NC Division of Aging and Adult Services NC Center for Health & Wellness, UNC Asheville (828)

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1 2017 National Falls Prevention Awareness Day 10 Years Standing Together to Prevent Falls September 22, 2017 Dear Falls Prevention Partners: The NC Division of Aging and Adult Services is excited to partner with the NC Center for Health and Wellness at the University of North Carolina Asheville to share with you some ideas and best practices for National Falls Prevention Awareness Day. Each year community partners across the nation offer classes, activities and educational presentations on falls prevention awareness day or throughout the week. This day offers individuals across the nation an opportunity to bring to light the concerns surrounding falls and provides an opportunity to educate individuals on how to prevent a fall. NC DAAS and the NC Center for Health and Wellness have put together the attached packet for your use. Attached you will find 6 Steps to Prevent a Fall, a Continuum of Care document, a Falls Prevention Fact Sheet (Nationally), Falls Prevention Crossword, a Stay Independent Brochure. In addition, your agency may want to consider having a presenter speak on falls, falls related injuries, and/or how medications can increase falls risk; examples of presenters in your area may include a pharmacist, physical therapist, someone from the Alzheimer s Association, or someone from your local fire department or EMT. EMT and the fire departments are usually the first people to interact with an individual when they have had a fall. They are great partners for falls prevention programming and are often looking for resources in their area. For additional ideas and marketing materials please visit: the Healthy Aging NC Resource Center and As always, please feel free to contact us with questions! Jen Teague, MA Ayden Jones, BS Healthy Aging Specialist Falls Prevention Programs Project Manager NC Division of Aging and Adult Services NC Center for Health & Wellness, UNC Asheville (828) jen.teague@dhhs.nc.gov aojones@unca.edu

2 National Council on Aging s full section of resources for Fall Prevention Awareness Day North Carolina s Fall Prevention Resource Center: Fall Prevention Center of Excellence Organizational Resources International Council on Active Aging information about Active Aging Week Center for Disease Control toolkit and materials

3 Take Control of Your Health: 6 Steps to Prevent a Fall Every 11 seconds, an older adult is seen in an emergency department for a fall-related injury. Many falls are preventable. Stay safe with these tips! Find a good balance and exercise program Look to build balance, strength, and flexibility. Contact your local Area Agency on Aging for referrals. Find a program you like and take a friend. Talk to your health care provider Ask for an assessment of your risk of falling. Share your history of recent falls. Regularly review your medications with your doctor or pharmacist Make sure side effects aren t increasing your risk of falling. Take medications only as prescribed. CONTINUES.

4 Take Control of Your Health: 6 Steps to Prevent a Fall Get your vision and hearing checked annually and update your eyeglasses Your eyes and ears are key to keeping you on your feet. Keep your home safe Remove tripping hazards, increase lighting, make stairs safe, and install grab bars in key areas. Talk to your family members Enlist their support in taking simple steps to stay safe. Falls are not just a seniors issue. To learn more, visit ncoa.org/fallsprevention. N A T IONA L C O UNC I L O N A G ING National Council on Aging. All Rights Reserved.

5 Continuum of Care Toolkit for Fall Prevention Assess and know your risk: Have you fallen in the past year? Do you feel unsteady when standing or walking? Do you worry about falling? Do you have a chronic disease such as diabetes, COPD, heart disease, or arthritis? Do you have hearing loss? If you answered yes to any of the above questions you ARE at increased risk for a fall. Talk to your doctor: Use our handy infographic for quick guidance on talking with your doctor. This information packet is a valuable resource for talking about fall concerns. Read more about fall risk for those with chronic disease and hearing loss. Always talk to your doctor before starting an exercise program. Join a community evidenced based program to improve or maintain your strength, balance, and sense of control. Click on a link below for a full description of each of our programs: Otago Exercise Program A Matter of Balance Tai Chi for Arthritis YMCA: Moving for Better Balance If you are living with a chronic disease, you are at a higher risk for falling. Consider joining a living healthy program to share and learn about ways to manage the condition Chronic Disease Self Management Program

6 It really is true that you use it or lose it when it comes to muscle strength so it is important to be active. See healthyagingnc.com for a complete list of programs across the state. See the North Carolina Organizations page to find out about local resources in your community. Create and follow a Fall Free Plan to keep Balance! Be sure to follow these 6 steps for Fall Prevention. Follow the home safety checklist in this information packet to ensure your home is free of fall hazards. Participate in one of North Carolina s evidenced-based fall prevention programs:

