention Research Dr Jasmine Menant NSW Falls Prevention Network Rural Forum 17 th October 2014 Acknowledgement: Prof Stephen Lord Recent falls risk factor studies Vascular disease 38.6%
More informationHealth and Social Care Act 2008 (Regulated Activities) Regulations
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 12 Policy Statement The human body is essentially unstable; a vertical column on a narrow base. To be able to remain standing upright
More informationMental Health, Substance Abuse & Primary Care: Bridging Gaps in Access
1 Mental Health, Substance Abuse & Primary Care: Bridging Gaps in Access Christopher Carroll, Director, Health Care Financing and Systems Integration Substance Abuse and Mental Health Services Administration
More informationAssessment of locomo,on ability
Université catholique de Louvain Cliniques universitaires St-Luc Département de Médicine Physique et de Réadapta,on Introduc,on Assessment of locomo,on ability Development of ABILOCO - ABILOCO-Kids Caty
More informationGuidelines for the Physiotherapy management of older people at risk of falling
Guidelines for the Physiotherapy management of older people at risk of falling AGILE: Chartered Physiotherapists working with Older People Produced by the AGILE Falls guidelines working group: Victoria
More informationPreven&on of Falls in Older Adults
David Ganz, MD, PhD Staff Physician, VA Greater Los Angeles Assistant Professor of Medicine, UCLA Preven&on of Falls in Older Adults No conflicts of interest to disclose Objectives Detail the evidence-based
More informationThe effect of water based exercises on fall risk factors: a mini-review. Dr Esther Vance, Professor Stephen Lord
The effect of water based exercises on fall risk factors: a mini-review Dr Esther Vance, Professor Stephen Lord Falls and Balance Research Group, NeuRA. There is considerable evidence from systematic reviews
More informationLetter from Home for Direct Care Providers Fall Risk Identification and Prevention
Letter from Home for Direct Care Providers Fall Risk Identification and Prevention Each year, thousands of older adults will have a fall in their home. Falls are more common than strokes and can have just
More informationWelcome! Pragmatic Clinical Studies. David Hickam, MD, MPH Program Director Clinical Effectiveness Research. David Hickam, MD, MPH
Pragmatic Clinical Studies David Hickam, MD, MPH Program Director Clinical Effec2veness Research June 23, 2015 Welcome! David Hickam, MD, MPH Program Director Clinical Effectiveness Research 2 In this
More informationBruyère Reports. What interventions prevent falls in long-term care? The case of Saint-Louis Residence. A Bruyère Rapid Review. Issue No.
Bruyère Reports Issue No. 4 June 2017 What interventions prevent falls in long-term care? The case of Saint-Louis Residence A Bruyère Rapid Review REPORT AUTHORS Vivian Welch Elizabeth Ghogomu Beverley
More informationObjec ves. Sports- Related Concussions in Student- Athletes: A 2015 Update 8/30/15
Sports- Related Concussions in Student- Athletes: A 2015 Update Joel S. Brenner, M.D., M.P.H., F.A.A.P. Medical Director, CHKD Sports Medicine Program Director, CHKD Sports Concussion Program Associate
More informationBalance and Falls in the Elderly
ML IV Balance and Falls in the Elderly Heidi Piccione, DPT, GCS Jeannie Stephenson, PT, PhD, NCS USF Morsani College of Medicine School of Physical Therapy and Rehabilitation Sciences ML IV Healthcare
More informationSIMPATH Y. S*mula*ng Innova*on Management of Polypharmacy and Adherence in the Elderly Simpathy
S*mula*ng Innova*on Management of Sunfrail Transla1onal workshop Understanding and caring for frailty and mul1morbidity Bologna, March 22nd 2016 S*mula*ng Innova*on Management of Polypharmacy and Adherence
More informationFall Risk Assessment and Prevention in the Post-Acute Setting A Road Map
Fall Risk Assessment and Prevention in the Post-Acute Setting A Road Map Cora M. Butler, JD, RN, CHC HealthCore Value Advisors, Inc. Juli A. James, RN Primaris Holdings, Inc. Objectives Explore the burden
More informationPrevention (Home Care)
Prevention (Home Care) Improvements in Balance in Older Adults Engaged in a Specialized Home Care Falls Prevention Program. Whitney SL, Marchetti GF, Ellis JL, Otis L. J. Geriatr. Phys. Ther. 2012; epub(epub):
More informationE. Scafato C. Gandin, L. Galluzzo, S. Ghirini, S. Martire, R. Scipione Istituto Superiore di Sanità, Italy
Guidelines to support early identification and brief interventions for alcohol use disorders in Europe: overview of RARHA survey results and of other EU projects E. Scafato C. Gandin, L. Galluzzo, S. Ghirini,
More informationThank You to Our Sponsors: Evaluations & CE Credits. Featured Speakers. Conflict of Interest & Disclosure Statements 10/18/2016
Thank You to Our Sponsors: University at Albany School of Public Health NYS Department of Health Conflict of Interest & Disclosure Statements The planners and presenters do not have any financial arrangements
