abc’s of fall prevention: from evidence to …€™s of fall prevention: from evidence to...

26th Annual Fall Symposium – New Frontiers in Geriatrics - Arizona Geriatrics Society

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2014 Arizona Geriatrics Society All Rights Reserved

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ABC’S OF FALL PREVENTION: From Evidence to Practice

Babak Nayeri, ND, FACFE, DAAPM

Arizona Healthy Aging

Jeffrey Alexander, PhD A.T. Still University

DISCLOSURE OF COMMERCIAL SUPPORT Babak Nayeri, ND, FACFE, DAAPM and Jeffrey Alexander, PhD do not have a significant financial interest or other relationship with manufacturer(s) of commercial product(s) and /or

provider(s) of commercial services discussed in this presentation.

Learning Objectives:

● Discuss the prevalence of falls and fall-related injuries among older adults. ● Review the health and economic burden of falls on systems of care. ● Integrate evidence-based management strategies and programs for fall prevention.




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Health and Wellness for all Arizonans

NEW FRONTIERS IN GERIATRICSNEW FRONTIERS IN GERIATRICSFrom Prevention to Intervention and Beyond

ABC's of FALLS PREVENTION ‐ FROM EVIDENCE TO PRACTICE

2626thth Annual Fall SymposiumAnnual Fall Symposium

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Disclosure

• We have no financial interest, relationship, or affiliation that would constitute a conflict of interest

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Objectives

• Discuss prevalence of falls and fall‐related injuries among older adults

• Review health and economic burden of falls on systems of care

• Integrate evidence‐based management strategies and programs for falls prevention

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National Prevalence

• Every 1515 seconds an older adult is seen in an ED

• Falls are the leading cause of:– ≥ 6 million medically treated injuries

– 2.4 million injuries treated in emergency departments annually

– fatal injury‐related deaths (>21,700)

– 772,000 hospitalizations for non‐fatal injuries & ED visits1

ACL and CDC

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National Prevalence (Continued)

• Direct medical cost of falls $30++ billion annually2

• By 2020 nearly $62 billion

• Medicare cost of $46 billion

2014 Aging in Arizona Report

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Arizona’s Prevalence

• 2013, falls was the third leading cause of fatal injuries in Arizonans (n=880; 18%)

• Majority of these death among individuals 65+ (n=767; 87%)

• Unintentional falls were the leading cause of non‐fatal injuries for both hospitalizations (n=17,031; 45%) and…

2014 Aging in Arizona Report

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Arizona’s Prevalence (Continued)

• …ED visits (n=122,187; 31%)

• 68% percent (n=11,600) and 27% (n=33,588) among adults 65+ respectively

2013 Arizona Injury Prevention Plan

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Disparate Population

• Men are more likely than women to die from a fall.

• In 2011, age‐adjusted, falls related mortality rate was 41% higher for men than for women.1

• Older whites are 2.7 times more likely to die from falls as their black counterparts. 1

• Older non‐Hispanics have higher fatal fall rates than Hispanics.3

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Disparate Population (Continued)

• 75+ are four to five times more likely to be admitted to a long‐term care facility for a year or longer 4

• Rates of fall‐related fractures twice more among older women than men5

• Hip fracture risk among white women > black women6

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Economic Burden

ADHS Office of Injury Prevention

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Economic Burden (Continued)

• Unknown costs

– Post‐acute care

– Long‐term care

– Assisted Living Facilities

– Independent Living Facilities

– Home care agencies

– Non‐medical home care

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Risk Facto

rs

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www.AzHealthyAging.com

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Intrinsic/Extrinsic Risk Factors8,9

• Muscular weakness

• Poor balance

• History of falls

• Poor mobility/gait

• Use of assistive device

• Vision impairment

• Hearing impairment10

• Age (>80 yrs old)

• Postural hypotension11

• Medications– Polypharmacy12

– Sedatives, antidepressants13

• Environmental– Inside residence

– Outside residence/ community

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Co‐occurring Disorders

Estimated prevalence of depression in older adults Community‐ 14% to 20% Inpatient‐ 12% to 45% Long‐term care facilities‐ 40% According to the CDC, 14.9 out of 100,000 adults ≥ 65 years old

commit suicide each year

Depression in older adults has been associated with increased disability, nursing home placement, cognitive impairment, and mortality

Depression has been associated with prolonged physical recovery

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Medications: Less is More• Among adults ≥ 60 years, 76% take 2 to 4 medications and 40% take 5 or more

• Four medications or classes were implicated in 67% of adverse drug reaction (ADR)‐related hospitalizations in older adults (warfarin, insulin, oral antiplatelet agents, oral hypoglycemic agents).

