Health Care Professional Educational Module

Module GoalsModule 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 GoalsModule Goals

Intervention ContentIntervention 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 FallDefinition 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 ProblemScope 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

Scope of the ProblemScope 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

Cost of Falls Among Cost of Falls Among Older AdultsOlder 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

Challenges to Be MetChallenges 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?

Risk FactorsRisk 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 factors24

Internal Risk FactorsInternal 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 year9,25,33

Previous falls often leads to fear of falling, which may lead to decreased activity and loss of self-confidence27

History of Falls History of Falls (Previous falls)(Previous falls)

FALL

DECREASED ACTIVITY

FEAR OF FALLING

REDUCED ▪ MUSCLE

STRENGTH▪ BALANCE

AND GAIT▪ FLEXIBILITY

DECREASED FUNCTIONAL

ABILITY

History of Falls History of Falls (Previous falls)(Previous falls)

Visual ImpairmentVisual 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

Medication Use Medication Use (Pol(Polypharmacy)ypharmacy)

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.)

Balance, Gait, and Muscle Balance, Gait, and Muscle Strength Strength (Lack of physical activity)(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

Podiatric ConditionsPodiatric 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

External Risk FactorsExternal Risk Factors

Unsafe home environment Inadequate footwear Unsafe outdoor environment Unsafe emergency department/

hospital/facility environment

Unsafe Home Unsafe Home EnvironmentEnvironment22,2522,25

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 FootwearInadequate 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 Unsafe Outdoor Outdoor EnvironmentEnvironment

Uneven sidewalk, terrain, curbs, sidewalks

Lack of or structurally unsecured handrail

Hazardous materials (ice, snow, gravel, etc.)

Poor lighting

Unsafe Unsafe ED/ED/Hospital/Facility Hospital/Facility EnvironmentEnvironment

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

The goal of a falls prevention program is to reduce the

number of risk factors

How Can You Prevent How Can You Prevent Falls From Occurring?Falls From Occurring?

Intervention ModelIntervention Model

Community Setting Presentation/Intervention

Emergency department, hospital, senior living community Intervention

Falls-Risk AssessmentFalls-Risk Assessment(Previous falls)(Previous falls)

Falls-Risk Assessment Tools Morse Fall Scale (MFS) Hendrich II Fall Risk Scale Falls – Assessment/Screening/

Diagnosis Scale

Falls-Risk AssessmentFalls-Risk Assessment(Previous falls)(Previous falls)

Community Presentation Conducted before presentation

Emergency Department, Hospital, or Senior Living Community Conduct screening when fitting

(triage, admission, move-in)

Vision ExaminationVision Examination(Visual impairment)(Visual impairment)

In all settings Educate older adults Refer to primary care provider for

regular eye examinations

Medication ReviewMedication Review(Polypharmacy)(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 ActivityPhysical Activity(Reduced balance, gait, and (Reduced balance, gait, and muscle strength)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 Examples of Physical ActivitiesActivities

Walking Gardening Dancing Strength, resistance, and flexibility

exercises Yoga Tai Chi

In-Home safetyIn-Home safety(Unsafe home environment)(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 In-Home Modifications and Assistive Devices 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 CheckFeet and Footwear Check(Podiatric problems and inadequate (Podiatric problems and inadequate footwear)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 Adequate/Inadequate FootwearFootwear Adequate

Proper fit Non slippery soles Low heels

Inadequate Floppy slippers Loose fitting Wearing socks only

Assistive DevicesAssistive Devices

Cane Walker Hip protectors Grip bars Shower chair Raised toilet seat

Community Services and Community Services and ReferralsReferrals

Home care service agencies Personal trainer or exercise

program dedicated to older adults Social services Day care Meals on Wheels