Fall Prevention in Canada: Fall Prevention in Canada: Fall Prevention in Canada: Fall Prevention in Canada: Fall Prevention in Canada: Fall Prevention in Canada: Fall Prevention in Canada: Fall Prevention in Canada: Epidemiological and Program Epidemiological and Program Epidemiological and Program Epidemiological and Program Epidemiological and Program Epidemiological and Program Epidemiological and Program Epidemiological and Program UpdateUpdateUpdateUpdateUpdateUpdateUpdateUpdate

Vicky Scott, PhD, RNVicky Scott, PhD, RNVicky Scott, PhD, RNVicky Scott, PhD, RNVicky Scott, PhD, RNVicky Scott, PhD, RNVicky Scott, PhD, RNVicky Scott, PhD, RN

Senior Advisor, Fall & Injury Senior Advisor, Fall & Injury Senior Advisor, Fall & Injury Senior Advisor, Fall & Injury Senior Advisor, Fall & Injury Senior Advisor, Fall & Injury Senior Advisor, Fall & Injury Senior Advisor, Fall & Injury Prevention, BCIRPU and MHLS;Prevention, BCIRPU and MHLS;Prevention, BCIRPU and MHLS;Prevention, BCIRPU and MHLS;Prevention, BCIRPU and MHLS;Prevention, BCIRPU and MHLS;Prevention, BCIRPU and MHLS;Prevention, BCIRPU and MHLS;

Director, Centre of Excellence on Director, Centre of Excellence on Director, Centre of Excellence on Director, Centre of Excellence on Director, Centre of Excellence on Director, Centre of Excellence on Director, Centre of Excellence on Director, Centre of Excellence on Mobility, Fall Prevention & Injury in Mobility, Fall Prevention & Injury in Mobility, Fall Prevention & Injury in Mobility, Fall Prevention & Injury in Mobility, Fall Prevention & Injury in Mobility, Fall Prevention & Injury in Mobility, Fall Prevention & Injury in Mobility, Fall Prevention & Injury in Aging (CEMFIA)Aging (CEMFIA)Aging (CEMFIA)Aging (CEMFIA)Aging (CEMFIA)Aging (CEMFIA)Aging (CEMFIA)Aging (CEMFIA)

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AcknowledgementsAcknowledgementsAcknowledgementsAcknowledgementsAcknowledgementsAcknowledgementsAcknowledgementsAcknowledgements

Ministry of Healthy Living and Ministry of Healthy Living and Ministry of Healthy Living and Ministry of Healthy Living and SportSportSportSport• Matt HermanMatt HermanMatt HermanMatt Herman• Alison SumAlison SumAlison SumAlison Sum• Lori WagarLori WagarLori WagarLori Wagar

CEMFIACEMFIACEMFIACEMFIA• Karim KahnKarim KahnKarim KahnKarim Kahn• Heather McKayHeather McKayHeather McKayHeather McKay• Steve RobinovitchSteve RobinovitchSteve RobinovitchSteve Robinovitch• Maureen AsheMaureen AsheMaureen AsheMaureen Ashe• Fabio FeldmanFabio FeldmanFabio FeldmanFabio Feldman

BCIRPUBCIRPUBCIRPUBCIRPU• Ian PikeIan PikeIan PikeIan Pike• Sarah ElliottSarah ElliottSarah ElliottSarah Elliott• Hansdeep BawaHansdeep BawaHansdeep BawaHansdeep Bawa• Fahra RajabaliFahra RajabaliFahra RajabaliFahra Rajabali• Dorry SmithDorry SmithDorry SmithDorry Smith

BC Fall & Injury Prevention BC Fall & Injury Prevention BC Fall & Injury Prevention BC Fall & Injury Prevention Coalition: Coalition: Coalition: Coalition: professional professional professional professional organizations, policy, research and organizations, policy, research and organizations, policy, research and organizations, policy, research and practice, including RHA leads:practice, including RHA leads:practice, including RHA leads:practice, including RHA leads:• MerryMerryMerryMerry----Jo LeversJo LeversJo LeversJo Levers• Tom McLeodTom McLeodTom McLeodTom McLeod• Kelly WilsonKelly WilsonKelly WilsonKelly Wilson• Cheryl Leia/Tanya DunnCheryl Leia/Tanya DunnCheryl Leia/Tanya DunnCheryl Leia/Tanya Dunn• Fabio FeldmanFabio FeldmanFabio FeldmanFabio Feldman

