Preventing Falls: Whose Role Is It?

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A non-profit service and advocacy organization © 2011 National Council on Aging

Bonita Lynn Beattie, PT, MPT, MHA

Vice President, Injury Prevention,

National Falls Free© Initiative

National Council on Aging

[email protected]

Preventing Falls: Whose Role Is It?

March 2012

Emily Watson, MPH

Senior Program Associate

Center for Healthy Aging


[email protected]

mailto:[email protected]

mailto:[email protected]

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NCOA - National Council on Aging

NCOA is a nonprofit service and advocacy organization.

Our mission is to improve the lives of millions of older

adults, especially those who are vulnerable and

disadvantaged.

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How NCOA accomplishes its mission

Collaborative Leadership

NCOA brings together nonprofit

organizations, businesses, and

government to address key challenges

of an aging society.

Innovation NCOA helps to develop and ―bring to

scale‖ innovative services that improve

health and financial well-being.

http://www.OneAway.org

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How NCOA accomplishes its mission

Advocacy

NCOA is the leading national voice

and advocate for vulnerable and

disadvantaged older adults and

the organizations that help them.

Services

NCOA works with thousands of

organizations across the country

to help seniors find jobs and

benefits, improve their health and

live independently.

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Learning Objectives

1. Understand the magnitude and impact of older adult

falls and fall-related injuries.

2. Identify proven methods for preventing falls and tools

for screening, assessing, and referring older adults to

appropriate resources.

3. Provide user-friendly information and resources on

collaborating with partners to address falls prevention.

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Common

Predictable largely

Preventable

Everyone has a role to play and can make a difference within their own sphere of influence

Older Adult Falls, Falls Related

Injuries and Deaths

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Falls Free© Initiative

Coalition of 70 national organizations, professional

associations and federal agencies; and 40 states

working collaboratively to reduce falls and fall-

related injuries among older adults

Working to bring Health Care, Public Health and

Aging together

Falls Free© supported by

• The Archstone Foundation 2004-2012

• Home Safety Council 2004-2008

• CDC National Center for Injury Prevention &

Control 2007-current

• US Administration on Aging 2007-current

• Humana, Inc 2011-current

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Hawaii

AK

MT

ID

WA

CO

WY

NV

CA

NM AZ

MN

KS

TX

IA

WI

IL

KY

TN

IN OH

MI

AL MS

AR

LA

GA

FL

SC

WV VA

NC

PA

VT

RI

ME

NH OR

SD

ND

MO

OK

NE

NY

CT NJ

MD

DE

Northern Marianas

Guam

MA

States operating or developing Fall Prevention Coalitions (February 2012)

State Coalitions on Fall Prevention: Working Collaboratively to Make a Difference

www.ncoa.org/fallsmap

State Coalitions on Fall Prevention

Workgroup

http://www.ncoa.org/fallsmap

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Intersection of Public Health, Aging/Disability

Services and Health Care Sectors

Falls Prevention,

CDSMP, DSMP

Public

Health

Health Care

Delivery

Aging/

Disability

Services

ADRC/Care Transitions

Evidence-based Activities

and Programs

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Falls are Common

Many older adults think ―Falling happens to other

people, not to me‖ The truth is 1 in 3 older adults—

about 13 million—fall every year in the U.S.

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Did You Know?

2.3 million ED visits (2010), does not include:

• the direct admissions, new study demonstrates 31% increase in

admissions for falls (2001-2008)

• those who fall and self treat, limit activities or see a provider other

than at the ED

• those ―pick up with out transport‖ fallers

20,000 deaths (2009), does not include:

• those non-immediate deaths precipitated by the fall

$28.2 Billion (2010 dollars), does not include:

• indirect costs, caregiver costs, employer costs, opportunity costs…

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New Hampshire visual representing Fatalities due to falls in 2010

Who Ultimately Pays the Cost?

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Fall Risk Factors

• Intrinsic

• Extrinsic

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Intrinsic Factors

• Older age

• Female

• Chronic diseases

• Mentally impaired

• Medication side-

effects

• Muscle weakness

• Gait & balance

problems

• Poor vision

• Postural dizziness

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Leading Fall Risk Factors

__________

Rubenstein, Age & Aging, 2006

Risk Factor Relative Risk

Muscle weakness 4.9

Balance problems 3.2

Gait problems 3.0

Poor vision 2.8

Limited mobility 2.5

Cognitive impairment 2.4

Functional limitations 2.0

Postural hypotension 1.9

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Extrinsic Factors

• Clutter & tripping hazards

• No stair railings or grab bars

• Dim lighting

• Sidewalk damage

• Snow/ice

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Preventing Falls: What Works

