1. Around and Around We Go Falls in Elderly Presented By: Anna Moses - RN,BSN,CCRN,CEN Eastern Maine Medical Center Heather Harriman Eastern Maine Medical Center Angela Lufkin Gentiva Home Healthcare Lisa Dunning Eastern Area Agency on Aging

2. Around and Around We Go Falls in Elderly Anna Moses RN,BSN,CCRN,CEN Trauma Coordinator Eastern Maine Medical Center

3. Falls are a major contributing factor to elderly admissions to hospitals annually –In 2013 201 admissions for falls resulting in serious/multiple injuries for persons age 65 and older. this # does not include surface level falls with hip fracture Statistics

4. 2.5 million non-fatal falls in 2013 –Greater than 734,000 of these were admitted to hospitals Medical costs in excess of $34 BILLION 1 in 3 older adults fall each year, with less than half of these talk about it with their Primary Care Physician For many people that fall, even if no serious injury, a fear of falling develops The Problem

5. 2.5 million non-fatal falls in 2013 –Greater than 734,000 of these were admitted to hospitals Medical costs in excess of $34 BILLION 1 in 3 older adults fall each year, with less than half of these talk about it with their Primary Care Physician For many people that fall, even if no serious injury, a fear of falling develops The Problem

6. 2.5 million non-fatal falls in 2013 –Greater than 734,000 of these were admitted to hospitals Medical costs in excess of $34 BILLION 1 in 3 older adults fall each year, with less than half of these talk about it with their Primary Care Physician For many people that fall, even if no serious injury, a fear of falling develops The Problem

7. 2.5 million non-fatal falls in 2013 –Greater than 734,000 of these were admitted to hospitals Medical costs in excess of $34 BILLION 1 in 3 older adults fall each year, with less than half of these talk about it with PCP For many people that fall, even if no serious injury, a fear of falling develops The Problem

8. Education is key Programs to assist in decreasing the risk –STEADI Toolkit –Bone Builders –Matter of Balance –Gentiva: Safe Strides What Do We Do to Stop the Falling?

9. An Adventure

10. 75 yr old Female, fell down cellar stairs at 3am while going to the bathroom. Arrives to ER at 6am via EMS, was found by husband at 5am when he awoke. Mary is alert, but somewhat confused. Head laceration, c/o pain in R thigh, R chest Mary

11. Mary it is discovered has a mild concussion, 4 fractured ribs on the Right, and a Right Hip Fracture. What are the possible contributing factors to Mary’s fall? What is the possible follow up/ treatment plan? Mary

12. Over the next few days Mary is recovering after surgery to fix her hip, and aggressive pulmonary toileting for her rib fractures. A PT/OT evaluation is ordered to find her baseline for ambulation and self-care

13. Physical Rehabilitation Heather Harriman PT, MS Eastern Maine Medical Center

14. The next morning Mary is met by Physical Therapy (PT) and Occupational Therapy (OT) who go through a baseline evaluation with her. –From those evaluations it is determined that Mary would benefit from a brief stay in Rehab and then likely home with further therapy services. PT/OT Evaluations

15. Evaluations will look at: Prior Level of Function Household Set Up Bathroom Set Up Supports in place Cognition Vision/Hearing Acute Evaluations

16. Also addressed: Vital signs ROM Strength Self Care Bed mobility Transfers Gait Post-concussive assessment Evaluations

17. Meeting with care management Review of the medical status Ensure nursing goals have been met Different levels of rehab options Patient input Liaisons from the accepting facility Discharge planning

18. When Mary gets to Rehab she will undergo another set of evaluations by the therapists at that facility. –included here is a formal walking assessment –strength –bed mobility –balance assessment –estimation of her length of stay Rehabilitation

