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

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 Module Goals

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

 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 DECREASED FUNCTIONAL ABILITY REDUCED ▪ MUSCLE STRENGTH ▪ BALANCE AND GAIT ▪ FLEXIBILITY DECREASED ACTIVITY FEAR OF FALLING History of Falls (Previous falls)

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

The goal of a falls prevention program is to reduce the number of risk factors How Can You Prevent Falls From Occurring?

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 community presentation  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