More informationDementia and Fall Geriatric Interprofessional Training. Wael Hamade, MD, FAAFP
Dementia and Fall Geriatric Interprofessional Training Wael Hamade, MD, FAAFP Prevalence of Dementia Age range 65-74 5% % affected 75-84 15-25% 85 and older 36-50% 5.4 Million American have AD Dementia
More informationGenetic Tests and Genetic Counseling How to Analyze Your Own Genome
Genetic Tests and Genetic Counseling 02-223 How to Analyze Your Own Genome Genetic Tests for Huntington Disease Hun7ngton Disease Incurable brain disorder that runs in families Movement, cogni7ve, and
More informationFALL PREVENTION AND OLDER ADULTS BURDEN. February 2, 2016
February 2, 2016 FALL PREVENTION AND OLDER ADULTS Each year in Winnipeg, one in three adults over 65 years of age will experience a fall. 1 Approximately one third of people 65 years of age and older and
More informationMobility & Wound Healing a2er Trauma6c Amputa6on. David Jones PT, CWS Duke University Medical Center Department of Physical and Occupa6onal Therapy
Mobility & Wound Healing a2er Trauma6c Amputa6on David Jones PT, CWS Duke University Medical Center Department of Physical and Occupa6onal Therapy Objec6ves Discuss the physical therapist s role during
More informationDepartment of Emergency Office of Research. Shannon McNabb, MA, MPH Clinical Research Manager January 2017
Department of Emergency Medicine Office of Research Shannon McNabb, MA, MPH Clinical Research Manager January 2017 EM Study Tracking System UPDATED ON: 12/5/2016 TOTAL 68 Grants Submitted, Award Pending
More informationSafe & Effective Exercises for Osteoporosis
Safe & Effective Exercises for Osteoporosis Karen Kemmis, PT, DPT, MS, GCS, CDE, FAADE SUNY Upstate Medical University Physical Medicine & Rehabilitation Joslin Diabetes Center and University Endocrinologists
More informationCondi&oning and Injury Preven&on in Youth Sports
Condi&oning and Injury Preven&on in Youth Sports Marcia Whalen, D.O., FAOASM Head Team Physician USA Water Polo USOC Physician London Olympics 2012 Medical Director Personalcare Physicians Newport Beach,
More informationFrailty: what s it all about?
Frailty: what s it all about? What is frailty? 1. an inevitable consequence of aging 2. A state due to multiple long term conditions 3. A condition in which the person becomes fragile 4. A state associated
More informationMental health and falls in older people. Stephen Lord
Mental health and falls in older people Stephen Lord Depression Common Risk Factors Biderman et al (2002) Identified 5 common risk factors for depression and falls Poor self-rated health Poor cognitive
More informationDevelopment and Applica0on of Real- Time Clinical Predic0ve Models
Development and Applica0on of Real- Time Clinical Predic0ve Models Ruben Amarasingham, MD, MBA Associate Professor, UT Southwestern Medical Center AHRQ- funded R24 UT Southwestern Center for Pa?ent- Centered
More informationMedica8on Assisted Treatment (MAT) in Jails and Community- Based SeDngs
Medica8on Assisted Treatment (MAT) in Jails and Community- Based SeDngs Lisa Ramirez, Lead Program Specialist, Texas Department of State Health Services, Mental Health and Substance Abuse Division Rebecca
More informationPaget s Disease of Bone
Paget s Disease of Bone Copyright Copyright 2019 American 2019 American Associa7on Associa7on of Clinical of Clinical Endocrinologists Endocrinologists 1 A Common Bone Disorder Paget s disease of bone
More informationMul$ple Risk Factor Interven$on Trial (MRFIT) in Osteoarthri$s
Mul$ple Risk Factor Interven$on Trial (MRFIT) in Osteoarthri$s Marc C. Hochberg, MD, MPH Professor of Medicine and Epidemiology and Public Health Relevant Disclosures I have received consul$ng and speaking
More informationExercise, Physical Therapy and Fall Prevention
Exercise, Physical Therapy and Fall Prevention University of Davis Medical Center Rosy Chow Neuro Clinical Specialist Physical Therapist Outline of Talk Role of Physical Therapy in care of people with
More informationPrevention of falls in older age: The role of physical activity. Dr Anne Tiedemann Senior Research Fellow
Prevention of falls in older age: The role of physical activity Dr Anne Tiedemann Senior Research Fellow Fall definition Prevention of Falls Network Europe (ProFaNE) definition 1 : an unexpected event
More informationSpo$ng and Managing Delayed Recovery in Injured Workers
Disclosure Informa5on Western Occupa5onal Health Conference 2011 I have the following financial rela5onships to disclose: I have nothing to disclose - and- I will not discuss off label use and/or inves5ga5onal
More informationFall Prevention. Reduce Your Risk of Falling With Six Easy Exercises. Presenter: Laurie Swan, PT, PhD, DPT
Fall Prevention Reduce Your Risk of Falling With Six Easy Exercises Presenter: Laurie Swan, PT, PhD, DPT Address SightConnection 9709 Third Ave NE #100 Seattle, WA 98115 2027 Agency website www.sightconnection.org
More informationCleveland Clinic Mellen Center for Multiple Sclerosis. Mellen Center Approaches: Falls and Fall Prevention in MS. Q: What is a fall?
