Solving Gravity: Injury Prevention

Transcription

1 Solving Gravity: Injury Prevention Sally Aerts, MPH, PT Falls Prevention Specialist, Utah Department of Health/Bureau of Health Promotion; Salt Lake City, Utah Kristen Gooch, MPH, RN Trauma Outreach and Injury Prevention Coordinator, Intermountain Medical Center, Intermountain Healthcare; Salt Lake City, Utah Objectives: Discuss the need for an evidence-based injury prevention program at a Level 1 Trauma Center Identify the scope and impact of falls on the older adult Describe the stepping On program: Key components, prior research findings, and current outcomes Outline a comprehensive multidisciplinary program focused on prevention of older adult falls

2 The Utah Senior Falls Prevention Program Kristen Gooch, RN, BSN, MPH Trauma Outreach and Injury Prevention Coordinator Intermountain Medical Center Sally Aerts, PT, MPH Utah Department of Health Violence and Injury Prevention Program

3 Objectives 1. Identify the scope and impact of falls on the older adult. 2. Understand the need for an evidence-based injury prevention program at a Level 1 Trauma Center. 3. Understand the Stepping On program: key components, prior research, and current outcomes. 4. Outline a comprehensive multi-disciplinary program focused on prevention of older adult falls. e-supercut-the-physical- C#c=90N6LH0CH5M854GD&t=Vulture

4 Topics Covered Burden of Senior Falls Preventing Falls Resources Utah and IMC Falls Prevention Program

5 Falls are Common in Older Adults HALF of adults 80+ fall each year Two-thirds of those who fall will do so again within 6 months

6 FALLS

7 How big is the problem in Utah? fall-related hospitalizations Falls account for over 52% of all injury-related deaths. As many as 30% of older adults who fall suffer significant injuries which may limit their ability to live independently.

8 2015 ALL TRAUMA PATIENTS 5% 20% 17% 6% 3% 3% 17% 29% MCC MVC GSW GLF Fall PED Ski/Snowboard Other

9 7% 4% 2014 Trauma Registry Deaths 18% 35% 8% 19% 9% Falls 65+ Fall GSW MCC MVC PED Other

10 Cycle of Consequences Fear of falling/loss of confidence Loss of physical fitness/ Functional decline Activity restriction Isolation Reduced mobility

11 Modifiable Risk Factors Biological Behavioral Muscle weakness Gait and balance problems Poor vision Risky behaviors 4+ medications Psychoactive meds Inactivity Environmental Clutter and tripping hazards in the home No stair railings or grab bars Poor lighting

12 Occurrence of Falls by Number of Risk Factors Percent Falling 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Number of risk factors Tinetti et al, NEJM 1988; 319:1701

13 Performance of Fall Risk Assessments Fall description Postural hypotension Vision Gait/balance LE muscle strength Feet/footwear Home/environment safety Vitamin D High fall risk medication Medication addressed 0% 20% 40% 60% 80% 100%

14 Medications CLASS ODDS RATIO (95% CI) Psychotropic Meds 1.96 Antipsychotics 3.62 Hypnotics and anxiolytics 1.81 Antidepressants 2.35 Short acting benzodiazepines 1.94 A.M. van Strien et al. / Maturitas 74 (2013)

15 Programs selected for trauma center injury prevention efforts should be proven and promising programs. The public health framework views injury as a disease that can be prevented.

16 Evidence Based Programs Applying the best available research results (evidence) when making decisions about health care. Evidenced Based Programs have been proven effective through evaluation of outcomes.

17 Public Health Model

18 Public Health Model The public health model focuses on the health and safety of the entire population and incorporates a collaborative approach that involves a multi-disciplinary team.

19 Location of fall- Utah 4% 15% 13% 68% Home/Residence Residential Institution Health Care Facility All other

20 Financial Burden $35, , the total direct medical costs, was 34 billion dollars. One of the most expensive conditions among this age group.

21 Many falls are preventable! Falls are NOT an inevitable part of aging

22 Stepping On Evidence-based CDC and AoA endorsed 31% reduction in falls! 7 weeks, 14 hours For older adults who: a) are at risk of falling, b) have a fear of falling, or c) who have fallen one or more times.

23 Why Stepping On works Empowers older adults to make changes to reduce risk of falls. Subjects covered: Improving balance and strength home modifications community safety vision medication review safe footwear

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25 Core demographics Female Live alone Have a fear of falling Fallen in past 3 months Multiple chronic health Limit activity 0% 20% 40% 60% 80% 100%

26 More comfortable increasing activity Strongly agree Agree Disagree Strongly disagree

27 More comfortable talking to healthcare provider about falls Strongly agree Agree Disagree Strongly disagree

28 Would recommend program Strongly agree Agree Disagree Strongly disagree

29 Steps taken to reduce fall risk

30 Fall Prevention at Intermountain Medical Center Collaborative/Multidisciplinary Falls Prevention approach Unified Fire Department Emergency Department Inpatient floor T-11 Inpatient floor T-8

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32 2014 EMS Dispatches Adults 65 and older 9382 Fall 20.3% Transfer 14.9% Sick person 13.0% 6216 All Others 51.8%

33 EMS- Unified Fire Department

34 Emergency Department

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36 Falls Risk Assessment (Stay Independent) Developed by Greater Los Angeles VA Geriatric Research Education Clinical Center and affiliates and is a validated fall risk selfassessment. Rubenstein et al. J Safety Res; 2011:42(6)

37 - Inpatient Floors, T-8 and T-11

38 STEADI: Stopping Elderly Accidents, Deaths, and Injuries

39 Home Safety The home environment is implicated in 35-40% of falls. Josephson et al, 1991

40 Efficacy of Home Modifications Gillespie et al, Cochrane Review Fall Interventions, 2012 Home safety interventions reduce rate of falls and risk of falling More effective in people at higher risk of falling.

41 Reasons for not doing home modifications Not being able to do it themselves - 37% Can't afford to make changes - 36% Not trusting contractors - 29% Not knowing how to make changes - 25% Not having anyone to do it for them - 23% Not know how to find a contractor - 22% 0% 5% 10% 15% 20% 25% 30% 35% 40% AARP 2000 Fixing to Stay: A National Survey of Housing Home Modifications Issues

42 2-1-1 Resource Line

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44 Utah senior falls prevention Health systems and Health plans Healthcare providers Community programs Aging services, care givers, professional organizations First responders Public awareness

45 Class Schedules Online: workshop_search/ Within Salt Lake County: Salt Lake Aging and Adult Services Salt Lake County Health Department Intermountain Healthcare

46 Contact Information Kristen Gooch, RN, BSN, MPH Trauma Outreach and Injury Prevention Coordinator Intermountain Medical Center Sally Aerts, PT, MPH Utah Department of Health Violence and Injury Prevention Program