Health Care Professional Educational Module

Module Goals

To increase:

 Health care professional knowledge about falls-related issues and prevention interventions among older adults   The number of health care professionals who attend the

Stand Strong for Life

: Health Care Professional Educational module The number of health care professionals who educate older adults about fall prevention using the

Stand Strong for Life

intervention

Module Goals

To Increase:

 The number of health care professionals who attend the

Stand Strong for Life

: Health Care Professional Educational module  The number of emergency departments, hospitals, and senior living facilities that implement falls prevention initiatives  Community partnerships among health agencies to increase falls prevention among community-dwelling older adults

Intervention Content

   

Stand Strong for Life:

Health Care Professional Educational Module

Stand Strong for Life:

Community dwelling older adults PowerPoint presentation Four brochures that accompany the community-dwelling older adult presentation Resources and Tools

Definition of Fall

A fall is “any event in which a person unintentionally comes to rest on the ground or another lower level such as a chair, toilet, or bed.” 12

Scope of the Problem

 For adults 65+, falls are the leading cause of injury-related death 3,4  Each year, more than one-third of older adults fall 5-9  In 2004, 2.9 M older adults were treated for non-fatal injuries in U.S. emergency departments; of those, 1.9 M were the result of falls 10  Nearly one-half of all falls among older adults occur in or around their homes 10

Scope of the Problem

 Of those who fall, 20% to 30% suffer moderate to severe injuries 13  Nearly 50% of those hospitalized after a fall die within one year 9  In 2003, nearly 13,820 older adults died from fall-related injuries: of those, approximately 50% were age 85 and older.

10

Cost of Falls Among Older Adults

 Fall-related injury costs $20 billion per year 21  By 2020, total annual direct cost is expected to reach $32,4 million 21  Direct costs do not account for the long term consequences of these injuries 22

Challenges to Be Met

 Between 2000 and 2030, the older adult population (65+) is projected to grow from 35 million (12.4% of the population) to over 70 million (20% of the population) 1,2  The U.S. public health service estimates that 66 percent (2/3) of deaths related to fall are preventable 14  How do we go about facing the challenge of reducing falls and fall-related injuries among older adults?

Risk Factors

 Internal – integral to patient’s system  Medical conditions  Aging process  External – physical environment  Living environment  Emergency Department/Hospital/ Senior Living Facility  Outdoors

Falls among older adults are usually not the result of a single risk factor, but of a combination of internal and external factors 24

Internal Risk Factors

 History of Falls (Previous Falls)  Medication use (Polypharmacy)  Balance, gait, and muscle strength (Lack of Physical exercises)  Vision impairment  Podiatric problems

History of Falls

(Previous falls)

 Older adults who have previously fallen or who stumble frequently are 2 to 3 times more likely to fall within the next year 9,25,33  Previous falls often leads to fear of falling, which may lead to decreased activity and loss of self-confidence 27

History of Falls

(Previous falls) FALL FEAR OF FALLING DECREASED FUNCTIONAL ABILITY REDUCED ▪ MUSCLE STRENGTH ▪ BALANCE AND GAIT ▪ FLEXIBILITY DECREASED ACTIVITY

Visual Impairment

 Poor visual acuity 27  Older adults experience decreased night vision, altered depth perception, decline in peripheral vision, and glare intolerance 25,37  Also be aware of old or new prescription glasses 27

Medication Use

(Polypharmacy)

 Types of medications 25,32  Psychoactive medicines  Number of administered or prescribed medications (polypharmacy) 25,27  Rule of thumb: 4 or more medications  Number and types of over-the-counter medication (NSAIDs, vitamins, supplements, homeopathy, etc.)

