Falls Prevention in the Hamilton Niagara Haldimand Brant Local Health Integration Network (HNHB LHIN)

Transcription

1 270 Main Street East, Units1-6 Grimsby ON L3M 1P8 Tel: Fax: , rue Main Est, unités 1-6 Grimsby ON L3M 1P8 Tél : Téléc : Falls Prevention in the Hamilton Niagara Haldimand Brant Local Health Integration Network (HNHB LHIN) I. Why Falls Prevention? II. What do we Know about Falls and Seniors? a) A Profile of Falls in the HNHB LHIN b) Risk Factors Highlighted in the Research c) A Summary of Falls Prevention Related Activities in HNHB LHIN III. HNHB LHIN Falls Prevention Planning Activities IV. A Planning Framework for Falls Prevention

2 I. Why Falls Prevention? II. Every 10 minutes in Ontario, at least one senior visits an emergency department due to a fall Every 30 minutes in Ontario, at least one senior is admitted to hospital due to a fall Falls are the leading cause of injury among older adults accounting for 59% of injury-related emergency department visits and 80% of injury Hospitalizations $5.7 billion dollars is the estimated annual cost For intentional and unintentional injuries in Ontario 1 What do we Know about Falls and Seniors? a) Falls in Ontario and in the HNHB LHIN A Closer Look at Falls in the HNHB LHIN in Comparison to Other LHINS (2004/05 data) 2 Indicator HNHB LHIN Ranking Among LHINs Number of emergency 19,023 1st department visits Number of hospitalizations 3,906 1st Emergency department visit rate per 100,000 9,297 6th Injury hospitalization rate per 100,000 1,806 7th 1 The Economic Burden of Injury in Ontario SMARTRISK 2 Economic Burden of Injury in Ontario (2006) Injuries Among Seniors in Ontario (2007) The Ontario Injury Prevention Resources Centre at SMARTRISK 2

3 An Analysis of Emergency Department Visits due to Falls in HNHB LHIN Communities (65+ years, 2005/06) 3 Ranking Location Number of Falls 1 Hamilton 4,207 2 St. Catharines 1,300 3 Burlington 1,154 4 Niagara Falls Brantford Norfolk County Welland Haldimand County Fort Erie Port Colborne 295 An Analysis of Hospitalizations due to Falls due to Falls in HNHB LHIN Communities (65+ years, 2005/06) 4 Ranking Location Rate of Falls (per 100,000) 1 Port Colborne 2,043 2 Welland 1,974 3 Haldimand County 1,920 4 Brantford 1,820 5 Norfolk County 1,705 6 Brant County 1,627 7 St. Catharines 1,502 8 Fort Erie 1,474 9 Niagara-on-the-Lake 1, Hamilton 1,417 3,4 Economic Burden of Injury in Ontario (2006) Injuries Among Seniors in Ontario (2007) The Ontario Injury Prevention Resources Centre at SMARTRISK 3

4 b) Risk Factors Highlighted in the Research There are several factors that individually or in combination put older people at risk for falling. Fear of Falling Medication Use Vision Mobility / Gait / Balance External Environment History of Falls Medical Condition (e.g. Osteoporosis, Chronic conditions) Mental Health Cognitive Impairment Nutrition Lack of Physical Senior s Home (inside and outside the home) Continence Excessive Alcohol Consumption History of Falls Evidence suggest that individuals 65 years of age and older who have had a previous fall within the past 12 months, are at an increased risk of a subsequent fall. Fear of Falling Older adults who have previously fallen or who are becoming increasingly frail can become apprehensive of falling and the subsequent outcomes. These include being unable to get up and being injury and/or hospitalized, social embarrassment associated with the fall, potential loss of independence and having to move from home. Fears and anxieties can compromise `individuals quality of life and further increase their risk of falling due to adaptive behaviours. These include restricting activities necessary to 4

