ma ala falls prevention€¦ · ma ala falls prevention july 24, 2018 kathleen cameron, mph senior...

MA ALA

Falls Prevention

July 24, 2018

Kathleen Cameron, MPH

Senior Director

Chelsea Gilchrist, MGS

Senior Program Manager

Center for Healthy Aging

National Council on Aging

Improving the lives of 10 million older adults by 2020 | © 2018 National Council on Aging 2

About NCOA

Who We Are: NCOA is the national voice for

every American’s right to age well

Our Vision:A just and caring society in which

each of us, as we age, lives with

dignity, purpose, and security


Our Mission:Improve the lives of millions

of older adults, especially

those who are struggling

Our Social Impact Goal:Improve the health and

economic security of 10

million older adults by 2020


How We Accomplish Our Mission

• Innovative Programs: NCOA’s online and in-community programs empower

individuals to take small steps that can significantly improve their daily lives.

• Advocacy: NCOA works in a bipartisan manner to protect and improve federal programs that Americans depend on, like Medicare, Medicaid, and the Older Americans Act.

• Partnerships: NCOA supports a national network of local partners that provide personalized services to help individuals stay healthy and economically secure as they age.


NCOA’s Center for Healthy Aging

Goal: Increase the quality and years

of healthy life for older adults and

adults with disabilities

Two national resource centers

funded by the Administration for

Community Living, HHS

Chronic Disease Self-

Management Education (CDSME)

Falls Prevention

Other key areas: behavioral health,

physical activity, immunizations, oral

health


National Falls Prevention Resource Center

Increase public awareness about falls prevention

Serve as the national clearinghouse for tools and resources

Support and stimulate evidence-based programs and strategies

www.ncoa.org/healthy-aging/falls-prevention/


Technical Assistance

NationalResource Centers

Annual Meeting One-on-

one support

Networking Learning

Collaboratives and

workgroups

WebinarsOnline

tools and resources

Best practices

Data Management


National Falls Free ® Initiative

• A thousands-strong and growing network

• National Action Plan developed in 2005; updated in 2015

• Strong partnerships

– ACL and the Aging Network

– CDC’s National Center for Injury Prevention and Control

– National professional and consumer organizations

– State and local public health entities

• Falls Free® is a critical effort to meet Healthy People 2020

goals of reducing older adult fall-related ED visits by 10%

• 43 State Falls Prevention Coalitions


2015 National Falls Prevention Action Plan

12 Goals, 40 strategies and 242 action steps

• Physical Mobility

• Medication Management

• Home Safety

• Environmental Safety

• Public Awareness and Education

• Funding and Reimbursement

• Expansion of Evidence-based Programs

• Policy and Advocacy

Source: www.ncoa.org/healthy-aging/falls-prevention/2015-falls-prevention-action-plan/

http://www.ncoa.org/healthy-aging/falls-prevention/2015-falls-prevention-action-plan/


What We Know about Falls and Fall-Related Injuries

Common 1 in 4

20% of falls result in injuries

Leading cause of fatal and nonfatal injuries among older adults

Costly $50 billion per year

Impactful

Predictable

Largely Preventable

Everyone has a role to play and

can make a difference within their

own sphere of influence.


MA Executive Office of Elder Affairs AL Regulations

January 2017 changes included:

Enhanced the Specialized Training Requirements ((651CMR 12.07(4)(f)(2)) to include the annual in-service education requirement for all employees include “falls prevention”which should be based on the Residence’s established policies and procedures;

Each ALR is required to implement an Evidenced Based Informed Falls Prevention Program, to be included in the annual Quality Assurance and Performance Improvement program focusing on “Resident Safety and Assurances.”


Falls Risk Factors: A Tower of Blocks

• History of falling –

• Impairment of balance and gait

• Mobility problems: muscle weakness, inability to transfer,

decreased coordination, sedentary

• Medications: number and type

• Postural hypotension or low blood pressure

• Sensory deficits, such as vision or hearing impairments,

loss of sensation in feet

• Limitations in activities of daily living

• Home or environmental hazards

• Cognitive decline

• Chronic conditions: Arthritis, Diabetes, Neurological

disease (stroke, Parkinson’s disease), cardiovascular

disease, chronic pain

• Depression

• Age >80 years, Female gender, Living alone

• Transitions from home to another setting


Percent Falling by Number of Risk Factors

0

20

40

60

80

100

Perc

en

t F

all

ing

0 1 2 3 4+

Number of Risk Factors

8

%19%

32

%

60

%

78

%

No. Falling 4 20 30 35 18

No. Subjects 51 106 94 58 23Tinetti et al, NEJM 1988;