CFPECCFPECCFPECCFPEC• Anne HigginsonAnne HigginsonAnne HigginsonAnne Higginson• Ginette AsslineGinette AsslineGinette AsslineGinette Assline• Julian YoungJulian YoungJulian YoungJulian Young• Provincial/Territorial LeadsProvincial/Territorial LeadsProvincial/Territorial LeadsProvincial/Territorial Leads• CFPC ParticipantsCFPC ParticipantsCFPC ParticipantsCFPC Participants

FundersFundersFundersFunders• MHLS; PHAC; CIHR; MSHRF; MHLS; PHAC; CIHR; MSHRF; MHLS; PHAC; CIHR; MSHRF; MHLS; PHAC; CIHR; MSHRF;

RHAs; U.S. CDC; etc.RHAs; U.S. CDC; etc.RHAs; U.S. CDC; etc.RHAs; U.S. CDC; etc.

3

Implementing the Program

Public Health Approach to Fall Prevention

PopulationPopulation

ApproachApproach

Program

Planning

Steps

Program

Planning

Steps

Strategies

& Actions

Strategies

& Actions

Social &

Policy

Context

Social &

Policy

Context

LTC Residential

Public Health Approach

Identifying Risk Factors

Examining Best Practices

Evaluating the Program

Older Persons, Families, Care Providers, Policy Makers of Procedures, Accreditation Standards and Legislation

Data Sources

Assessment Tools

Evaluation Tools

Defining the Problem

Evidence/Guidelines

Acute/RehabCommunity

(services)

Community(no services)

Knowledge to Action

DEFINING THE PROBLEMDEFINING THE PROBLEMDEFINING THE PROBLEMDEFINING THE PROBLEMDEFINING THE PROBLEMDEFINING THE PROBLEMDEFINING THE PROBLEMDEFINING THE PROBLEM

4444

5555

Canadian Fall FactsCanadian Fall FactsCanadian Fall FactsCanadian Fall FactsCanadian Fall FactsCanadian Fall FactsCanadian Fall FactsCanadian Fall Facts

• Account for 8.5% of all Account for 8.5% of all Account for 8.5% of all Account for 8.5% of all hospitalizations for seniorshospitalizations for seniorshospitalizations for seniorshospitalizations for seniors

• Account for 85% of all Account for 85% of all Account for 85% of all Account for 85% of all injury related injury related injury related injury related hospitalizations for seniorshospitalizations for seniorshospitalizations for seniorshospitalizations for seniors

• 53,545 hospitalizations 53,545 hospitalizations 53,545 hospitalizations 53,545 hospitalizations each yeareach yeareach yeareach year

• $2 billion annually or $2 billion annually or $2 billion annually or $2 billion annually or almost $500 per senior per almost $500 per senior per almost $500 per senior per almost $500 per senior per year year year year (SMARTRISK, 2009) (SMARTRISK, 2009) (SMARTRISK, 2009) (SMARTRISK, 2009)

6

Hip Fracture Hospitalizations, 65+, Hip Fracture Hospitalizations, 65+,

2008/09 2008/09

• 95% of hip fractures

r/t a fall

• Hip fractures

account for 38% fall-

related

hospitalizations

• Hip fracture rates

lowest in the

Territories; highest in

NL

11

Length of Stay: Falls vs OtherLength of Stay: Falls vs Other

• Acute days: 70% longer for fall-related injuries vs all other

• ALC days: average of 6.5 days for falls vs 2 days for all other

12

Data IssuesData IssuesData IssuesData IssuesData IssuesData IssuesData IssuesData Issues

•Lack of reporting by settings, regions Lack of reporting by settings, regions Lack of reporting by settings, regions Lack of reporting by settings, regions and provincesand provincesand provincesand provinces

•Under reporting of falls and fall Under reporting of falls and fall Under reporting of falls and fall Under reporting of falls and fall injuriesinjuriesinjuriesinjuries