5 maintain strength and balance, or making changes in balance control which can result in stiffening or loss confidence in their ability to prevent or manage falls. Nutrition An unbalanced diet can result in poor balance and weakness, which contribute to an overall increase in the incidence of falls. Poor nutrition also prolongs the recovery period after a fall and can result in increasingly severe injuries after a fall. Inadequate vitamin D and calcium intake contributes to accelerated bone loss and significant decreases in bone mineral density, placing individuals at an increased risk of fractures following a fall. Research links good nutrition with risk reduction and disease management. 5 Medication Use Seniors may experience increased sensitivity to medication for a number of reasons: decreased functioning of their liver and kidney, ability to maintain a normal blood pressure range, sensitivity to hot and cold, changes in their digestion, decreased metabolic rate and a higher prevalence of chronic diseases. This often results in unpredictable cumulative effects of multiple medications. Polypharmacy (use of multiple medications prescription, non-prescription and natural remedies) is increasingly common in older individuals, which increases the risk of side effects such as dizziness, drowsiness, decreased mental alertness, changes in balance, and impaired mobility which together can result in instability and falls. Medical Condition (e.g. Osteoporosis, Chronic Conditions) Balance and mobility can be significantly impaired by chronic conditions, which place affected individuals at higher risk of a fall. High risk conditions include stroke, multiple 5 Eating for Health, Shepell-fgi Health & Wellness Resource (2006) 5

6 sclerosis, Parkinson s disease, arthritis, low blood pressure, coronary heart disease or osteoporosis. For example, individuals with osteoporosis are also more susceptible to fractures after a fall, as their bones have become increasingly porous (decreased bone mineral density), making them less resistant to stresses. Cognitive Impairment Confusion, disorientation, and memory decline are symptoms associated with Alzheimer s disease, dementias and deliriums. The incidence of falls in this population is significantly higher and they have a tendency to sustain more serious injuries, a poorer prognosis for recovery, and an increased risk of hospitalization or institutionalization after a fall. Vision Assessment Vision changes and/or vision losses are commonly associated with aging. Glaucoma, cataracts, macular degeneration, retinopathy, limited or poor vision, and glasses with incorrect prescription all contribute to an increased risk of falls by disturbing balance and obscuring hazards. Mobility/Gait/Balance Age associated changes in mobility, gait and balance include muscle weakness as a consequence of muscle tone loss, joint stiffness, slowed reflexes, a decreased sense of body position, and changes in walking ability. As a result, individuals have decreased mobility and a poor sense of balance, making them unsteady on their feet and therefore at an increased risk of a fall. Continence Individuals who have bladder or bowel control issues, or who now require more frequent trips to washroom facilities are at an increased risk of falling, with the risk increased during the night. Falls can occur if the individual is rushing to reach the facilities within an appropriate time or incontinence can result in slipping on wet floors. Dizzy spells are 6

7 also commonly associated with bladder control issues, which can contribute to the risk of falling. Lack of Physical Exercise The relationship between exercises (regardless of the type) and falls prevention is well documented in the research. Findings of a study conducted by The Canadian Cancer Society and Cancer Care Ontario of Ontario adults, found that 53% of women and 43% of men did not meet the recommended 3 hours of moderate to vigorous physical activity per week. Mental Health Mood and psychotic disorders, such as depression can leave individuals less interested and able to participate in physical activities, resulting in a loss of muscle tone and strength. Individuals with mental health issues may have difficulty understanding the precautions necessary to prevent and manage falls. Excessive Alcohol Consumption Alcohol use can significantly alter balance and impair judgment, which together may increase the risk of falling. The Environment (Within the Senior s Home/property) The internal home environment refers to where the seniors lives (both inside and outside a senior s home this includes driveways and sidewalks). This includes a range of accommodations (e.g. Long term care facility, retirement homes, senior s apartments, houses etc.) A variety of environmental hazards can increase an older individual s risk for fall (e.g. loose or uneven rugs, poor lighting, unstable furniture, spills not properly wiped up, lack of grab bars, hall rugs, and slippery floors). External Environment 7

