Health Care Professional Educational Module

1. Health Care Professional Educational Module

2. 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

3. Module Goals 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

4. 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

5. 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

6. Scope of the Problem • For adults 65+, falls are the leading cause of injury-related death3,4 • Each year, more than one-third of older adults fall5-9 • 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 falls10 • Nearly one-half of all falls among older adults occur in or around their homes10

7. Scope of the Problem • Of those who fall, 20% to 30% suffer moderate to severe injuries13 • Nearly 50% of those hospitalized after a fall die within one year9 • In 2003, nearly 13,820 older adults died from fall-related injuries: of those, approximately 50% were age 85 and older.10

8. Cost of Falls Among Older Adults • Fall-related injury costs $20 billion per year21 • By 2020, total annual direct cost is expected to reach $32,4 million21 • Direct costs do not account for the long-term consequences of these injuries22

9. 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 preventable14 • How do we go about facing the challenge of reducing falls and fall-related injuries among older adults?

10. Risk Factors • Internal – integral to patient’s system • Medical conditions • Aging process • External – physical environment • Living environment • Emergency Department/Hospital/ Senior Living Facility • Outdoors

11. Falls among older adults are usually not the result of a single risk factor, but of a combination of internal and external factors24

12. Internal Risk Factors • History of Falls (Previous Falls) • Medication use (Polypharmacy) • Balance, gait, and muscle strength (Lack of Physical exercises) • Vision impairment • Podiatric problems

13. History of Falls (Previous falls) • Older adults who have previously fallen or who stumble frequently are 2 to 3 times more likely to fall within the next year9,25,33 • Previous falls often leads to fear of falling, which may lead to decreased activity and loss of self-confidence27

14. History of Falls (Previous falls)

15. Visual Impairment • Poor visual acuity27 • Older adults experience decreased night vision, altered depth perception, decline in peripheral vision, and glare intolerance25,37 • Also be aware of old or new prescription glasses27

16. Medication Use (Polypharmacy) • Types of medications25,32 • 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.)

17. Balance, Gait, and Muscle Strength (Lack of physical activity) • Less than 25% of older adults exercise regularly40 • By age 65, a 20% decrease in strength and flexibility usually occurs41,42 • After age 70, decrease in strength is even greater 41,42

18. Podiatric Conditions • Nearly 75% of older adults have some type of foot and ankle problems49 • Decreased sensation in the feet21 • Foot conditions can impair balance function50

19. External Risk Factors • Unsafe home environment • Inadequate footwear • Unsafe outdoor environment • Unsafe emergency department/ hospital/facility environment

20. Unsafe Home Environment22,25 • 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

21. 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

22. Unsafe Outdoor Environment • Uneven sidewalk, terrain, curbs, sidewalks • Lack of or structurally unsecured handrail • Hazardous materials (ice, snow, gravel, etc.) • Poor lighting

23. Unsafe ED/Hospital/Facility Environment • Transfer to or from a bed or chair17 • Bed height16 • Attachment to equipment (IV, oxygen)17 • Slippery floors • Lack of assistive devices • Clutter, tripping hazard • Unreachable bell, side table • Improper lighting • Mechanical restraints19,20

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

25. Intervention Model • Community Setting Presentation/Intervention • Emergency department, hospital, senior living community Intervention

26. Falls-Risk Assessment(Previous falls) • Falls-Risk Assessment Tools • Morse Fall Scale (MFS) • Hendrich II Fall Risk Scale • Falls – Assessment/Screening/ Diagnosis Scale

27. 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)

28. Vision Examination(Visual impairment) • In all settings • Educate older adults • Refer to primary care provider for regular eye examinations

29. Medication Review(Polypharmacy) • Community Presentation • Educate older adult • Refer to primary care provider or pharmacist • Distribute SafeMedication 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 SafeMedication Card

30. Physical Activity(Reduced balance, gait, and muscle strength) • Community Presentation • Educate older adult • Distribute and PracticeHealthy 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)

31. Examples of Physical Activities • Walking • Gardening • Dancing • Strength, resistance, and flexibility exercises • Yoga • Tai Chi

32. 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

33. 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

34. 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

35. Adequate/Inadequate Footwear • Adequate • Proper fit • Non slippery soles • Low heels • Inadequate • Floppy slippers • Loose fitting • Wearing socks only

36. Assistive Devices • Cane • Walker • Hip protectors • Grip bars • Shower chair • Raised toilet seat

37. Community Services and Referrals • Home care service agencies • Personal trainer or exercise program dedicated to older adults • Social services • Day care • Meals on Wheels