State of the States in Head Injury

Transcription

1 State of the States in Head Injury Successful Strategies to Reduce Older Adult Falls Risks Ellen Schneider, MBA National Falls Prevention Resource Center National Council on Aging University of North Carolina at Chapel Hill Marissa Whitehouse, MEd National Falls Prevention Resource Center National Council on Aging 1

2 Learning Objectives Define ACL s goals related to their National Falls Prevention Resource Center and the state and Tribal grants awarded to implement and sustain EBFP programs. Describe lessons learned based on the experiences and data collected from the ACL-funded state and Tribal grantees, as well as an update on falls prevention as it relates to traumatic brain injury. Understand the role of NCOA's National Falls Prevention Resource Center in national, state and local falls prevention initiatives and identify ways that professionals, older adults, caregivers, and advocates can utilize the Center s resources. Identify national and state-based strategies of the National Falls Prevention Action Plan that are being implemented to accomplish the plan's goals. 2

3 Percent of U.S. Population Age 65+, 2010 AK Hawaii Color Legend WA OR NV CA ID AZ MT WY CO NM ND SD NE KS OK MN WI IA IL MO AR VT NY MI PA OH IN WV VA KY NC TN SC ME NH MA RI CT NJ DE MD < 15% > 15% % > 20 % TX LA MS AL GA FL Data source: U.S. Administration for Community Living/Administration on Aging, 2016, based on U.S. Census data

4 Percent of U.S. Population Age 65+, 2030 AK Hawaii WA OR NV CA ID AZ MT WY CO NM ND SD NE KS OK MN WI IA IL MO AR VT NY MI PA OH IN WV VA KY NC TN SC ME NH MA RI CT NJ DE MD Color Legend MS AL GA < 15% > 15% % > 20 % TX LA FL Data source: U.S. Administration for Community Living/Administration on Aging, 2016, based on U.S. Census data

5 Older Adults Make Up at Least 20% of the Population in One-Quarter of U.S. Counties Population Reference Bureau, 2015

6 Falls: A Growing Public Health Issue For older adults: The leading cause of injuries and injury deaths. 27,000 die each year from a fall one every 19 minutes. Every 11 seconds, an older adult is treated in an ED for a fall. $34 billion is spent on direct medical costs related to falls. Huge impact on quality of life. 6

7 Falls Are Usually Multifactorial Non-Modifiable Factors Age Modifiable Factors Muscle Weakness Race Sex FALLS Gait & Balance Problems Vision Impairment Prior Fall 4+ Meds or using psychoactive meds American Geriatrics Society & British Geriatrics Society, 2010 Environmental Factors/Home Risks 7

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9 Traumatic Brain Injuries from falls Falls are the most common cause of traumatic brain injuries. More than half (55%) of TBIs among children 0 to 14 years were caused by falls. One out of five falls causes a serious injury such as broken bones or a head injury More than twothirds (81%) of TBIs in adults aged 65 and older are caused by falls. 9

10 Population aging is a triumph of humanity but also a challenge to society. World Health Organization 10

11 The Good News: Most falls are preventable! 11

12 Falls are Preventable: LARGELY What Works Clinical assessment, treatment & referral Maximize vision Participation in evidence-based programs Opportunities to partner

13 ACL Falls Prevention Grant Goals 1. Significantly increase the number of older adults and older adults with disabilities who participate in evidence-based community falls prevention programs 2. Implement innovative funding arrangements to support these programs beyond grant period, embedding programs into an integrated, sustainable network Moving beyond discretionary grants, Older Americans Act funding, etc. 13

14 National Falls Prevention Resource Center Funded by the Administration for Community Living/ Administration on Aging Increase public awareness about falls prevention Serve as the national clearinghouse for tools and resources Support and stimulate evidence-based programs and strategies Began September

