fall reduction essential to overall senior wellness and ......eye conditions affecting seniors...
TRANSCRIPT
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Fall Reduction – Essential to Overall Senior Wellness and the Community’s HealthSandi Brekke, COTA; Healthy Living & Senior Summit CoordinatorWalt Schroeder, Pharm.D., Director; Transition and Senior Care Strategy
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2 | © Kaiser Permanente 2010-2011. All Rights Reserved.November 9, 2015
Learning Objectives
List resources available to Kaiser Permanente
members to reduce fall risk
Summarize examples of how Kaiser Permanente
applied the foundational elements of fall
prevention into practice
Assess opportunities for improving fall
prevention awareness/interventions within your
organization
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Facts around falls
1 in 3 elders fall each year; less than half tell their doctor
Falling once doubles your chance to fall again
More than 95% of hip fractures are caused by falling
Half of all falls happen at home
Many elders hospitalized after a fall never achieve independence again
3 | © Kaiser Permanente 2010-2011. All Rights Reserved.November 9, 2015
Source: http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html
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4 | © Kaiser Permanente 2010-2011. All Rights Reserved.November 9, 2015
Kaiser Permanente is committed to aging
well; understanding, planning and
supporting all stages of life
A vision for elder care…
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Partnership with the Fall Prevention Consortium
Coordinated and aligned with Fall Prevention Awareness 2015 campaign
State’s Fall Prevention awareness videos
– Kaiser Permanente Moanalua Medical Center closed circuit television system
– Fall Prevention Classes within Kaiser Permanente Clinics
Joint KHON, Fall Prevention Consortium and Kaiser Permanente media campaign on fall prevention awareness (to air late 2015)
5 | © Kaiser Permanente 2010-2011. All Rights Reserved.November 9, 2015
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Internal Alignment within Kaiser Permanente
Exercise
Home SafetyVision Checks
Medication Review
State’s Fall Prevention Campaign
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7 | © Kaiser Permanente 2010-2011. All Rights Reserved.November 9, 2015
Exercise
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Benefits of staying activeExercise • You are less likely to fall by staying active and
participating in activities such as tai chi, hula,
gardening, and walking around the mall or
neighborhood. (http://health.hawaii.gov/injuryprevention/home/preventing-falls/information)
• World’s largest fall prevention study in Sydney in 2007
– After 16 weeks of learning and practicing Tai Chi the
results showed that Tai Chi significantly reduced the
number of falls.
• Tai Chi for Fall Prevention (Dr. Paul Lam) – Waipio,
Honolulu
• Chairobics - Honolulu
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Incorporating STEADI into your programExercise STEADI – Stopping Elderly Accidents, Deaths and Injuries
• Balance and Fitness Testing – Honolulu, Kailua,
Mapunapuna and Waipio
• Timed Up and Go (agility/dynamic balance)
• 30-Second Chair Stand (lower body strength)
• 4-Stage Balance Test
• Fall Prevention class
• Tai Chi for Fall Prevention
• Chairobics
• Silver&Fit (YMCA, Tai Chi home program)
• Exercise handout
• NIA exercise video & guide
• Health Coach
At Risk
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10 | © Kaiser Permanente 2010-2011. All Rights Reserved.November 9, 2015
Home Safety
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Improving home safety
Home Safety
Bathrooms
– Grab bars
– Non-slip mats
– Shower bench
Clutter
– Clear pathways
– Remove rugs & extension cords
Lighting
– Increase brightness
– Night lights
– Stair edging
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Available Resources
Home Safety
Home Health
Project Dana
Fall Prevention Home Safety
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13 | © Kaiser Permanente 2010-2011. All Rights Reserved.November 9, 2015
Medication Review
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High Risk Medications for Falls
Muscle relaxants (e.g. cyclobenzaprine)
Sleep aids (e.g. zolpidem)
Glyburide
Over the Counter Products
– Diphenhydramine (Benadryl)
– Chlorpheniramine (AllerChlor, Chlor-Trimenton)
– Combination products
Tylenol PM
NyQuil