•Inconsistency in analysis, e.g., CIHI Inconsistency in analysis, e.g., CIHI Inconsistency in analysis, e.g., CIHI Inconsistency in analysis, e.g., CIHI data:data:data:data:

– SeparationSeparationSeparationSeparation----based analysis VERSUSbased analysis VERSUSbased analysis VERSUSbased analysis VERSUS

– EpisodeEpisodeEpisodeEpisode----based analysisbased analysisbased analysisbased analysis

13131313

Sources of DataSources of DataSources of DataSources of DataSources of DataSources of DataSources of DataSources of Data

Definition of a Fall Definition of a Fall Definition of a Fall Definition of a Fall Definition of a Fall Definition of a Fall Definition of a Fall Definition of a Fall

•Unintentionally coming to rest on the Unintentionally coming to rest on the Unintentionally coming to rest on the Unintentionally coming to rest on the ground or other lower level with or ground or other lower level with or ground or other lower level with or ground or other lower level with or without an injurywithout an injurywithout an injurywithout an injury

RISK ASSESSMENTRISK ASSESSMENTRISK ASSESSMENTRISK ASSESSMENTRISK ASSESSMENTRISK ASSESSMENTRISK ASSESSMENTRISK ASSESSMENT

16161616

American/British Geriatric Society American/British Geriatric Society American/British Geriatric Society American/British Geriatric Society American/British Geriatric Society American/British Geriatric Society American/British Geriatric Society American/British Geriatric Society

Guidelines, 2009Guidelines, 2009Guidelines, 2009Guidelines, 2009Guidelines, 2009Guidelines, 2009Guidelines, 2009Guidelines, 2009

17171717

ABGS Risk FactorsABGS Risk Factors

• History of falls

• Medications

• Gait, balance and mobility

• Visual acuity

• Other neurological impairments

• Muscle strength

• Heart rate and rhythm

• Postural hypotension

• Feet and footwear

• Environmental hazards

18

Risk Assessment Tool SelectionRisk Assessment Tool SelectionRisk Assessment Tool SelectionRisk Assessment Tool SelectionRisk Assessment Tool SelectionRisk Assessment Tool SelectionRisk Assessment Tool SelectionRisk Assessment Tool Selection

•Valid and reliable:Valid and reliable:Valid and reliable:Valid and reliable:

– strong predictive validity among the population strong predictive validity among the population strong predictive validity among the population strong predictive validity among the population of interestof interestof interestof interest

– Consistent findings across repeated prospective Consistent findings across repeated prospective Consistent findings across repeated prospective Consistent findings across repeated prospective teststeststeststests

•Appropriate for settingAppropriate for settingAppropriate for settingAppropriate for setting

– Affordable and easy to useAffordable and easy to useAffordable and easy to useAffordable and easy to use

– Includes clear instructions; training Includes clear instructions; training Includes clear instructions; training Includes clear instructions; training requirements; equipment needs; recommended requirements; equipment needs; recommended requirements; equipment needs; recommended requirements; equipment needs; recommended ‘‘‘‘cutcutcutcut----offoffoffoff’’’’ scoresscoresscoresscores

EXAMINING BEST PRACTICESEXAMINING BEST PRACTICESEXAMINING BEST PRACTICESEXAMINING BEST PRACTICESEXAMINING BEST PRACTICESEXAMINING BEST PRACTICESEXAMINING BEST PRACTICESEXAMINING BEST PRACTICES

20202020

Major Fall Prevention StudiesMajor Fall Prevention StudiesMajor Fall Prevention StudiesMajor Fall Prevention StudiesMajor Fall Prevention StudiesMajor Fall Prevention StudiesMajor Fall Prevention StudiesMajor Fall Prevention Studies

TopicTopicTopicTopic Institution/LocationInstitution/LocationInstitution/LocationInstitution/Location

Mobility, balance, musculoskeletal Sunnybrook ON; U. Quebec; McMasters; UBC; U. Manitoba