319:1701


Adverse Consequences of Falls for Older Adults

• Serious injuries – hip and spinal fractures, brain

injuries, broken bones, e.g., wrist, femur

• Increased fear of falling and restriction of activities,

social isolation, depression, helplessness

• Decreased ability to function

• Loss of independence and reduced quality of life

• Increased risk of premature death


Adverse Consequences of Falls for Assisted Living

• Frequent calls EMS

• Increased levels of assistance required

for residents who fall

• Increased paperwork for staff

• Poor survey results

• High insurance premiums

• Lawsuits


CDC Tools

STEADI Resources

(Stopping Elderly

Accidents,

Deaths and Injuries)

Based on the AGS/BGS

Falls Prevention

Guidelines (evidence-based)


Evidence-Based Falls Prevention Approach

Comprehensive Approach:

CDC’s STEADI Tool Kit• Screening

• Assessment of risk factors

• Intervention to address risk factors

– Exercise – strength & balance

– Clinical – Geriatric care to address chronic

conditions, medication, vision, nutrition

– Home assessment and modification for fall

hazards


Stopping Elderly Accidents, Deaths and Injuries (STEADI) Resourceswww.cdc.gov/steadi/index.html

http://www.cdc.gov/steadi/index.html


Assessment for Fall Risk

• Get Up and Go Test*

• Timed Up and Go Test*

• Four Stage Balance Test*

• Tinetti Gait and Balance Test

• Functional Reach Test

• Hendrich Fall Risk Model

• Postfall Assessment In CDC STEADI Tool Kit Resources


Postural Hypotension

• Checking PH routinely

in all elders is critical

and often overlooked.

• PH is defined as > 20

mmHG drop in systolic

Bp or > 10 mmHG

drop in diastolic

• Does the elder report

falling back into chair

during sit to stand?


Postural Hypotension: What It Is and How to Manage It


Protect Your Loved Ones from Falling


Falls Prevention in Assisted Living

• Assessing residents to identify and

address risk factors and refer to treat the

underlying medical conditions.

• Educating staff about fall risk factors,

their role in preventing falls and prevention

strategies.

• Reviewing prescribed medications to

assess their potential risks and benefits

and to minimize use.


Falls Prevention in Assisted Living

• Making environmental changes to make

it easier for residents to move around

safely.

• Offering exercise programs

• Teaching residents who are not

cognitively impaired behavioral

strategies to avoid potentially hazardous.

• Providing residents with hip pads that

may prevent a hip fracture if a fall occurs.


Environmental Strategies

• Proper lighting

• Signage

• Flooring, e.g., reduce glare, remove scatter rugs

• Bed height

• Armchair and couch height, armrest placement

• Stairways and step edges

• Supports and Grab bars stairways, hallways, in

toileting and bathing areas

• Absence of clutter and other trip hazards


Medication As A Falls Risk Factor

• Benzodiazepines

• Antidepressants

• Antipsychotics

• Opioid analgesics

• Anti-hypertensives

• Cardiovascular medications

• Diabetic Medications

• Eye Drops and Ointments

• Anticoagulants and Antiplatelet Agents

• Multiple medications


Reducing Falls and Injuries

• Alerts by risk

• Call bells

• Commodes

• Floor mats

• Companions, including remote

companions?

• Hip protectors?


Evidence-Based Falls Prevention Programs

• Proven to help older adults reduce their risk of falling and/or fear of falling

• Programs available for older adults with low, moderate, and high risk for a fall

• Program content includes one or more of the following:

• Cognitive restructuring

• Balance, strength, and gait training exercises

• Group discussion

• Practical solutions

• Home safety modifications

• Educational presentations from experts in the community

• For information about program summaries, costs, and training requirements, visit:

https://www.ncoa.org/healthy-aging/falls-prevention/falls-prevention-programs-for-older-adults/

https://www.ncoa.org/healthy-aging/falls-prevention/falls-prevention-programs-for-older-adults/


Community-Based, Evidence-Based Falls Prevention Program/Falls Risk Pyramid

Note: An individual’s level of falls risk may change and should be periodically reassessed. The CDC’s STEADI toolkit is an evidence based framework

that can be used to assess risk. Individuals can move from program to program, depending on their individual needs and level of falls risks.

Adapted from Mahoney, J & Shea, T.

CAPABLE, Otago

FallsTalk/FallsScape,

Healthy Steps for Older Adults,

A Matter of Balance,

Stepping On

EnhanceFitness, Fit & Strong! Healthy Steps in Motion, SAIL, Tai Chi for Arthritis, Tai Ji Quan: Moving for Better

Balance, YMCA Moving for Better Balance

Falls Risk

Detailed information on all programs available here

https://www.cdc.gov/steadi/index.html

https://www.ncoa.org/wp-content/uploads/Select-Evidence-Based-Fall-Prevention-Programs-Grid-July-20-2017.pdf


You Have the Power to Prevent a Fall Video

https://vimeo.com/182773116

https://vimeo.com/182773116


A Matter of Balance

CAPABLE

EnhanceFitness

FallsTalk/FallScape

Fit & Strong!

