Transcript Interior Health Youth Suicide and Abuse Prevention Planning

THE EVOLUTION OF SENIORS’
FALLS PREVENTION IN BRITISH
COLUMBIA
Dr. Vicky Scott,
Lillian Baaske, Dorry
Smith, Tessa
Graham, Dr. Elaine
Gallagher, Dr. Ian
Pike, Matt Herman &
Mike Vanderbeck
B.C. Seniors
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Those 65+ account for 13.7% of the B.C.
population
1995 to 2004 population 65+ rose from
475,300 to 574,400 (21% increase)
2004 to 2010, number of seniors is expected
to grow by another 17% to 672,000
Between 2001 to 2021 the average age in
B.C. will increase from 38.2 to 42.6 years
Outline
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Laying the Groundwork
Policy Considerations
Environmental Scan in B.C.
Translation of Research to Practice
The Interior Health Authority Experience
Laying the Groundwork for B.C.’s Success
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15 years of sustained collaboration
Champions positioned to support and influence
Recognition of opportunities and timing
Shared vision and commitment
Leadership
Strategic investment of limited resources
Strategic multi-sectoral partnerships
Involve the right people in decisions, including those
affected by the problem
Respect for roles and responsibilities
Essential Questions for Falls Prevention Planning
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What is the nature and magnitude of the problem in
your region?
What policies do you need to support prevention?
Who should be involved in prevention?
Who is at risk for falls and injuries?
What are the best prevention strategies?
How will you know if the strategies work?
How will prevention efforts be sustained?
Falls & Injury Prevention Planning
RESEARCH
POLICY
PRACTICE
What is the nature and
magnitude of the falls in
your region?
Who is at risk for falls and
injuries?
Are you using the best data sources
to highlight the problem? Do you
know how the problem has changed
over time and what is expected in
the future? Do you know the
economic burden of falls for your
region and how this compares to
other health issues and other
regions?
What are the risk factors for falling
and sustaining a fall-related injury?
Who is at greatest risk? How does
risk vary across sub-populations of
men and women, active seniors vs.
frail seniors in the community,
seniors in acute care or residential
settings?
What are the most
reliable sources of
evidence?
How will you engage policy
makers, health care
managers and agencies to
support your research and
translation efforts?
Who in your region is
conducting research on falls
prevention? Can you access
those who are able to identify
reliable sources of research and
translate findings into effective
practice?
What policies, regulations
or guidelines do you need
to support falls
prevention?
How will you resource the
strategies? What time commitments
are required? Will you engage those
at risk, volunteers, staff and
managers? How will you contact
your target audience? Who has the
greatest potential for planning,
implementing and evaluating
prevention activities?
What evidence do you need to
affect decision-making, program
planning, evaluation and resource
allocation? Who has the greatest
potential for effecting change in
policy and practice? Who will fund
research efforts?
What are the best
practices and prevention
strategies?
How do we know what works best
to reduce risk and minimize
outcomes? How do we know what
will work in practice? What policies
are needed for strategies to be
effective? Can you translate the
evidence into a business case for
resources to support cost-effective
prevention?
What policies do you need
to support evidencebased prevention?
Can research be used to create
a climate for this issue? What
evidence is needed before this
issue will gain the support of
policy-makers and those that
will resource prevention efforts?
How will you know if the
strategies work?
How will prevention
efforts be sustained?
What will be evaluated? What
process and outcome measures will
you use? How will you know if your
strategies are cost-effective? How
will you know if there are gaps in
your efforts? How will you share
this information and for what
purpose?
How will you use the evaluation
outcomes to improve your
prevention plan? What research
and policy support do you need
to maintain effective prevention
efforts?