Risk factors for injurious falls VCH Research Institute, BC

Effectiveness/cost effectiveness VCH Research Institute, BC; FHA, BC

Hip protector compliance FHA, BC

Fall prevention in LTC Simon Fraser U., BC

Neurocognitive impairments VCH Research Institute, BC

Fallers in ED UBC

Clinical/economic factors VCH Research Institute, BC

Exercise UBC

21212121

BEEEACH Prevention Model

Education

Behaviour Change

Health Management

Environment

Clothing and Footwear

Activity

Equipment

IMPLEMENTING THE PROGRAMIMPLEMENTING THE PROGRAMIMPLEMENTING THE PROGRAMIMPLEMENTING THE PROGRAMIMPLEMENTING THE PROGRAMIMPLEMENTING THE PROGRAMIMPLEMENTING THE PROGRAMIMPLEMENTING THE PROGRAM

23232323

CollaborationCollaborationCollaborationCollaborationCollaborationCollaborationCollaborationCollaboration

• Canadian Fall Prevention Education CollaborativeCanadian Fall Prevention Education CollaborativeCanadian Fall Prevention Education CollaborativeCanadian Fall Prevention Education Collaborative

• Centre of Excellence on Mobility, Fall Prevention & Centre of Excellence on Mobility, Fall Prevention & Centre of Excellence on Mobility, Fall Prevention & Centre of Excellence on Mobility, Fall Prevention & Injury in Aging (CEMFIA)Injury in Aging (CEMFIA)Injury in Aging (CEMFIA)Injury in Aging (CEMFIA)

• BCIRPU and other Injury Prevention Centres BCIRPU and other Injury Prevention Centres BCIRPU and other Injury Prevention Centres BCIRPU and other Injury Prevention Centres

• International Collaboration:International Collaboration:International Collaboration:International Collaboration:

– U.S. CDCU.S. CDCU.S. CDCU.S. CDC

– California FP Centre of ExcellenceCalifornia FP Centre of ExcellenceCalifornia FP Centre of ExcellenceCalifornia FP Centre of Excellence

– U.S. Falls Free CoalitionU.S. Falls Free CoalitionU.S. Falls Free CoalitionU.S. Falls Free Coalition

– Falls and Balance Research Group, NSWFalls and Balance Research Group, NSWFalls and Balance Research Group, NSWFalls and Balance Research Group, NSW

– ProFANEProFANEProFANEProFANE

– World Health OrganizationWorld Health OrganizationWorld Health OrganizationWorld Health Organization

24242424

Program ExamplesProgram ExamplesProgram ExamplesProgram ExamplesProgram ExamplesProgram ExamplesProgram ExamplesProgram Examples

•Canadian Falls Prevention CurriculumCanadian Falls Prevention CurriculumCanadian Falls Prevention CurriculumCanadian Falls Prevention Curriculum

•Finding Balance AlbertaFinding Balance AlbertaFinding Balance AlbertaFinding Balance Alberta

•Nova Scotia FP NetworkNova Scotia FP NetworkNova Scotia FP NetworkNova Scotia FP Network

•Fall Prevention Mobile ClinicsFall Prevention Mobile ClinicsFall Prevention Mobile ClinicsFall Prevention Mobile Clinics

•Strategies and Actions for Strategies and Actions for Strategies and Actions for Strategies and Actions for Independent Living: FP in Home CareIndependent Living: FP in Home CareIndependent Living: FP in Home CareIndependent Living: FP in Home Care

•Promoting Active Living: FP in Assisted Promoting Active Living: FP in Assisted Promoting Active Living: FP in Assisted Promoting Active Living: FP in Assisted LivingLivingLivingLiving

26262626

PAL GuidelinesPAL GuidelinesPAL GuidelinesPAL GuidelinesPAL GuidelinesPAL GuidelinesPAL GuidelinesPAL Guidelines

• Collaboratively Collaboratively Collaboratively Collaboratively developed and tested developed and tested developed and tested developed and tested for validity and for validity and for validity and for validity and feasibilityfeasibilityfeasibilityfeasibility

• Disseminated to each Disseminated to each Disseminated to each Disseminated to each ALR in BCALR in BCALR in BCALR in BC

Copies available at:Copies available at:Copies available at:Copies available at:

www.qpbooks.cawww.qpbooks.cawww.qpbooks.cawww.qpbooks.ca or call 1 or call 1 or call 1 or call 1 800 663800 663800 663800 663----6105 6105 6105 6105