7 F A C T S H E E T Falls Prevention Falls are the leading cause of fatal and nonfatal injuries for older Americans. Falls threaten seniors' safety and independence and generate enormous economic and personal costs. However, falling is not an inevitable result of aging. Through practical lifestyle adjustments, evidence-based falls prevention programs, and clinical-community partnerships, the number of falls among seniors can be substantially reduced. The Challenge According to the U.S. Centers for Disease Control and Prevention: One-fourth of Americans aged 65+ falls each year. Every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall. Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults. Falls result in more than 2.8 million injuries treated in emergency departments annually, including over 800,000 hospitalizations and more than 27,000 deaths. In 2013, the total cost of fall injuries was $34 billion. The financial toll for older adult falls is expected to increase as the population ages and may reach $67.7 billion by Falls, with or without injury, also carry a heavy quality of life impact. A growing number of older adults fear falling and, as a result, limit their activities and social engagements. This can result in further physical decline, depression, social isolation, and feelings of helplessness. N A T I O N A L C O U N C I L O N A G I N G th Street South, Suite 500 Arlington, VA

8 F A L L S P R E V E N T I O N F A C T S H E E T NCOA s Role NCOA leads the National Falls Prevention Resource Center, which supports awareness and educational efforts about falls and promotes evidence-based falls prevention programs and strategies across the nation. The purpose of the center is to: Increase public awareness and educate consumers and professionals about the risks of falls and how to prevent falls. Support and stimulate the implementation, dissemination, and sustainability of evidencebased falls prevention programs and strategies to reduce the incidence of falls among older adults and adults with disabilities. Serve as the national clearinghouse of tools, best practices, and other information on falls and falls prevention. The National Falls Prevention Resource Center leads the Falls Free Initiative, a national effort to address the growing public health issue of falls, fall-related injuries and deaths. The initiative includes a coalition of over 70 national organizations charged with working toward the progress of one or more of the strategies in the National Action Plan. Members are engaged in disseminating proven falls prevention programs, advocating for funding, and educating older adults about how they can reduce their risk of falling. The initiative also includes a 43-member State Coalition on Falls Prevention Workgroup charged with collaboratively promoting effective strategies to address falls. Falls Free National Action Plan In March 2005, NCOA released the landmark evidence-based Falls Free National Action Plan to prevent falls and fall-related injuries in older adults. The plan was updated in 2015 and continues to serve as a roadmap and catalyst for action. The plan includes goals, strategies and action steps to increase physical mobility, reduce the impact of medications as a falls risk factor, and improve home and environmental safety. The plan also promotes the expansion and funding of falls risk screening, assessment, and evidence-based programs. National Falls Prevention Awareness Day Every September on the first day of fall, the Falls Free Initiative promotes National Falls Prevention Awareness Day. States are encouraged to host and promote falls prevention awareness and screening activities to draw attention to the problem and offer older adults practical solutions. Forty-eight states and DC participated in the 2015 event. For more information, please visit For questions, please fallsfree@ncoa.org About NCOA The National Council on Aging (NCOA) is a respected national leader and trusted partner to help people aged 60+ meet the challenges of aging. Our mission is to improve the lives of millions of older adults, especially those who are struggling. Through innovative community programs and services, online help, and advocacy, NCOA is partnering with nonprofit organizations, government, and business to improve the health and economic security of 10 million older adults by Learn more at ncoa.org The Falls Free Initiative's work includes: N A T I O N A L C O U N C I L O N A G I N G th Street South, Suite 500 Arlington, VA National Council on Aging. All Rights Reserved.

9 North Carolina Special Emphasis Report: Fall Injuries among Older Adults A GROWING CONCERN QUICK FACTS Unintentional falls among older adults are a leading cause of fatal and nonfatal injury in the U.S. and North Carolina. Hospital costs associated with injuries sustained by falls account for a substantial share of health care dollars spent on injury-related care. In 2014, 908 North Carolina residents ages 65 and older died and over 75,000 fall injuries were treated at hospitals and emergency departments (Figure 1). This report provides recent data on unintentional fall injuries and deaths among North Carolina residents ages 65 and older. It includes information about groups with the highest rates, associated costs and current prevention strategies and activities in North Carolina. Residents ages 65 and older account for 88% of all fall deaths and 73% of nonfatal fall hospitalizations in North Carolina. Falls are a leading cause of traumatic brain injury (TBI) in North Carolina residents ages 65 and older, accounting for 36% of TBI deaths and 43% of TBI hospitalizations. Eighty-four percent of fall deaths and 69% of hospitalizations among older adults were associated with a TBI. Projected lifetime costs associated with fall injuries in 2014 among North Carolina residents ages 65 and older are estimated to be almost $1.4 billion. FIGURE 1. Burden of Fall Injuries among Residents Ages 65 and older North Carolina, Deaths Each week, there are 1,189 emergency department visits among residents ages 65 and older, 266 hospitalizations, and 17 deaths due to fall injuries in North Carolina. 13,841 Hospitalizations 61,810 Emergency Department Visits In 2014, 58% fall deaths among this age group occurred in the home, less than 1% occurred in a residential facility such as a nursing home. The location wasn t known for 12%. This document was produced in conjunction with CDC's Core Violence and Injury Prevention Program Under Cooperative Agreement Released October 2016