Scott et al., 2005. Evolution of Seniors’ Falls Prevention in British Columbia
Policy Considerations
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Action on falls did not happen overnight
Important ingredients: policy decisions,
champions, evidence, opportunities and timing
Collaborative jurisdictional action on aging:
the context
Policy Considerations
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Key policy and documents
commissioned/released by F/P/T Ministers
Evidence led to action and engagement of
experts and those affected by the problem
Commitment to injury prevention and falls was
built over time
Nationally unique partnership between Health
Canada and Veterans Affairs launched in
2001
Policy Considerations
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Continued federal/provincial/regional collaboration
following the HC/VAC program
Critical mass of individuals involved at different levels
in the issue developed: state of readiness to act
Environment created to support further collaboration
Development and release of the Environmental Scan:
Seniors and Veterans Falls Prevention Initiatives in
B.C. 2005
Establishment and support of BC Falls Prevention
Coalition 2005
Overview of Activities
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Ottawa Charter (1986)
National Framework on Aging (1998)
BC Office for Injury Prevention (OIP) – focus 0-24 years
Deputy PHO created BCIRPU – focus on all ages (1997)
BC Summit on Falls Prevention (1998)
F/P/T Ministers of Health and Safety and Security
Working Group (SSWG) (1999) – Seniors’ injury seen as
priority
F/P/T Advisory Committee on Population Health - Subcommittee of Public Health – Falls Among Elderly seen
as priority
Activities Continued
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OIP and B.C. Office for Seniors jointly created Falls
Prevention Specialist position (2001)
Veterans Affairs and Health Canada Falls Initiative
(2001-2004)
Special PHO report on Falls and Injuries among the
Elderly (2004)
Partnership with Knowledge Network for social
marketing of falls prevention (2004)
BC Falls Prevention Coalition (2005)
B.C. Research History
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Scope of the problem
Risk factor evidence
Prevention evidence
Capacity building
Sustainability
Dissemination
Scope of the Problem
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First profiled as a serious issue in B.C. in 1989 at an
Inter-ministerial Committee on Aging
MOH led a provincial meeting on fall-related
hospitalizations (Dr. Bob Fisk, 1990)
1st RCT on falls in B.C. “Head Over Heels” (Gallagher
& Brunt, 1991)
Health Canada funded the “STEPS” project on falls in
public places (Gallagher & Scott, 1994)
Mortality and Morbidity of Falls in B.C. (Scott &
Gallagher, 1997 )
Risk Factors & Prevention
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U.Vic: Risk factors for falls and injuries among frail community
seniors (Scott & Gallagher, 2000)
Population Health/BCIRPU: “Stepping In” Fall Prevention in LTC
(Scott et al., 2003)
BCIRPU: EDISS Reports on Fall Injury in Emergency Dept.
(2004); “SAIL” Pilot and RCT (Scott et al., 2004/2005)
UBC: Risk reduction for women with osteoporosis (Lui-Ambrose
& Kahn, 2003); Strength & Balance in Reducing Falls (Donaldson
& Kahn, 2005); Fall Risk for Women with Visual Impairment
(Szabo & Kahn, 2006); ED Fall Outcomes (Salter, 2004)
SFU: Biomechanics of Falls & Hip Fractures (Robinovitch, 2005);
Floor Stiffness & Risk of Hip Fracture (Laing, 2003-)
Other: Paramedics for Early Intervention of Falls (Robinson,
2004); OT Falls Assessment (Dixon, 2004); Centre for Hip Health
(Oxland, 2006)
Capacity Building, Sustainability & Dissemination
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F/P/T: Systematic Review of Best Practice in Falls
Prevention (2000)
F/P/T: National Inventory of Falls Prevention (2000)
BCIRPU: Economic Burden of Unintentional Injury in
B.C. (Smartrisk, 2001); Unintentional Fall-related
Injury and Deaths: Trends, Patterns & Projections
(BCIRPU, 2002)
MOH/BCIRPU: Prevention of Falls & Injury Among the
Ederly: PHO Report
PHAC/MOH: Environmental Scan: Seniors & Veterans
Falls Prevention Initiatives in B.C.
Fall-related Hospital Rates per 1,000 by Provinces and
Territories, 1998/99 – 2002/03, Ages 65+
40
1998/99
35
1999/00
2000/01
30
2001/02
25
2002/03
20
15
10
5
0
NEWFOUNDLAND
PRINCE EDWARD
ISLAND
NOVA SCOTIA
NEW
BRUNSWICK
ONTARIO
SASKATCHEWAN
ALBERTA
BRITISH
COLUMBIA
TERRITORIES
Source: Acute separations from 1998/99 to 2002/03 Canadian Institute of Health Information Discharge Abstract Database.
*age standardized to 1991 Canadian population
**Quebec and Rural hospitals in Manitoba do not submit to the Discharge Abstract Database (DAD)
FALLS IN SENIORS, HOSPITAL CASES AND RATES, B.C., 1992/93 TO 2004/05
10000
60
9000
Number of Cases
7000
40
6000
5000
30
4000
20
3000
2000
Cases per 1,000 Population
50
8000
10
1000
0
0
1992/93 1993/94 1994/95 1995/96 1996/97 1997/98 1998/99 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05
Cases 65 - 74
Rate 65 - 74
Trend (regression analysis):
p < 0.001
Cases 75 - 84
Rate 75 - 84
Cases 85+
Rate 85+
p < 0.001
p < 0.001
Cases 65+
Rate 65+ *
p < 0.001
* Age-Standardized.
Source: Discharge Abstract Database, Population Health Surveillance and Epidemiology, B.C. Ministry of Health.
Age-Specific Rates - the number of hospital cases or days in the population for a specific age-group, multiplied by 1,000.
Age-Standardized Rates - the number of hospital cases or days in the population for all age groups of interest (i.e. 65-74, 75-84, and 85+ years), adjusted to
a standard population (the 1991 Canada population), multiplied by 1,000.