Maximize vision

Review and manage

medications

Improve home safety

Exercise for strength and

balance

Clinical assessment

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Effective Fall Prevention

Clinical assessment,

treatment, referral & follow-up

_______

Gillespie, Cochrane Database Systematic Review, 2003

AGS, Clinical Practice Guidelines, 2010

borrowed from CDC - STEADI

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Overview of Toolkit Content

STEADI: Stopping Elderly Accidents,

Deaths and Injuries

•Provider resources

•Training materials

•Patient education

www.cdc.gov/injury/STEADI

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STEADI

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Provider Pocket Guide

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Referral Forms

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Training Materials

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Training Materials SPECIALISTS FALL PREVENTION CLASSES

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Assessment Tools

• Stay Independent brochure for self-risk

assessment

• Instructions for

–3 standardized gait & balance tests

–orthostatic blood pressure measurement

• Fall Risk Checklist for summarizing risk

assessment findings

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Patient Self-Assessment

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Patient Education

• 3 CDC

brochures

• Sit to stand

chair exercise

instructions

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Intersection of Public Health, Aging/Disability

Services and Health Care Sectors

Falls Prevention,

CDSMP, DSMP

Public

Health

Health Care

Delivery

Aging/

Disability

Services

ADRC/Care Transitions

Evidence-based Activities

and Programs

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Evidence-based programs

Evidence-based programs, services and

resources to older adults targeting

prevention through risk reduction – must

be accessible to those at most risk

Community infrastructure of integrated

services and programs

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Stepping On Fall Prevention Program

2-hour classes once a week for 7 weeks

Stepping On is designed to empower older adults to carry out health

behaviors that:

o reduce the risks of falls,

o improve self-management, and

o increase quality of life

The program includes instruction or provides information on:

o Balance

o Strength building

o Home environmental safety

o Vision

o Management of medication

More information on phconnect.org site

Slides adapted from CDC

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A physical therapist (PT) visits patient four times at home over the first 2

months and visits again for a booster session at 6 months

During the visits, the PT prescribes

a set of in-home exercises and a walking plan

Strength training

Balance and stability

Active range of motion

Walking plan

Participants are encouraged to complete

the exercises three times a week and to walk

outside the home at least two times a week

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Yang Style

12 weeks or more, 3 times a week, with each class lasting one hour (one hour at home)

Delivered by a trained Tai Chi Instructor

Eight forms taught in a progressive fashion

Master Trainers: Dr. Fuzhong Li and YMCA of USA Faculty Trainers

More information on phconnect.org site

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Return on Investment of Falls Prevention Programs

Tai Chi Moving for Better Balance

o $1.60 return on a $1 investment in direct medical costs

Stepping On Fall Prevention Program o $70 return on a $100 investment in direct

medical costs

Otago Exercise Program delivered to persons aged 80 and older

o $1 return on a $1 investment in direct medical costs

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How Will We Make a Real Difference?

Local, state and national

collaboration that promotes &

sustains salience, belief and

behavior change among key

stakeholders:

Older Adults

Caregivers/family members

Health Care and other service

providers

POLICYMAKERS

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What Does that Difference Look Like?

Broad awareness to the issue – falls

are not an inevitable part of aging

Training and education to providers

Evidence-based programs, services and

resources to older adults targeting

prevention through risk reduction –

must be accessible to those at most risk

Provide seamless transitions to

community programs from health care

and vice versa

Local, state and national collaboration that brings:

Broad Community Engagement

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Get involved in your coalition

• Learn what is going on in

your area and contact

your state coalition lead

to get involved.

• URL:

www.ncoa.org/fallsmap

http://www.ncoa.org/fallsmap

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Falls Prevention Awareness Day

• First day of Fall

• 2012 is the 5th annual

national Falls Prevention

Awareness Day (FPAD)

• 43 states, DC and Puerto

Rico participated in 2011,

bringing national awareness

to this important issue.

FPAD 2012

Saturday, September 22nd

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Partnering with the Aging Network

• The Older Americans’ Act (OAA) was passed in 1965 response to

concern about a lack of community social services for older persons.

• The act created the aging network to provide services for community-

dwelling older adults and established the Administration on Aging (AoA)

as the Federal agency focused on older persons.

Source: http://www.aoa.gov/AoA_programs/OAA/index.aspx

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The Aging Network: Today

• The OAA funds the delivery of social and nutrition

services for older adults through a national network of

– 56 State agencies on aging

– 629 Area Agencies on Aging

– 20,000 service providers

– 44 Tribal organizations .

• These community-based organizations serve as the

bridge between clinical treatment and home.

Source: http://www.aoa.gov/AoA_programs/OAA/index.aspx

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Putting the Pieces Together

Among coalitions many challenges, how to

integrate the contributions of many to affect a

community model of falls prevention.

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Common

Predictable

largely

Preventable

Everyone has a role to play and can make a difference within their own sphere of influence.

To Wrap Up

Documents

Preventing Falls: Whose Role Is It?