15 U.S. Administration on Aging 2016 Falls Prevention Grantees Inter Tribal Council of AZ Indian Health Council, CA Iowa Department of Public Health Rush University Medical Center, IL Elder Services of the Merrimack Valley, MA Southern Maine AAA MAC Incorporated, MD Spirit Lake Tribe, ND Mescalero Apache Tribe, NM NM Department of Health Marymount University, VA Administration for Community Living/Administration on Aging Falls Prevention Grantees: 15

16 ACL Grantee Evidence-based Falls Prevention Programs A Matter of Balance Tai Ji Quan: Moving for Better Balance Tai Chi for Arthritis YMCA Tai Chi: Moving for Better Balance Stepping On Otago Exercise Program Stay Safe, Stay Active FallScape Stay Active and Independent for Life (SAIL) 16

17 Benefits of Falls Prevention Programs Falls Prevention Program Tai Chi: Moving for Better Balance Stepping On Otago Exercise Program (adults 80+) A Matter of Balance Effectiveness Fall rate among participants was reduced by 55% Fall rate among participants was reduced by 30% Reduction of 35% in adults over age 80 Significant increase in falls efficacy, falls management, and falls control Sources: Report to Congress in November 2013: The Centers for Medicare & Medicaid Services Evaluation of Community-based Wellness and Prevention Programs under Section 4202 (b) of the Affordable Care Act. Stevens JA, Sogolow, ED. Preventing Falls: What Works A CDC Compendium of Effective Community-based Interventions from Around the World; Atlanta, GA: CDC, Carande-Kulis, VG, Stevens, JA, Beattie, BL & Arias, LA cost-benefit analysis of three older adult fall prevention interventions, Journal of Safety Research, National Council on Aging 17

18 Return on Investment of Falls Prevention Programs Tai Chi Moving for Better Balance o $1.60 return on a $1 investment in direct medical costs Stepping On Fall Prevention Program o $70 return on a $100 investment in direct medical costs Otago Exercise Program delivered to persons aged 80 and older o $1 return on a $1 investment in direct medical costs 18

19 Return on Investment: 2013 CMS Report to Congress A Matter of Balance (MOB) Meeting the Institute of Healthcare Improvement s Triple Aims Better Health Increased physical strength and activity Better Care Increased physical and occupational therapy use Communication Program participation correlated with reduced mortality rates Lower Cost $938 decrease in total medical cost savings per year $517 reduction in unplanned hospitalization costs $234 reduction in skilled nursing facility costs $81 reduction in home health costs 19

20 Program Reach Since September 2014, nearly 24,000 older adults and adults with disabilities have enrolled in ACL grantee-supported falls prevention programs! % Reporting Relevant Data Living Alone 49% Average Age 76 At least one fall in last three months 20% At least one chronic condition 89% Chronic conditions Arthritis (61%), Heart Disease (28%), Diabetes (22%) Disability 39% Fearing falls somewhat or a lot 49% 20

21 Reported Outcomes Between September 2014 and July 2016, participants enrolled in ACL grantee-supported falls prevention programs reported the following outcomes: Program helped reduce their fear of falling Feel they can protect themselves from a fall % Improved/Maintained 83% 88% Can find a way to reduce falls 90% Can find a way to get up if they ve fallen 87% Can increase their physical strength 88% Have become more steady on their feet 86% 21

22 What encourages seniors to enroll in a fall prevention program? Feel that program is relevant Believe it will improve quality of life Low intensity exercise Invitation from a healthcare provider Involved in decision making Good self-efficacy Social support Acknowledgement: Dr. Rita Noonan, CDC 22

23 What discourages seniors? Fatalism Denial of fall risk Poor self-efficacy No history of exercise Fear of falling Poor health & functional abilities Low health expectations Stigma of programs for older adults Acknowledgement: Dr. Rita Noonan, CDC 23

24 Saving Lives, Saving Money 2015 National Council on Aging 24

25 Implementation, Partnership, and Sustainability Strategies Contract with insurance companies, such as Medicare Advantage plans, to reimburse for programs Engage hospitals and trauma centers to embed programs Work with first responders to embed STEADI/make program referrals 2015 National Council on Aging 25