Balance, Gait, and Muscle Strength

(Lack of physical activity)

 Less than 25% of older adults exercise regularly 40  By age 65, a 20% decrease in strength and flexibility usually occurs 41,42  After age 70, decrease in strength is even greater 41,42

Podiatric Conditions

 Nearly 75% of older adults have some type of foot and ankle problems 49  Decreased sensation in the feet 21  Foot conditions can impair balance function 50

External Risk Factors

 Unsafe home environment  Inadequate footwear  Unsafe outdoor environment  Unsafe emergency department/ hospital/facility environment

Unsafe Home Environment

22,25

        Slippery flooring and carpeting Use of throw rugs Inadequate furnishing design and position Poor lighting Lack of equipment in bathroom and bathtub Lack of or structurally unsecured handrails Clutter Inadequate assistive devices

Inadequate Footwear

Improper shoes can: 27  Lead to painful mobility  Increase potential for feet problems  Prevent older adults from staying active  Increase the risk for falls

Unsafe Outdoor Environment

 Uneven sidewalk, terrain, curbs, sidewalks  Lack of or structurally unsecured handrail  Hazardous materials (ice, snow, gravel, etc.)  Poor lighting

Unsafe ED/Hospital/Facility Environment

 Transfer to or from a bed or chair 17  Bed height 16  Attachment to equipment (IV, oxygen) 17  Slippery floors  Lack of assistive devices  Clutter, tripping hazard  Unreachable bell, side table  Improper lighting  Mechanical restraints 19,20

How Can You Prevent Falls From Occurring?

The goal of a falls prevention program is to reduce the number of risk factors

Intervention Model

 Community Setting Presentation/Intervention  Emergency department, hospital, senior living community Intervention

Falls-Risk Assessment

(Previous falls)



Falls-Risk Assessment Tools

 Morse Fall Scale (MFS)   Hendrich II Fall Risk Scale Falls – Assessment/Screening/ Diagnosis Scale

Falls-Risk Assessment

(Previous falls)



Community Presentation

 Conducted before presentation 

Emergency Department, Hospital, or Senior Living Community

 Conduct screening when fitting (triage, admission, move-in)

Vision Examination

(Visual impairment)



In all settings

 Educate older adults  Refer to primary care provider for regular eye examinations

Medication Review

(Polypharmacy)



Community Presentation

   Educate older adult Refer to primary care provider or pharmacist Distribute

Safe Medication Card



Emergency Department, Hospital, or Senior Living Community

 Educate older adult  Refer to primary care provider or pharmacist   Refer to

Stand Strong for Life

Distribute

Safe Medication Card

Physical Activity

(Reduced balance, gait, and muscle strength)



Community Presentation

    Educate older adult Distribute and Practice

Healthy Movements

Distribute

Health Calendar Contract

Refer to primary care provider or community and home health services 

Emergency Department, Hospital, or Senior Living Community

   Educate older adult Distribute

Healthy Movements

Refer to

Stand Strong for Life

(medium and high risk)

Examples of Physical Activities

 Walking  Gardening  Dancing  Strength, resistance, and flexibility exercises  Yoga  Tai Chi

In-Home safety

(Unsafe home environment)



Community Presentation

   Educate older adult Distribute

Check for Safety: A Home Fall Prevention Checklist for Older Adults

brochure Refer to community and home health services 

Emergency Department, Hospital, or Senior Living Community

    Educate older adult Distribute

Check for Safety

brochure Refer to

Stand Strong for Life

community presentation (medium and high risk) Refer to community and home health services

In-Home Modifications and Assistive Devices

 Widening doorways  Remove any clutter (staircase, floor)  Remove throw rugs  Remove electric cords  Install railings on stairways  Install grab bars in bathtub, shower, and by toilet  Use shower chair  Install raised toilet seat

Feet and Footwear Check

(Podiatric problems and inadequate footwear)

 

Community Presentation

  Educate older adult Distribute

Foot and Footwear Check

brochure  Refer to primary care physician and home health services, if needed

Emergency Department, Hospital, or Senior Living Community

    Educate older adult Distribute

Foot and Footwear Check

brochure Refer to

Stand Strong for Life

presentation community Refer to primary care physician and home health services, if needed

Adequate/Inadequate Footwear

 Adequate  Proper fit  Non slippery soles  Low heels  Inadequate  Floppy slippers  Loose fitting  Wearing socks only

Assistive Devices

 Cane  Walker  Hip protectors  Grip bars  Shower chair  Raised toilet seat

Community Services and Referrals

 Home care service agencies  Personal trainer or exercise program dedicated to older adults  Social services  Day care  Meals on Wheels