10 North Carolina Special Emphasis Report: Fall Injuries among Older Adults FALL DEATHS FIGURE 2. Age-adjusted Rate of Fall Deaths by Sex, Ages 65 and older North Carolina, Rate per 100,000 population Male Female TOTAL From 2005 to 2014, the age-adjusted rate of fall deaths increased from 47.0 per 100,000 in 2005 to 67.3 per 100,000 in Fall death rates increased among both males and females during this time period. In 2014, the fall death rate in males was approximately 48% higher than in females. Year FIGURE 3. Age-specific Rate of Fall Deaths by Age Group, Ages 65 and older North Carolina, Rate per 100,000 population Ages Ages Ages 85+ Fall death rates increased among all three age groups. The highest increase was among persons ages 85 and older. Rates for persons ages 85 and older increased, from per 100,000 in 2005 to per 100,000 in Year

11 North Carolina Special Emphasis Report: Fall Injuries among Older Adults NONFATAL FALL HOSPITALIZATIONS FIGURE 4. Age-adjusted Rate of Nonfatal Fall Hospitalizations by Sex, Ages 65 and older North Carolina, Rate per 100,000 population 1,600 1, Male Female Total Nonfatal fall hospitalizations remained relatively stable from 2005 to Rates decreased between 2010 and 2012, but have since begun to increase slightly. In 2014, rates among females are approximately 1.6 times that of males. Year FIGURE 5. Percent of Nonfatal Fall Hospitalizations by Discharge Disposition, Ages 65 and older North Carolina, 2014 Percent 100% 80% 60% 40% 20% 0% All Hospitalized Falls Hospitalized Falls with Hip Fracture Other discharge type Routine discharge to home Discharged home with home health care services Discharged to rehabilitation unit/facility Discharged to skilled nursing facility Sixty-two percent of all fall hospitalizations were discharged to a skilled nursing facility. Among falls resulting in a hip fracture, 73.6% were discharged to a skilled nursing facility and 9.6% discharged to a rehabilitation facility. 1 Among those with a hip fracture, only 2.8% had a routine discharge to home and 8.1% were discharged home with home health services. 1 Rehabilitation includes inpatient hospital rehab units as well as other outside facilities.

12 DEMOGRAPHIC DATA North Carolina Special Emphasis Report: Fall Injuries among Older Adults TABLE 1. Number and Rate of Fall Deaths and Nonfatal Fall Hospitalizations and Emergency Department (ED) Visits, Ages 65 and older North Carolina, 2014 Number of Deaths Fall Deaths Death Rate per 100,000 2 Nonfatal Fall Hospitalizations and Emergency Department (ED) Visits Number of Hospitalizations Nonfatal Hospitalization Rate per 100,000 2 Number of ED Visits Nonfatal ED Visit Rate per 100,000 2 TOTAL ,841 1, ,810 4,471.4 Sex Male , ,605 3,348.0 Female ,922 1, ,200 5,239.8 Age Group Ages , ,640 2,378.5 Ages , ,809 5,129.2 Ages ,267 1, ,361 11,363.3 Race/Ethnicity White, NH ,291 1,115.7 Black, NH Hispanic Asian/PI 4, NH AI/AN 5, NH ,041.2 Males had a higher rate of fall deaths than females (84.0 per 100,000 and 56.8 per 100,000, respectively). Females had higher rates for nonfatal hospitalizations and ED visits. Persons ages 85 and older had the highest rates of fatal and nonfatal fall injuries. This age group had 19 times the rate of deaths than those aged American Indian/Alaskan Native residents had the highest rates of fall deaths and Black Non-Hispanic residents had the lowest. American Indian/Alaskan Native residents had the highest rates of fall hospitalizations and Non-Hispanic Asian/Pacific Islander residents had the lowest. Race/Ethnicity data was left out for ED visits due to incompleteness. 2 Rates are age-adjusted except for rates by age group. 3 Non-Hispanic 4 Pacific Islander 5 American Indian/Alaskan Native