Healthy Steps for Older Adults

Otago Exercise Program

Stay Active and Independent for Life

(SAIL)

Stepping On

Stay Safe, Stay Active

Tai Chi for Arthritis

Tai Ji Quan: Moving for Better

Balance

YMCA Moving for Better Balance

Evidence-Based Falls Prevention Programs

Full list is available at:

https://www.ncoa.org/resources/select-evidence-based-falls-prevention-programs/


Falls Prevention

ProgramEffectiveness Net Benefits and ROI

Tai Chi: Moving for Better

Balance

Fall rate among participants was

reduced by 55%

Net benefit = $530

ROI = 509%

Stepping OnFall rate among participants was

reduced by 30%

Net benefit = $134

ROI = 64%

Otago Exercise Program Reduction of 35% in adults over age 80Net benefit = $429

ROI = 127%

A Matter of BalanceSignificant increase in falls efficacy, falls

management, and falls control

Total cost savings per

Medicare beneficiary = $938

Sources:

Report to Congress in November 2013: The Centers for Medicare & Medicaid Services’ Evaluation of Community-based Wellness and Prevention Programs under Section 4202 (b) of the Affordable Care Act.

Stevens JA, Sogolow, ED. Preventing Falls: What Works A CDC Compendium of Effective Community-based Interventions from Around the World; Atlanta, GA: CDC, 2009.

Carande-Kulis , VG, Stevens, JA, Beattie, BL & Arias, LA cost-benefit analysis of three older adult fall prevention interventions, Journal of Safety Research, 2015

Benefits of Falls Prevention Programs


Evidence-Based and Evidence-Informed Interventions for Persons

with Dementia

• National Alzheimer’s and Dementia Resource Center

Grantee-Implemented Interventions

o New Ways for Better Days: Tailoring Activities for Persons with

Dementia and Caregivers (previously called Tailored Activities

Program or TAP)

o Reducing Disability in Alzheimer’s Disease (RDAD). For information

about implementing the program, contact Linda Teri at University of

Washington ([email protected])

https://nadrc.acl.gov/node/140

https://learn.nursing.jhu.edu/face-to-face/institutes/NewWay-TAP/index.html

http://www.rosalynncarter.org/caregiver_intervention_database/dimentia/reducing_disability_in_alzheimers_disease/

mailto:[email protected]


National Fall Prevention Awareness Day (FPAD)

• September 22, 2018: 1st day of fall

• 11th Annual FPAD in 2018

• Raise awareness about how to prevent fall-related injuries

among older adults.

• U.S. Senate Resolution passed unanimously in 2017

• Visit www.ncoa.org/FPAD

http://www.ncoa.org/FPAD


State and Local FPAD Activities

• Proclamations – state and local

• Public awareness activities

• Professional education

• Physical activity events

• Falls risk screening fairs

• Medication review

• Enrolling older adults in evidence-based

falls prevention programs

• State and local advocacy activities


Fall Prevention Resources &

Handouts

Falls Prevention & Healthy Aging Blog

6 Steps to Prevent a Fall infographic and video

6 Steps to Protect Your Loved One from a Fall

18 Steps to Modify Your Home Video

Winterize to Prevent Falls

Osteoarthritis and Falls

Osteoporosis and Falls

Myths about Falls

Falls Prevention Conversation Guide for Caregivers

Download these free resources and more at:

https://www.ncoa.org/healthy-aging/falls-

prevention/falls-prevention-awareness-

day/general-resources/infographics-handouts/

https://www.ncoa.org/healthy-aging/falls-prevention/falls-prevention-awareness-day/general-resources/infographics-handouts/


6 Steps to Prevent a Fall Video (in English and Spanish)6 Steps to Prevent a Fall Video (In English and Spanish)


Caregiver Education

• Why falls prevention is important.

• Caregivers can participate, too!

• Falls prevention basics.

• Step 1: Is it time to talk?

• Step 2: Who and how to talk to others who

may be involved.

• Step 3: Develop a falls prevention action

plan.

• Perspectives: You are not alone.

• Additional Resources.

Falls Prevention Conversation Guide for Caregivers


Join Us!

• Visit ncoa.org and sign up for enews

• Follow @NCOAging on social media

• Donate to support NCOA’s work:

ncoa.org/Donate

• Share NCOA’s free, trusted

tools with older adults

o BenefitsCheckUp.org

o EconomicCheckUp.org

o MyMedicareMatters.org

http://www.ncoa.org/Donate

http://www.benefitscheckup.org/

http://www.economiccheckup.org/

http://www.mymedicarematters.org/


Thank You!

Kathleen Cameron, MPHSenior Director

Center for Healthy [email protected]

Chelsea Gilchrist, MGSSenior Program ManagerCenter for Healthy Aging

[email protected]




Questions

ma ala falls prevention€¦ · ma ala falls prevention july 24, 2018 kathleen cameron, mph senior...

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