19. Mary will work with PT and OT on a regular basis to progress toward her goals. The “team” will meet to discuss discharge dates and equipment needs. They will discuss transition to home and equipment and further therapy needs. PT will work with Mary using a device on level surfaces, stairs and outside if appropriate. They will work on car transfers. OT will address bathing/dressing and cooking tasks in the kitchen. They will also follow her cognition to ensure the symptoms of the concussion resolve. Rehabilitation

20. Once Mary meets her therapy goals she will transition to home. –Can this person safely return to home? –Do they need a home health referral for PT/OT and/or nursing care? –Does a home evaluation need to be completed? –Does she have the equipment she needs? –Have safety recommendations and reasonable adaptations been done to the home? Transition to Home

21. Home Healthcare after falling Angela Lufkin Gentiva Home Health Home Healthcare after falling Angela Lufkin Gentiva Home Health

22. 22 REWIND ■ Verification of insurance Communication with Hospital and patient prior to discharge ■ Disciplines ordered ■ Confirmation of discharge date ■ Location in which services will be provided ■ Visit from the liaison at hospital to confirm hhc ordered

23. 23 Opening to Services ■ Review of Hospital orders ■ Next day Start of Care ■ Home Safety Evaluation ■ Medication Reconciliation ■ Development of the plan of care

24. 24 Physical Therapy ■ Perform time up and go Dig deeper to determine strengths and weaknesses ■ Evaluation of transfers and balance ■ Evaluation of strength and flexibility ■ Measure gait speed and observe gait patterns

25. 25 Physical Therapy Continued I.Vestibular II.Somatosensory III.Vision IV.Musculoskeletal

26. 26 Occupational Therapy ■ Home modifications ■ ADLs ■ Adaptive Equipment ■ Energy Conservation

27. 27 Nursing ■ Pain Management ■ Wound care ■ Disease state training ■ Diet and Hydration

28. Total Team effort ■ Communication with PCP ■ Communication with each other ■ Communication with family ■ Preparing for discharge from services

29. Around and Around we go Falls Lisa Dunning, Health Programs Manager Eastern Area Agency on Aging

30. Time out! What if we had prevented Mary’s fall? Let’s say Mary shared her concerns about balance with her healthcare provider. Her well-informed provider instantly opened up www.eaaa.org and sent a HIPPA compliant referral to EAAA for a Falls Risk Assessment.www.eaaa.org 30

31. Click HERE!

32. 32 Print any of these for your consumer to take home.

33. Once Mary is connected with EAAA, she participates in an in-home Falls Risk Assessment. This includes: Personal and medical questionnaire, including fall history Medication usage Home environment and safety 3 physical tests: visual acuity screening, functional reach, and a 10’ timed up and go

34. This information is used to generate a Falls Risk Assessment Score Report, which is the beginning of the education process. Mary is empowered to make changes to improve her risk of falling.

35. Mary reviewed her results and was empowered to make some changes in herself and her home to improve her balance and overall well-being.

36. EAAA Health Programs Falls Risk Assessments Balancing Act Matter of Balance Senior Strength Walk with Ease ® Tai ChiYogaWalk StrongFitness Fun Functional Fitness & Wellness Living Well Linedancing & more!

37. Falls Risk Assessment Balancing Act Matter of Balance Senior Strength Finally got her eyeglass prescription updated (because she saved $ on her drugs) All prescriptions at one pharmacy Reduced risk of drug interactions Reduced cost by assigning Mary to the correct formulary Bathroom grab bars Handrails on interior AND exterior stairways Fixed the light switch outside her bedroom Tack down her loose carpet EZ Fix Program Benefits Checkup Health Programs Outside Referrals There is no wrong door…

38. 38

39. Contact information: 39 Anna Moses - RN,BSN,CCRN,CEN Trauma Coordinator Eastern Maine Medical Center amoses@emh.org (207) 973-7920 Angela Lufkin Maine Market Manager Gentiva Home Healthcare Angela.Lufkin@gentiva.com (207) 990-9000 Lisa Dunning Health Programs Manager Eastern Area Agency on Aging ldunning@eaaa.org (207) 941-2865