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Health Care Professional Educational Module. Module Goals. To increase: Health care professional knowledge about falls-related issues and prevention interventions among older adults

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Health Care Professional Educational Module

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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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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


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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 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


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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


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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


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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 preventable14

  • 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 factors24


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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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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


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History of Falls (Previous falls)


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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


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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.)


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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


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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


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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 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


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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 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


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How Can You Prevent Falls From Occurring?

The goal of a falls prevention program is to reduce the number of risk factors


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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 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


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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)


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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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