8 The external physical environment refers to outdoor public spaces and buildings, green spaces, noise levels, air pollution, cleanliness, safe pedestrian crossing, safety and security, accessibility and outdoor resting areas. Potential hazards for falls include poor building design, lack of building maintenance, curbed and uneven sidewalks, poor lighting, lengthy distances to sitting areas, heavy doors, sidewalks covered in snow or ice, lack of accessible washrooms and wheelchair ramps that are too steep. These problems directly impact on a senior s mobility, safety, security, health status and ability to participate in society. c) Summary of Falls Prevention Related Activities in HNHB LHIN A survey was distributed in January 2008 to health service providers from across the continuum in the Hamilton Niagara Haldimand Brant Local Health Integration Network. The results of this survey reflect existing programs, resources and expertise within HNHB LHIN related to falls prevention. This summary is intended to: Serve as a tool for individuals to make connections locally Identify opportunities to learn from each other and build upon knowledge, skills and Facilitate collaboration across health services and the broader community for effective falls prevention and management II. HNHB LHIN Falls Prevention Planning The Hamilton Niagara Haldimand Brant Local Health Integration Network (HNHB LHIN) has a higher proportion of seniors than the Ontario average. They have responded to issues of safety and security by actively engaging key leaders and stakeholders to 8

9 assist in developing a planning framework that focuses on prevention, decreasing the incidence and reducing the impact of falls on seniors. Two HNHB LHIN wide meetings on Falls Prevention were held on February 14 th and June 5 th The full proceedings of these meetings and the presentations are posted on the website under Aging at Home, Falls Prevention. These proceedings are intended to provide some of the foundational information to facilitate Service Plan development for the Aging at Home Strategy in Year 2 of the HNHB LHIN. Falls Prevention has been identified by the HNHB LHIN Board of Directors as one of the priority areas for Year 2 Aging at Home funding. IV. A Planning Framework for Falls Prevention A Falls Prevention Planning Framework was developed to serve as a consistent reference point and a common vision about what is needed for effective falls prevention and management. It provides a common understanding of the risk reduction factors identified in the research re: Falls Prevention. This framework will guide efforts for cross-sector collaboration across health system and the broader community in the HNHB LHIN. 9

10 HAMILTON NIAGARA HALDIMAND BRANT LOCAL HEALTH INTEGRATION NETWORK FALLS PREVENTION PLANNING FRAMEWORK (July ) Goal: To prevent, decrease the incidence and reduce the impact of falls amongst seniors living in Hamilton, Niagara, Haldimand, Brant, Norfolk, and Burlington Range of Interventions to Decrease Falls A Safe External Physical Environment Age friendly, safe, accessible communities, barrier free design, safety audits and transportation Assessing and Modifying a Senior s Home Environment (inside & outside home) Home hazard assessment and implementing results Regular Exercise Muscle strengthening, balance, endurance, flexibility & co-ordination Medication Review and Modification Interactive effects of multiple medications, reduce / substitute psychotropic, narcotics & anticonvulsants Nutritional Review & Vitamin Supplement Vitamin D & calcium supplements, bone health, healthy eating & hydration Raising Public Awareness/ Education Target audience are seniors, caregivers, health service providers, physicians & general public Enhancing Senior s Health Status Medical care, assistive devices(hip protectors, gait stabilizing device) counselling, vision assessment, foot care, chronic disease self management, appropriate use of least restraint Target Group Well Elderly / Low Risk Medium Risk High Risk Middle aged adults Seniors who have been identified as Seniors who have a high frequency Seniors who have not had a fall at-risk or who have had of falls; Seniors who have severe occasional falls/near falls fall related injuries and/or who continue to fall despite interventions Ongoing Activities Identification of seniors at risk of falls using a variety of methods and access points Screening and assessment of seniors to determine risk and the appropriate intervention(s) Building the skill and knowledge of health care providers Measuring the impact of interventions at an individual, community and HNHB LHIN wide level Long Term Objectives Reduction in emergency room visits and/or hospital admissions related to falls Reduction in percent of seniors on long stay home care who report a fall within 90 days Move forward collectively on a HNHB LHIN wide Falls Prevention Strategy that is sustainable building on local leadership and resources Each intervention will require different strategies and stakeholders; There are cross over implications for each of the interventions Home refers to where the seniors lives and includes a range of accommodations (e.g. Long term care facility, retirement homes, senior s apartments, houses etc.)