FALLS IN SENIORS, HOSPITAL DAYS AND RATES, B.C., 1992/93 TO 2004/05
220000
1400
200000
Number of Days
160000
1000
140000
800
120000
100000
600
80000
400
60000
40000
Days per 1,000 Population
1200
180000
200
20000
0
0
1992/93 1993/94 1994/95 1995/96 1996/97 1997/98 1998/99 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05
Trend (regression analysis):
Cases 65 - 74
Cases 75 - 84
Cases 85+
Rate 65 - 74
Rate 75 - 84
Rate 85+
p = 0.420
p = 0.603
p < 0.001
Cases 65+
Rate 65+ *
p = 0.250
* Age-Standardized.
Source: Discharge Abstract Database, Population Health Surveillanc and Epidemiology, B.C. Ministry of Health.
Age-Specific Rates - the number of hospital cases or days in the population for a specific age-group, multiplied by 1,000.
Age-Standardized Rates - the number of hospital cases or days in the population for all age groups of interest (i.e. 65-74, 75-84, and 85+ years), adjusted to
Environmental Scan
Environmental Scan of Seniors and Veterans Falls
Prevention Initiatives
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Dr. Vicky Scott, Senior Advisor on Falls Prevention, BCIRPU
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Dr. Elaine Gallagher, Professor, UVic School of Nursing
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Dr. Mariana Brussoni, Associate Director, BCIRPU
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Kristine Votova, Doctoral Student, University of Victoria
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Dorry Smith, Researcher, BCIRPU
Purpose and Background
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Why falls?
 85% of all injuries to the elderly
 $180 million in direct health costs (BC,1998)
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Why a falls’ inventory?
 Reflect changes since the previous scan (Scott, Dukeshire,
Gallagher, & Scanlan, 2001)
 Aid practitioners/researchers to better understand critical
factors
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End result: prevent falls, promote networking and contribute
to a collective effort currently underway in the province to
reduce falls and injuries among older persons
Methods of Data Collection
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Epidemiological data
 Vital Statistics (mortality)
 Ministry of Health (hospital separation)
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Inventory data
 Province-wide survey of seniors falls prevention
initiatives
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Critical factors of success
 In-depth interviews with successful programs
Results
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116 completed inventories submitted
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Nine-fold increase in reported initiatives
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Initiatives categorized:
 Policy
 Research
 Practice
Results
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Community/Pre-Frail and Well-Elderly (32%)
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LTC/Frail and Cognitively Impaired Elderly (30%)
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Acute Care/Geriatric Rehab Services (5%)
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Cross-Site (11%)
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Research (11%)
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Policy (8%)
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Private Providers (3%)
Information Provided in the Scan
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Initiatives’ descriptive information
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Key findings of critical factors of success
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Recommendations to healthcare settings
and providers
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Indexes of tables
Translating Research to Practice
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Evidence-based
Applicable
Affordable
Effective
Sustainable
Evidence to Practice Example
The Interior Health Authority experience
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1995: Researchers bring the issue of falls to the region
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2000: North Okanagan Health Region (NOHR)
planners were alarmed at the high rate of falls for their
Health Area
Evidence to Action
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Partnerships formed
Communities buy-in
Three year funding received from HCVAC
Climate for Change
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Four health areas merge in 2000 creating a climate
change
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New health region holds Population Health Conference
in 2002 and Falls Program is showcased
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Aging Population = Higher Falls Numbers
Pop Health Jump Starts Falls Focus
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Champions were identified
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Project funds were strategically dispersed
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Strategic Plan was drafted
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Falls Prevention Manager appointed by Population
Health to provide leadership and support of regional
efforts
Building Capacity
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Created inventory with BCIRPU
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Hired BCIRPU to produce a comprehensive falls
report
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Identified and supported falls pilots in each sector
and health area based on sound research/best
practices
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Working with Municipal Councils, community groups
and seniors to develop partnership to address local
fall issues
Action to Practice
Internal:
 Residential Falls Program
 Acute Care Project
 Community Health Care Workers Project
External:
 Safe Communities falls prevention program
Challenges
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Constant change
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Compliance (Forms)
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Reliable “real time” internal data
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Developing universal reporting systems
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Sustaining the programs beyond the project phase
Next Steps in Interior Health
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Mandatory Performance Management indicators
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Across sector falls reports
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Hand over clinical piece to Performance Management
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Will expand focus to include assisted living and well
seniors in the community
What we have learned in B.C.
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It takes time
Need the evidence
Need the right partners
Need to integrate prevention into policy and
practice
Need to evaluate and disseminate
Need to build sustainability in from the start
Need to celebrate your successes
Next Steps for B.C.
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CFPC – national standardized training – B.C.
climate created opportunity to do this
Accountability by HAs and Professionals
 Regional performance indicators
 Setting-specific practice indicators
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BCFPC
 Monitoring and supporting
 Priority setting
 Disseminating
Questions?
Thank You!
Merci!