13 PROJECTED LIFETIME COSTS North Carolina Special Emphasis Report: Fall Injuries among Older Adults Lifetime costs 4 associated with unintentional fall injuries in 2014 among North Carolina residents ages 65 and older are estimated to be almost $1.4 billion. Most of these costs were associated with injuries requiring hospitalization. Number of Injuries Medical Cost Work Loss Cost Combined Cost Deaths 908 $20,762,000 $99,552,000 $120,314,000 Hospitalizations 13,841 $568,743,000 $417,559,000 $986,302,000 ED Visits 61,810 $200,858,000 $87,381,000 $288,239,000 TOTAL 76,559 $790,363,000 $604,492,000 $1,394,855,000 SURVEY DATA The Behavioral Risk Factor Surveillance Survey (BRFSS) is a statewide phone survey of community dwelling (i.e. non-institutionalized) North Carolina adults. It provides self-reported data on a variety of topics, including falls, fall-related injuries, and medical conditions. In 2014, an estimated 642 of North Carolina adults ages 65 and older reported having fallen and 36% reported a fall-related injury in the past 12 months. Percent FIGURE 6. Self-Reported Falls and Fall Injuries in the Past 12 Months, Ages 65 and older North Carolina, % 50% 40% 30% 20% Falls Falls with Injury 27.7% 35.8% 41.0% 43.9% Older North Carolina adults who reported the following conditions were significantly more likely 5 to report falls and fall-related injuries in the past 12 months: 10% 0% All Respondents Respondents Reporting a Disability poor mental health/depression diabetes asthma coronary artery disease (CAD) obesity no exercise stroke disability 6 Older adults who reported a physical, cognitive and/or emotional disability 6 had particularly high fall rates, with an estimated 41% reporting having fallen and 44% reporting fall-related injuries in the past 12 months. 4 Costs were calculated using the CDC s WISQARS Cost Module application which provides cost estimates for medical and work loss for injury-related deaths, hospitalizations, and emergency department visits. 5 These conditions are statistically significant at the (P<.05 level). However, causality shouldn t be assumed. Selected chronic health conditions: respondents reported Yes to EVER having been diagnosed with: Diabetes; Asthma; Stroke; Depression; Coronary artery disease (CAD)/Angina or with Myocardial infarction. Poor mental health includes persons who reported experiencing 14+ days of poor mental health in the past month. Respondents are asked their height and weight to calculate BMI. Obesity is defined as a BMI greater than or equal to Exercise is defined as respondents reporting No to ANY leisure-time physical activity. 6 Disability is defined as having one or more of the following conditions for at least one year; (1) impairment or health problem that limited activities or caused cognitive difficulties, (2) used special equipment or required help from others to get around.

14 North Carolina Special Emphasis Report: Fall Injuries among Older Adults FALL PREVENTION RESOURCES STEADI (Stopping Elderly Accidents Deaths & Injuries): The Centers for Disease Control and Prevention (CDC) is working to make fall prevention a routine part of clinical care. STEADI uses established clinical guidelines and effective strategies to help primary care providers address their older patients' fall risk and identify modifiable risk factors: PREVENTION ACTIVITIES IN NORTH CAROLINA Prevention activities surrounding falls are coordinated by the NC Falls Prevention Coalition. The Coalition partners with the NC Division of Aging and Adult Services (NC DAAS), the UNC Center for Aging and Health, the University of North Carolina Injury Prevention Research Center, along with the Division of Public Health (DPH) and many more to address: infrastructure development and maintenance, community awareness and education, provider education, risk assessment and behavioral intervention, surveillance and evaluation, and advocacy for supportive polices and environments. Through this work evidence-based falls prevention programs are offered across the state including: A Matter of Balance, the Otago Exercise Program, Tai Chi for Arthritis, and YMCA: Moving for Better Balance. The NC DPH-Injury & Violence Prevention Branch produces the CDC State Injury Surveillance, periodic short reports and surveillance updates that include falls information/data. Accomplishments/successes include: a grant awarded to NC DAAS to increase the number of those at risk for falls who participate in evidence-based falls prevention programs while increasing sustainability of these programs; the development of a statewide database hub to create a centralized referral system for falls prevention programs and information ( Statewide Falls Prevention Summits held in 2014, 2015, and upcoming in 2017; falls prevention being included in the injury recommendations for NC Healthy People 2020 initiative and the State Aging Services Plan; and the annual observance of NC Falls Prevention Awareness Week. DATA SOURCES and DEFINITIONS North Carolina State Center for Health Statistics, Vital Statistics-Hospitalizations, ; North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), ; CDC s Web-based Injury Statistics Query and Reporting System (WISQARS) Cost Module, 2014 North Carolina Behavioral Risk Factor Surveillance Survey (BRFSS), 2014; North Carolina Falls Prevention Coalition; National Council on Aging North Carolina Division of Public Health Released October, 2016