• Patients ≥ 65 years are approximately 7 times more likely to be hospitalized for a medication ADR than younger patients

• Medication‐related ADRs are estimated to be the 4th ‐6th leading cause of death in the United States

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Budnitz DS et al. NEJM 2011. Budnitz DS et al. JAMA 2006. Lazarou J et al. JAMA 1998. James JT. J Patient Saf 2013

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The 5th Vital Sign

• Pain

– 25% to 50% of community‐dwelling older adults suffer from “important pain problems”

– Up to 1/4 of older adults have untreated pain

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AGS Panel on Persistent Pain in Older Persons. J Am Geriatr Soc 2002, 2009. Cleeland CS, et al. JAMA. 1998

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Substance Use Past Month Illicit Drug Use among

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SAMHSA, Results from the 2012 National Survey on Drug Use and Health

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SUBSTANCE‐SPECIFIC DIFFERENCES IN OLDER ADULTS

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Center for Substance Abuse Treatment. Substance Abuse Among Older Adults. Treatment Improvement Protocol (TIP) Series, No. 26. Taylor MH. Prim Care Companion CNS Disord 2012. Mittleman MA. Circulation 2001.

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UNIQUE PATTERNS OF USE IN OLDER ADULTS

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Center for Substance Abuse Treatment. Substance Abuse Among Older Adults. Treatment Improvement Protocol (TIP) Series, No. 26. Taylor MH. Prim Care Companion CNS Disord 2012. Mittleman MA. Circulation 2001.

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2014‐2018 ARIZONA–HEALTHY AGING PLANFalls Prevention

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GOAL Develop a coordinated,

long‐term and multi‐

strategic approach to

reduce the impact of falls‐

related injuries among

Arizona residents.


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Strategies for Fall Prevention

and Risk Reduction

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6 Steps to Prevent a Fallwww.NCOA.org

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Multifactorial Risk Factor Assessment and Management14

• In‐depth screening tied to intervention recommendations and follow up14

• Chang et al. reported, via meta‐analysis, 11.8 fewer falls per 100 patients per month compared to usual care14

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Physical Activity/Exercise12

• Chang et al. reported, via meta‐analysis, 2.7 fewer falls per 100 patients per month14

• Include the following types of training:12

– Balance, gait, and strength

• Performed in a group or individually at home

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Environmental/Home Modification12

• Environment/Home Modification12

– Home hazard assessment

– Removal or modification of hazards

– Installation of safety devices such as . . .

– Improvement in lighting (inside and out)

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Medication Management12

• Medication review with healthcare provider or pharmacist to:

– Identify what meds or combination of meds increase fall risk

– Withdrawal/dose reduction of psychotropic meds

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Other Strategies12

• Managing postural hypotension

• Managing foot and footwear problems

• Managing heart rate and rhythm abnormalities

• Vitamin D supplementation15

• Education and information

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What to do if resources are limited?

Are single strategy approaches effective?

Is there one “best”strategy?

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Multifactor vs. Single Factor

• Campbell and Robertson16 found a single factor (23%) was as effective as multifactor interventions (22%) for falls reduction

• Exercise was the most common single factor intervention examined

• Strength and balance re‐training “most widely investigated”

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Exercise is one of the most important strategies for falls

prevention!

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Evidence‐Based Falls Prevention Programs

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Evidence‐based Programs17

• Tai Chi: Moving for Better Balance

• Otago Exercise Programme

• Stepping On

• Stay Safe, Stay Active

• And others . . .

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Matter of Balance: Managing Concerns About Falls

• Primarily behavioral change (fear of falling) program with low‐intensity multi‐component exercise

– ATSU students trained to deliver AMOB to residents in the Phoenix‐Metro area

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http://azlwi.org/calendar/amob

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Our Charge…

Use our knowledge, skills, and expertise to help prevent falls among older adults

throughout Arizona.