Mellen Center Approaches: Falls and Fall Prevention in MS Q: What is a fall? A: A fall can be defined as an unplanned change in position resulting in the individual resting on the ground or a lower level.
More informationLearning Objec1ves. Study Design Considera1ons in Clinical Pharmacy
9/28/15 Study Design Considera1ons in Clinical Pharmacy Ludmila Bakhireva, MD, PhD, MPH Pree Sarangarm, PharmD, BCPS Learning Objec1ves Describe the features, advantages and disadvantages of the observa1onal
More informationPsychological outcomes of cri2cal illness for pa2ents and family members. Erin K. Kross, MD Summer Lung Day June 18, 2010
Psychological outcomes of cri2cal illness for pa2ents and family members Erin K. Kross, MD Summer Lung Day June 18, 2010 Outline Overview of psychological outcomes for pa2ents and family members ager cri2cal
More informationLAI: Linee guida ed esperienze internazionali
LAI: Linee guida ed esperienze internazionali LAI: Guidelines and interna5onal experience PM Llorca CHU Clermont-Ferrand EA 7280 Université Clermont Auvergne Disclosures Advisory board: Allergan, Jansen,
More informationEffec&ve Messaging for Suicide Preven&on:
Effec&ve Messaging for Suicide Preven&on: Anara Guard anara@suicideispreventable.org Lessons from a statewide campaign and from a na&onal framework This morning The Know the Signs statewide social marke&ng
More informationNeurocogni*ve Deficits in Older Cancer Pa*ents. Beatrice J. Edwards, MD, MPH Central Texas Veterans Healthcare System
Neurocogni*ve Deficits in Older Cancer Pa*ents Beatrice J. Edwards, MD, MPH Central Texas Veterans Healthcare System Conflicts of Interest None Background By 2030 close to 70% of cancer pa5ents will be
More informationLearning Objec1ves. Study Design Strategies. Cohort Studies 9/28/15
9/28/15 Learning Objec1ves Describe the features, advantages and disadvantages of the observa1onal study designs Explain why the overall study design is important when evalua1ng studies & applying their
More informationPrevention of Falls and Fractures
Prevention of Falls and Fractures Jonathan Treml Consultant Geriatrician, Queen Elizabeth Hospital Birmingham Co-Chair, British Geriatrics Society Falls and Bone Health Section Manchester, May 2016 This
More informationRecrea&onal Therapy. Thomas K. Skalko, Ph.D., LRT/CTRS Chair, Commi<ee on Accredita&on of Recrea&onal Therapy Educa&on
Recrea&onal Therapy Thomas K. Skalko, Ph.D., LRT/CTRS Chair, Commi
More informationObjec8ves. Obesity Epidemic 12/6/11. The Obesity Epidemic: Implica8ons for the Physical Therapist Part 1
The Obesity Epidemic: Implica8ons for the Physical Therapist Part 1 LeeAnn Eagler, PT, DPT, GCS, CLT Sara Knox, PT, DPT Lynchburg College Lynchburg, Virginia Objec8ves Describe the current epidemiology
More informationA thorough history of falls is important to determine the mechanism of fall, the associated THE FALLING ELDERLY. Psychological trauma.