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Medication Review
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Where medication reviews occur
Clinical settings
– Hospital
– Nursing homes
– Clinic
– Kaiser Permanente Home Health
Senior Summit/Brown-bag events
Medicare Part D
Member request
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Medication Review
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16 | © Kaiser Permanente 2010-2011. All Rights Reserved.November 9, 2015
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Eye Conditions Affecting Seniors
Vision Checks
Cataracts
– Clouding of the lens of the eye
– Symptoms:
Blur
Glare
Halos
– Risk factors:
Aging
Excessive sunlight exposure
Smoking
Certain medications and diseases
– Treatment
Surgery
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Eye Conditions Affecting Seniors
Vision Checks
Glaucoma
– high pressure in the eye causing nerve damage (often)
– Symptoms
Slow loss of peripheral vision
– Risk Factors
Older age
Family history
African ancestry
Latino/Hispanic ethnicity
History of significant eye injury
– Treatment
Eye drops
Laser treatments
Surgery
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Eye Conditions Affecting Seniors
Vision Checks
Macular Degeneration
– Damage to the center of the retina
– Symptoms
Center of everything a person tries to look at is distorted or missing
– Risk Factors
Family history
Old age
Smoking
Excessive sunlight exposure
– Treatment
No effective treatments to restore vision
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Screening and Prevention
Vision Checks
Screening
– Yearly eye appointments
Prevention
– Green leafy and colorful vegetables
– Control blood sugar, cholesterol, blood pressure, weight
– Sunglasses
– Avoid smoking
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Transforming Practice
21 | © Kaiser Permanente 2010-2011. All Rights Reserved.November 9, 2015
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Transforming Elder Care
22 | © Kaiser Permanente 2010-2011. All Rights Reserved.November 9, 2015
who am I caring for?
what do they want?
how would I know?
Source: http//www.tomhussey.com
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23 | © Kaiser Permanente 2010-2011. All Rights Reserved.November 9, 2015
I’m old, sick and on a lot of medicine
She has dementia, metastatic colon cancer,
so I enrolled her in hospice in May
During my visit today, I told her things look
good! Continue your meds and follow-up in
6 months for lipids and chemistries
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24 | © Kaiser Permanente 2010-2011. All Rights Reserved.November 9, 2015
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Navigation: Social Care Insights
25 | © Kaiser Permanente 2010-2011. All Rights Reserved.November 9, 2015
What matters
most to
members?
Who are
members
routinely
interacting with?
Who provides
caregiver
support?
How will
members pay for
care?
Do members
understand their
current condition
and trajectory?
Are their
decisions clear to
everyone?
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Coordination: care delivery
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Integration: partnering differently
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Family Mediation/Conferencing Prevention Friendly visiting/home safety
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Incorporating fall prevention into programs
28 | © Kaiser Permanente 2010-2011. All Rights Reserved.November 9, 2015
Point of Contact: _____________ Ph: __________ Hours avail: Mon-Fri 8 am-4:30 pm Patient Name/MR#/Age/Sex/2-3 sentence overview (including “what matters most”)
Ambulation [N]
Activity [N]
Self-Care [N]
Intake [N] Issues with:
Wt. Loss
Constipation
Home/Family environment [N + HHRN]
AHCD [N] Decision: Power of Attorney: File date:
POLST [N] Decision: File date:
Desired location of passing [N]
Caregiver [N]
Identified Social Gaps [N]
Consciousness [N]
Capacity for Medical Decision Making [MD]
Yes/No
Should we turn off the care gaps on Mana Ku? [RN]
Yes/No
Likely to show up in the ED or clinic for:
(What do you want your colleagues to know/do?) [MD]
If ED/Hospitalized: [T]
RN Care Plan [RN + Home Health RN] E-Kit needed?
Things to know… [T]
Does the patient need [T]
Fall Prevention o Med Review o Vision Check o Home safety assessment o Exercise
Other…. [T]
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Thank you for your time and attention
Questions?
29 | © Kaiser Permanente 2010-2011. All Rights Reserved.November 9, 2015