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Contact Information

Dr. Jeff AlexanderAssociate Professor, Doctor of Health Sciences ProgramChair, ATSU Aging Studies Project Advisory Committee

480.219.6039 [email protected]

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Dr. Babak NayeriExecutive Consultant, Healthy Aging

602.364.0868 [email protected]

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References1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–

based Injury Statistics Query and Reporting System (WISQARS). Retrieved from http://www.cdc.gov/injury/wisqars/.

2. Stevens, J.A., Corso P.S., Finkelstein, E.A., & Miller TR. (2006). The costs of fatal and nonfatal falls among older adults. Injury Prevention, 12, 290–295.

3. Stevens, J.A. & Dellinger, A.M. (2002). Motor vehicle and fall related deaths among older Americans 1990–98: sex, race, and ethnic disparities. Injury Prevention, 8, 272–275.

4. Donald, I.P. & Bulpitt, C.J. (1999). The prognosis of falls in elderly people living at home. Age and Ageing, 28, 121–125.

5. National Hospital Discharge Survey (NHDS), National Center for Health Statistics. Retrieved from www.cdc.gov/nchs/hdi.htm.

6. Centers for Disease Control and Prevention. (2000, March 31). Reducing falls and resulting hip fractures among older women. MMWR. Morbidity and Mortality Weekly Reports, 49(RR02),1‐12. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4902a2.htm

7. CityofVacaville (2011, September 9). Fall Prevention. Retrieved April 25, 2013, from

http://www.youtube.com/watch?v=_R6iOWea00w

8. Adapted from Spirduso, W. W., Francis, K. L., & MacRae, P. G. (2005). Physical Dimensions of Aging(2nd ed.). Champaign, IL: Human Kinetics, p. 151.

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References9. Carter, S. E., Campbell, E. M., Sanson‐Fisher, R. W., Redman, S., & Gillespie, W. J. (1997).

Environmental hazards in the homes of older people. Age and ageing, 26(3), 195–202, Table 1, p. 196.

10. Lin, F.R. and Ferrucci, L. (2012). Hearing loss and falls among older adults in the United States. Archives of Internal Medicine, 172(4), 369‐371

11. Shubert, T. E. (2011). Evidence‐based exercise prescription for balance and falls prevention: a current review of the literature. Journal of geriatric physical therapy (2001), 34(3), 100–108. http://dx.doi.org/10.1519/JPT.0b013e31822938ac

12. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. (2011). Journal of the American Geriatrics Society, 59(1), 148–157. http://dx.doi.org/10.1111/j.1532‐5415.2010.03234.x

13. Woolcott, J. C., Richardson, K. J., Wiens, M. O., Patel, B., Marin, J., Khan, K. M., & Marra, C. A. (2009). Meta‐analysis of the impact of 9 medication classes on falls in elderly persons. Archives of internal medicine, 169(21), 1952–1960. http://dx.doi.org/10.1001/archinternmed.2009.357

14. Chang, J. T., Morton, S. C., Rubenstein, L. Z., Mojica, W. A., Maglione, M., Suttorp, M. J., …Shekelle, P. G. (2004). Interventions for the prevention of falls in older adults: systematic review and meta‐analysis of randomised clinical trials. British Medical Journal (Clinical research ed.), 328(7441), 1‐7. http://dx.doi.org/10.1136/bmj.328.7441.680

15. Bischoff‐Ferrari, H. A., Dawson‐Hughes, B., Willett, W. C., Staehelin, H. B., Bazemore, M. G., Zee, R. Y., & Wong, J. B. (2004). Effect of Vitamin D on falls: a meta‐analysis. JAMA: the journal of the American Medical Association, 291(16), 1999–2006. http://dx.doi.org/10.1001/jama.291.16.1999

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References16. Campbell, A. J., & Robertson, M. C. (2007). Rethinking individual and community fall prevention

strategies: a meta‐regression comparing single and multifactorial interventions. Age and ageing, 36(6), 656–662. http://dx.doi.org/10.1093/ageing/afm122

17. CDC ‐ Older Adult Falls ‐ Preventing Falls Among Older Adults ‐ Home and Recreational Safety ‐Injury Center. (n.d.). Retrieved October 24, 2014, from http://www.cdc.gov/homeandrecreationalsafety/Falls/compendium.html

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Health and Wellness for all Arizonans42

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abc’s of fall prevention: from evidence to …€™s of fall prevention: from evidence to...

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