26 Implementation, Partnership, and Sustainability Strategies Train Community Health Workers to deliver programs Curriculum for Community Health Workers/Promotores Train PT students to deliver programs Develop statewide databases/hubs for program referrals 2015 National Council on Aging 26

27 Supporting Clinical Screening, Assessment, Treatment, Referral & Follow Up 27

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29 STEADI Algorithm Adapted from AGS/BGS Clinical Practice Guidelines,

30 Stay Independent: A validated self-assessment tool Rubenstein, J Safety Res,

31 EMS and Falls Vermont Department of 31

32 National Falls Free Initiative A thousands-strong and growing network National Action Plan developed in 2005; updated in 2015 Strong partnerships ACL and the Aging Network CDC s National Center for Injury Prevention and Control National organizations State and local public health entities Falls Free is a critical effort to meet Healthy People 2020 goal of reducing older adult fall-related ED visits by 10% 43 State Falls Prevention Coalitions 32

33 NCOA Map of Partners & Programs National Council on Aging 33

34 Effective Coalitions Enfold Key Partners Public Health Health Care Providers Hospitals Home Health EMS/1st Responders Prof. Associations Older Adult Housing Others Premise of the National Action Plan: Everyone has a role to play, especially older adults and those who care for/about them. Aging Services Network 34

35 National Fall Prevention Awareness Day Ready, Steady, Balance: Prevent Falls in 2016 September 22, 2016: 1 st day of fall 9 th Annual FPAD in 2016 NCOA is working on obtaining a U.S. Senate Proclamation 2015 Reach: 41 State Falls Prevention Coalitions, D.C. Falls Free Coalition, and 7 states National awareness and education media efforts reached an estimated 97 million individuals State coalition efforts reached nearly 2 million individuals through education, awareness, and advocacy efforts, as well as fall prevention programs and fall-risk screenings 2015 National Council on Aging 35

36 State and Local FPAD Activities Proclamations state and local Public awareness activities Professional education Physical activity events Falls risk screening fairs Enrolling older adults in evidence-based falls prevention programs State and local advocacy activities 2015 National Council on Aging 36

37 FPAD Resources General Resources Marketing & Media How to Get Involved Past Activities Advocacy 37

38 Social Media Activities Twitter Chat Sept 2:00pm EDT Facebook Live event Sept 1pm EDT Topic: Home safety 38

39 NCOA Falls Free Video Contest Open to all! Images must be clear, sharp, and depict older adults participating in a falls prevention program or activity Need a signed consent form Cash prizes for 1 st, 2 nd, and 3rd place winners Send entries to FallsFree@ncoa.org More information:

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41 6 Steps to Prevent a Fall Video (in English and Spanish) 41

42 National Falls Prevention Action Plan 12 Goals, 40 strategies and 242 action steps Physical Mobility Medication Management Home Safety Environmental Safety Public Awareness and Education Funding and Reimbursement Expansion of Evidence-based Programs Policy and Advocacy Source: 42

43 Next Steps National Action Plan Broadly disseminate the plan Encourage ownership and adoption of the plan s strategies and action steps Collaborate with and involve key stakeholder organizations to further disseminate and implement the strategies and action steps. Seek funding to support key strategies, alone or in conjunction with stakeholders organizations. 43

44 Next Steps National Action Plan Partner with and/or advise organizations to support public policy and advocacy initiatives. Track progress by identifying national and state initiatives related to the implementation of the plan s strategies and action steps and their outcomes. Develop follow-up report three years after the 2015 National Falls Prevention Action Plan. 44

45 Better late than never Risks reduced even in late life Benefits significant despite age It s never too late to start, & it s always too early to stop! 45

46 It Takes A Village It takes a village of stake holders working together to prevent falls and reduce falls risk, tasks that no one stakeholder can accomplish alone Ganz,DA, Alkema,GE, and Wu,E. Injury Prevention,

47 Thank You Questions? 47