15 Four things you can do to prevent falls: Stay Independent 1 Begin an exercise program to improve your leg strength & balance 2 Ask your doctor or pharmacist to review your medicines 3 Get annual eye check-ups & update your eyeglasses 4 Make your home safer by: It s not the broken hip, it s the nursing home I don t want. I need to be independent, so I take Tai Chi. Leonard Jones, age 74 People who use canes are brave. They can be more independent and enjoy their lives. Shirley Warner, age 79 n emoving clutter & R tripping hazards n utting railings on all stairs P & adding grab bars in the bathroom n H aving good lighting, especially on stairs Contact your local community or senior center for information on exercise, fall prevention programs, or options for improving home safety. For more information on fall prevention, please visit: This brochure was produced in collaboration with the following organizations: VA Greater Los Angeles Healthcare System, Geriatric Research Education & Clinical Center (GRECC), and the Fall Prevention Center of Excellence Centers for Disease Control and Prevention National Center for Injury Prevention and Control 2015 CS259944D Falls are the main reason why older people lose their independence. Are you at risk?

16 Check Your Risk for Falling Please circle Yes or No for each statement below. Why it matters Yes (2) No (0) I have fallen in the past year. People who have fallen once are likely to fall again. Yes (2) No (0) I use or have been advised to use a cane or walker to get around safely. People who have been advised to use a cane or walker may already be more likely to fall. Yes (1) No (0) Sometimes I feel unsteady when I am walking. Unsteadiness or needing support while walking are signs of poor balance. Yes (1) No (0) I steady myself by holding onto furniture when walking at home. This is also a sign of poor balance. Yes (1) No (0) I am worried about falling. People who are worried about falling are more likely to fall. Yes (1) No (0) I need to push with my hands to stand up from a chair. This is a sign of weak leg muscles, a major reason for falling. Your doctor may suggest: Having other medical tests Changing your medicines Consulting a specialist Seeing a physical therapist Attending a fall prevention program Yes (1) No (0) I have some trouble stepping up onto a curb. This is also a sign of weak leg muscles. Yes (1) No (0) I often have to rush to the toilet. Rushing to the bathroom, especially at night, increases your chance of falling. Yes (1) No (0) I have lost some feeling in my feet. Numbness in your feet can cause stumbles and lead to falls. Yes (1) No (0) I take medicine that sometimes makes me feel light-headed or more tired than usual. Yes (1) No (0) I take medicine to help me sleep or improve my mood. Side effects from medicines can sometimes increase your chance of falling. These medicines can sometimes increase your chance of falling. Yes (1) No (0) I often feel sad or depressed. Symptoms of depression, such as not feeling well or feeling slowed down, are linked to falls. Total Add up the number of points for each yes answer. If you scored 4 points or more, you may be at risk for falling. Discuss this brochure with your doctor. This checklist was developed by the Greater Los Angeles VA Geriatric Research Education Clinical Center and affiliates and is a validated fall risk self-assessment tool (Rubenstein et al. J Safety Res; 2011:42(6) ). Adapted with permission of the authors.

17 Crossword Puzzle Across 4. Move your body every day to stay independent. Talk with this person before you become physically active. 6. Most falls occur at home. Turn these on as you move through the house and up and down the stairs. 7. Choose supportive footwear with these kinds of soles. Down 1. When you take four or more medications, including prescriptions, vitamins, herbal supplements, or over-the-counter remedies, your chance of these increases (2 words). 2. These floor coverings can cause you to trip (2 words). 3. These can help you feel better but can also make you feel drowsy, dizzy or lightheaded. Talk with your doctor and pharmacist about side effects. 5. One of the best forms of exercise it s easy and free. It can be done inside or outside, alone or with a friend. 06/08

18 Crossword Answers Learn more at the Minnesota Falls Prevention website, or call the Senior LinkAge Line at /08