EVALUATING THE PROGRAMEVALUATING THE PROGRAMEVALUATING THE PROGRAMEVALUATING THE PROGRAMEVALUATING THE PROGRAMEVALUATING THE PROGRAMEVALUATING THE PROGRAMEVALUATING THE PROGRAM

28282828

PHAC FP Inventories PHAC FP Inventories PHAC FP Inventories PHAC FP Inventories PHAC FP Inventories PHAC FP Inventories PHAC FP Inventories PHAC FP Inventories

•2000: 58 programs2000: 58 programs2000: 58 programs2000: 58 programs

•2003: 123 programs2003: 123 programs2003: 123 programs2003: 123 programs

•2005: 195 programs2005: 195 programs2005: 195 programs2005: 195 programs

•2010: 232 and counting2010: 232 and counting2010: 232 and counting2010: 232 and counting

29292929

30303030

Canadian Accreditation StandardsCanadian Accreditation Standards

On June 25, 2008, Accreditation Canada implemented the Required Organizational Practice under Patient Safety Area #6, to reduce the risk of injuries resulting from client falls, through the following:

• Implement and evaluate a fall prevention strategy Implement and evaluate a fall prevention strategy Implement and evaluate a fall prevention strategy Implement and evaluate a fall prevention strategy to minimize the impact of client falls.to minimize the impact of client falls.to minimize the impact of client falls.to minimize the impact of client falls.

• Tests for complianceTests for complianceTests for complianceTests for compliance– The team has implemented a fall prevention strategy.The team has implemented a fall prevention strategy.The team has implemented a fall prevention strategy.The team has implemented a fall prevention strategy.

– The strategy identifies the population(s) at risk for falls.The strategy identifies the population(s) at risk for falls.The strategy identifies the population(s) at risk for falls.The strategy identifies the population(s) at risk for falls.

– The strategy addresses the specific needs of the The strategy addresses the specific needs of the The strategy addresses the specific needs of the The strategy addresses the specific needs of the populations at risk for falls.populations at risk for falls.populations at risk for falls.populations at risk for falls.

– The team evaluates the fall prevention strategy on an The team evaluates the fall prevention strategy on an The team evaluates the fall prevention strategy on an The team evaluates the fall prevention strategy on an ongoing basis to identify trends, causes and degree of ongoing basis to identify trends, causes and degree of ongoing basis to identify trends, causes and degree of ongoing basis to identify trends, causes and degree of injury.injury.injury.injury.

– The team uses the evaluation information to make The team uses the evaluation information to make The team uses the evaluation information to make The team uses the evaluation information to make improvements to its fall prevention strategy.improvements to its fall prevention strategy.improvements to its fall prevention strategy.improvements to its fall prevention strategy.

Baseline Baseline Baseline Baseline Baseline Baseline Baseline Baseline –––––––– Can We Do Better?Can We Do Better?Can We Do Better?Can We Do Better?Can We Do Better?Can We Do Better?Can We Do Better?Can We Do Better?FallFallFallFall----related hospitalizations for seniors:related hospitalizations for seniors:related hospitalizations for seniors:related hospitalizations for seniors:

•808,671 acute bed days each year808,671 acute bed days each year808,671 acute bed days each year808,671 acute bed days each year

•327,424 ALC bed days, including 219,374 327,424 ALC bed days, including 219,374 327,424 ALC bed days, including 219,374 327,424 ALC bed days, including 219,374 days waiting to get into residential caredays waiting to get into residential caredays waiting to get into residential caredays waiting to get into residential care

•fill the equivalent of 15 two hundred bed fill the equivalent of 15 two hundred bed fill the equivalent of 15 two hundred bed fill the equivalent of 15 two hundred bed hospitals each year hospitals each year hospitals each year hospitals each year

•one senior hospitalized every 10 one senior hospitalized every 10 one senior hospitalized every 10 one senior hospitalized every 10 minutesminutesminutesminutes

31313131

TTTTTTTThank you!hank you!hank you!hank you!hank you!hank you!hank you!hank you!

And rememberAnd rememberAnd rememberAnd remember…………

Falls can be Falls can be Falls can be Falls can be prevented.prevented.prevented.prevented.

Except falling in love.Except falling in love.Except falling in love.Except falling in love.