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Health Care Professional Educational Module
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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
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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
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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
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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
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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
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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
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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
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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?
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Risk Factors Internal – integral to patient’s system Medical conditions Aging process External – physical environment Living environment Emergency Department/Hospital/ Senior Living Facility Outdoors
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Falls among older adults are usually not the result of a single risk factor, but of a combination of internal and external factors 24
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Internal Risk Factors History of Falls (Previous Falls) Medication use (Polypharmacy) Balance, gait, and muscle strength (Lack of Physical exercises) Vision impairment Podiatric problems
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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)
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FALL DECREASED FUNCTIONAL ABILITY REDUCED ▪ MUSCLE STRENGTH ▪ BALANCE AND GAIT ▪ FLEXIBILITY DECREASED ACTIVITY FEAR OF FALLING History of Falls (Previous falls)
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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
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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.)
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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
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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
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External Risk Factors Unsafe home environment Inadequate footwear Unsafe outdoor environment Unsafe emergency department/ hospital/facility environment
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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
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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
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Unsafe Outdoor Environment Uneven sidewalk, terrain, curbs, sidewalks Lack of or structurally unsecured handrail Hazardous materials (ice, snow, gravel, etc.) Poor lighting
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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
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The goal of a falls prevention program is to reduce the number of risk factors How Can You Prevent Falls From Occurring?
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Intervention Model Community Setting Presentation/Intervention Emergency department, hospital, senior living community Intervention
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Falls-Risk Assessment (Previous falls) Falls-Risk Assessment Tools Morse Fall Scale (MFS) Hendrich II Fall Risk Scale Falls – Assessment/Screening/ Diagnosis Scale
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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)
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Vision Examination (Visual impairment) In all settings Educate older adults Refer to primary care provider for regular eye examinations
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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
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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)
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Examples of Physical Activities Walking Gardening Dancing Strength, resistance, and flexibility exercises Yoga Tai Chi
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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
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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
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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
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Adequate/Inadequate Footwear Adequate Proper fit Non slippery soles Low heels Inadequate Floppy slippers Loose fitting Wearing socks only
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Assistive Devices Cane Walker Hip protectors Grip bars Shower chair Raised toilet seat
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Community Services and Referrals Home care service agencies Personal trainer or exercise program dedicated to older adults Social services Day care Meals on Wheels
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