deborah behre, dpm db.foot@comcast · pdf filemuscle weakness ... 3 gait, strength and balance...
TRANSCRIPT
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Deborah Behre, DPM [email protected]
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NO DISCLOSURES
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SAVE THE DATE ! SEPTEMBER 22
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PATIENTS
FAMILY & FRIENDS
YOU, YOUR STAFF AND YOUR PRACTICES
THE HEALTH CARE SYSTEM (MEDICARE)
CDC & WHO
WHO CARES?
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EVERY SECOND COUNTS 1 OUT OF 3 PEOPLE 65 Y.O. OR OLDER FALL (1 IN 4 REPORT) 1 OUT OF 5 IS SERIOUS TBI’S: 81% HIP FRACTURES: 95% 1 OUT OF EVERY 3 NEVER RETURN HOME
2012 3.2 MILLION NON FATAL INJURIES 24,190 FATALITIES
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NON FATAL FATAL
2012 $30.3 BILLION $616.5 MILLION
2015 $ 31.3 BILLION $637.5 MILLION
AVERAGE COST OF A FRACTURED HIP: $50,000
DIRECT MEDICAL COSTS FOR FALL RELATED INJURIES
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5000 providers
6 million Pts screened
1 million falls prevented (1 in 6)
$3.5 billion direct medical cost saving
Can we make a difference?
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VISION MEDICATIONS MUSCLE WEAKNESS BALANCE HISTORY OF A FALL (FEAR OF FALLING) PERIPHERAL NEUROPATHY PRE DISPOSING DISEASES (CVA, Parkinson’s) LOW VIT D LEVELS FOOTWEAR – SHOES & SOCKS FOOT PAIN OTHER PODIATRIC FACTORS
RISK FACTORS
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PERIPHERAL NEUROPATHY FOOT PAIN MUSCLE WEAKNESS (includes intrinsics) BALANCE PROPRIOCEPTION FOOTWEAR (SHOES & SOCKS) FOOT DEFORMITIES (hallux valgus, lesser toe deformities, equinus,foot
drop)
LOWER EXTREMITY RISK FACTORS
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WOMEN AGE BAREFOOT OR SOCKS – 11x HEEL HEIGHT > 4.5 CM – 1.9 X HALLUX VALGUS - 2x LESSER TOE DEFORMITIES – 1.32X POOR FITTING SHOES – CONTRIBUTED to 51% OF FALLS IN
HOSPITALS
RISK INCREASES
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EXERCISE – most important activity (Tai Ji Quan – for balance: 28% improvement)
VIT D – 43% improvement
RISK DECREASES
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Pre Fab Inserts Shoegear (Non skid – fitting) Falls Prevention Education Exercise 30 minutes 3X/week) Falls Decreased 36%
PODIATRY BASED PROGRAM
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HERE’S WHERE YOUR FALLS PREVENTION PROGRAM STARTS
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OR IT MAY START HERE
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IF YOU DO NOTHING ELSE HAND THIS TO YOUR PATIENTS
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CONSIDER GOING FURTHER
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Safety Appt Vision Exercise
SAVE
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CONSIDER GOING FURTHER
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THE RECOMMENDATION IS THAT EVERYONE 65 YEARS OR OLDER HAVE A YEARLY FALLS RISK ASSESSMENT
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HERE’S WHAT’S RECOMMENDED FOR FALLS RISK ASSESSMENT
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YOUR STAFF CAN DO THE FIRST PART OF THIS FORM
QUESTIONING ABOUT FALLS
3 GAIT, STRENGTH AND BALANCE TESTS TUG (Timed Up and Go) (Recommended) 30 second chair stand (Optional) 4 stage Balance Test (Optional)
WHY START HERE ?
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ARM CHAIR MARK 10 FEET AWAY FROM CHAIR RECORD TIME TO STAND UP, WALK TO MARK, RETURN AND SIT DOWN OBSERVE GAIT (12 SECONDS OR LONGER = HIGH FALL RISK)
TIMED UP AND GO (TUG)
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SIT IN CHAIR DON’T USE HANDS TO GET UP (USE OF HANDS = 0 SCORE) COUNT NUMBER LOOK UP SCORE ON CHART
30 SECOND CHAIR STAND
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4 DIFFERENT STANDING POSITIONS (PROGRESS IN DIFFICULTY)
IF CAN DO 10 SECOND HOLD, GO ON TO THE NEXT POSITION
IF CAN’T DO TANDEM STANCE FOR 10 SECS, HIGH FALL RISK
4 STAGE BALANCE TEST
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CONSIDER GOING FURTHER
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SELF PROGRAM
EXERCISE CLASS: TAI JI QUAN,YMCA MOVING FOR BETTER BALANCE, SAIL (stay active and independent for life), STEPPING ON
PT CONSULT (OTAGO EXERCISE PROGRAM - dec falls 35-40%)
EXERCISE CHOICES FOR YOUR PTS
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28 % improvement
WHY DISCUSS EXERCISE?
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CHAIR RISE EXERCISE
MARBLES
TOWEL CURLS
SELF PROGRAM
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MOVE 20 MARBLES PER FOOT
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TOWEL CURL EXERCISES
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CONSIDER GOING FURTHER
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CONSIDER GOING FURTHER
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PCP
OT (SAFETY)
PT (BALANCE, STRENGTH, PROPRIOCEPTION, OTAGO)
REFERRALS
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CONSIDER GOING FURTHER
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PRESCRIBE WALKING AIDS REFER FOR MOORE BALANCE BRACES PRESCRIBE AND DISPENSE MOORE BALANCE BRACES SELL SHOES AND SOCKS
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CONSIDER GOING FURTHER
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NO ONE WALKS ALONE (HOSPITAL BASED FALLS PREVENTION PROGRAM)
NOWA
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JAPMA Nov/Dec 2013 Vol 3 # 6
APMA Webinar ‘Cloud’ (Falls Prevention)
CDC
NCOA
Good Sources of Information
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SAVE THE DATE ! SEPTEMBER 22 NATIONAL FALLS PREVENTION DAY
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REFERENCES 1. CENTER FOR DISEASE CONTROL ATLANTA, GA 2. J AM GERIATRIC SOCIETY 64:425-431,2016 3. BMC GERIATRIC 2011; 11-51 4. AM J LIFESTYLE MEDICINE 2016; JAN-FEB: 10(1) 5. APMA FALLS PREVENTION WEBINAR 6. MENZ et al FOOT & ANKLE RISK FACTORS FOR FALLS IN OLDER PEOPLE; A PROSEPECTIVE STUDY; JL OF GERONTOLOGY
2006;8:866 7. NATIONAL COUNCIL ON AGING (NCOA) ARLINGTON, VA 8. KOBYASHI et al; J PHYS THER SCI 1999, 11:31-34 9. WWW.MOOREBALANCEBRACE.COM 10. SAFESTEP.NET 11. GUIDELINE FOR THE PREVENTION OF FALLS IN OLDER PERSONS; JAGS May 2001-Vol. 49, No 5 pp 664-672 12. EFFICACY OF A MULTIFACETED PODIATRY INTERVENTION TO IMPROVE BALANCE AND PREVENT FALLS IN OLDER PEOPLE;
STUDY PROTOCOL FOR A RANDOMISED TRIAL pp 1-16 Spink, Mens, Lord (Australia) BMC Geriatrics 2008 13. GAIT AND BALANCE DISORDERS IN OLDER ADULTS SALZMAN, MD AMERICAN FAMILY PHYSICIANS July 1, 2010 Vol 82 # 1
pp61-68
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Thank you!
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SIMBA BOOTS REX LEO !