T H E M E : E L D E R L Y A N D H O M E H E A L T H C A R E Dr Noor Hadfizah INTRODUCTION Each year, about one third of elderly above the age of 65 years old fall. Falls are so common amongst the elderly
More informationNTiNO. Suppor'ng Apparatus and Therapeu'c Applica'ons for the Development of Dynamic Standing Posi'on. A Standing Project by UtilisMotus
NTiNO Suppor'ng Apparatus and Therapeu'c Applica'ons for the Development of Dynamic Standing Posi'on A Standing Project by UtilisMotus Centre of Functional Physical Therapy, Athens, Hellas 2011 2016 Patent
More informationIncreased aeen9on. The biomechanics of the diabetic foot and the clinical evidence for offloading and footwear. Sicco A.
The biomechanics of the diabetic foot and the clinical evidence for offloading and footwear Increased aeen9on Sicco A. Bus, PhD Senior inves9gator and Head Human Performance Laboratory Academic Medical
More informationBalance Matters. Dan Mathers, MSPT. Balance Program Coordinator St. Vincent Rehabilitation.
Balance Matters Dan Mathers, MSPT Balance Program Coordinator St. Vincent Rehabilitation dpmather@stvincent.org Who I am Dan Mathers, MSPT Graduated with Master of Science in Physical Therapy in 1999 from
More informationTransforming Falls Prevention in Shropshire
Shropshire Public Health Transforming Falls Prevention in Shropshire Sandy Lockwood Falls Prevention Project Manager Public Health 28 th November 2014 This event has been organised by Sanofi Pasteur MSD
More informationIntegrated Mindfulness Interven1on
Integrated Mindfulness Interven1on Elizabeth Berlasso, NSRCT, Psychotherapist Rob Dickson, Clinical Team Leader Tara Sampalli, PhD, Manager Minakshi Dhir, Research Associate Integrated Chronic Care Service,
More informationPartnering with school- based. providers to improve HPV immunisa5on uptake in Victoria, Australia. Heather O Donnell December 2014
Partnering with school- based immunisa5on providers to improve HPV immunisa5on uptake in Victoria, Australia Heather O Donnell December 2014 Cervical screening & HPV immunisation, Australia! Public health
More informationCaring for cancer patients with comorbidity. Chair: Associate Professor Diana Sarfa3
Caring for cancer patients with comorbidity Chair: Associate Professor Diana Sarfa3 Why do we care? Comorbidity: is common among cancer pa3ents. has a major impact on pa3ents. has a major impact on health
More informationProperty of Horn & Neely. Not to be distributed or used without permission of the authors.
Prac%cal Interven%ons For Balance Impairments In Older Adults Linda B. Horn, PT, DScPT, MHS, GCS, NCS Laurie Neely, PT, DPT University of Maryland School of Medicine Physical Therapy and Rehabilita%on
More informationKupu Taurangi Hauora o Aotearoa
Kupu Taurangi Hauora o Aotearoa What it means to fall leading cause of injury in 65+ year olds loss of confidence, fear of further falls for frail elderly with osteoporotic fractures almost 50% will require
More informationWhat are you trying to achieve? Falls Prevention, Assessment and Management Strategies. Falls can be classified into four main groups:
What are you trying to achieve? Falls Prevention, Assessment and Management Strategies Dr Adam Darowski Community: Falls risk assessment: Falls risk is 50% per year in 80yr population and higher in those
More informationNvLearn the Signs. Act Early. Au7sm and Referral March 27, Nevada Leadership Education In Neurodevelopmental and Related Disabilities
NvLearn the Signs. Act Early. Au7sm and Referral March 27, 2013 Nevada Leadership Education In Neurodevelopmental and Related Disabilities Acknowledgements Thank you to Centers for Disease Control for
More informationPreventing falls in older people
Preventing falls in older people http://publications.nice.org.uk/ifp161 Published: June 2013 About this information NICE clinical guidelines advise the NHS on caring for people with specific conditions
More informationAgeing baby boomers: will falls prevention need to change as the ageing population changes?
Ageing baby boomers: will falls prevention need to change as the ageing population changes? Professor Keith Hill, Head, School of Physiotherapy and Exercise Science Keith.Hill@Curtin.edu.au Curtin University
More informationLong Term Management of the Stroke Pa2ent
Long Term Management of the Stroke Pa2ent Theodore Wein MD,FRCPC Assistant Professor of Neurology & Neurosurgery Stroke Preven2on Clinic Montreal General Hospital 514 934 8058 514 934 8057 Disclosure Disclosure
More informationFall Prevention for Community Dwelling Older Adults: An Update on Assessment and Intervention Strategies
Fall Prevention for Community Dwelling Older Adults: An Update on Assessment and Intervention Strategies Erica A. Pitsch, PT, MPT, DPT, NCS UCSF/SFSU Graduate Program in Physical Therapy Objectives Be
More information