Residential Care Summit: “Fall & Injury Prevention

Research to Action”

Dr. Vicky ScottDirector, Centre of Excellence on Mobility, Fall Prevention & Injury in Aging (CEMFIA)

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Summit Purpose

•To support RC facilities in meeting new accreditation and legislation for fall prevention

•To bring the expertise of researchers, practitioners and policy makers together to recommend strategies and actions to improve the status quo

•To identify tools and resources to support this work

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Summit Process

•Keynote Speakers, Concurrent Sessions, Expert Panel & Rapid Fire Sessions

•Mobile Lab Tours

•Working Groups– Recommendations

– Strategies & Actions

•Plenary Discussions

•Minister’s Closing Remarks

•Summit Report

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Fall Facts: Residential Care

• The average rate of falls in residential care is about 2.6 per person per year (Rubinstein 1990)

• Serious injuries occur in 10-20% of falls, with 2-6% resulting in fractures (Rubinstein 1998)

• Fall-related hospitalizations are 3.6 times greater for those from residential care (CIHR 2009)

• 95% of hip fractures are due to a fall (CIHR 2009)

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Canadian Accreditation StandardsOn June 25, 2008, Accreditation Canada implemented the Required Organizational Practice under Patient Safety Area #6, to reduce the risk of injuries resulting from client falls, through the following:

• Implement and evaluate a fall prevention strategy to minimize the impact of client falls.

• Tests for compliance– The team has implemented a fall prevention strategy.– The strategy identifies the population(s) at risk for

falls.– The strategy addresses the specific needs of the

populations at risk for falls.– The team evaluates the fall prevention strategy on an

ongoing basis to identify trends, causes and degree of injury.

– The team uses the evaluation information to make improvements to its fall prevention strategy.

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Resident Care RegulationsThe following regulation applies to all Licensed B.C. Residential Care Facilities and is taken from the “Residential Care Regulations” for British Columbia (Ministry of Healthy Living and Sport, 2009):

If a licensee provides Long Term Care (LTC), there must be written policies and procedures in respect to: – “an assessment of the nature of the risks that may

result in persons in care falling in the community care facility,

– a plan for preventing the person in care from falling, and

– a plan for responding to a fall suffered by a person in care, including steps to be taken to ensure the health and safety of the person in care who has fallen and to prevent subsequent falls by the person in care” (p. 33-34).

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Rationale

•Within the context of the Residential Care Regulations, Canadian Accreditation Standards and current RC policies, there are many fall and injury prevention practices currently in place. However, there is much room for improvement in the areas of standardization, evidence-based practice, practical solutions and evaluation. The purpose of this Summit is to draw on your expertise to raise the bar for fall and fall-related injury prevention in RC in BC.

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Paying attention to falls means that you are paying attention to good geriatric care (Dr. Shaun Peck, former

Deputy Provincial Health Officer).

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Implementing the Program

Residential Care Fall and Fall-related Injury Prevention Toolkit Framework

Population

Approach

Program Planning

Steps

Strategies& Actions

Social & Policy

Context

Residential

Public Health Approach1

Identifying Risk Factors

Examining Best Practices

Evaluating the Program

Residents, Families, Care Providers, Policies, Procedures, Accreditation Standards and Legislation

Data Sources

Assessment Tools

Program Examples

Evaluation Tools

1 Adapted from Scott, V. et al (2007). Canadian Falls Prevention Curriculum, October 2009

Defining the Problem

Best Practices/Guidelines

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B.C. Fall-related Injuries, Ages 65+

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Fall-Related Deaths Among Seniors B.C., 2007

• Population 65+ = 601,6761

• Population in RC = 33,9781

• Percent in RC = 5.6%1

Deaths 65+:

• Non-residential = 651

• Residential = 185

22%

78%

Residential Non-residential

1Quantum Analyzer Version 2.12 People 33, 2006/2007

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Fall-related Death Rates by Gender Among Seniors, 2000 - 2007

•Non-residential rates for men greater than for women

•Residential rates for men were lower than for women until 2006-2007, when rates for men increased and are now the same as for women

1.7

1.9

2.3

1.0

1.3

2.3

1.9

2.3

2.6

1.4

1.5

2.5

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

BC

Northern

Vancouver Island

Vancouver Coastal

Fraser

Interior

Hea

lth A

utho

rity

Rate Per 10,000*

FemalesMales

Direct and Indirect Death Rates Due to Falls Among Seniors in Residential Care, by Gender and Health Authority, B.C., 2003-2007

* Age-Standardized to B.C. 1991 population, with 95% Confidence Intervals.

Notes:Direct cause of death = the underlying cause of death or what the person died of.Indirect cause of death = contributing, associated, or antecedent causes to the underlying cause of death.Falls = ICD-9 E880 - E888, ICD-10 W00 - W19.Source: B.C. Vital Statistics Agency; Vital Statistics mortality data produced by Health Sector IM/IT Informatics group, June 2009.Prepared by: Population Health Surveillance and Epidemiology, Ministry of Healthy Living and Sport, 2009.

0

100

200

300

400

500

600

700

800

2000 2001 2002 2003 2004 2005 2006 2007Year

Num

ber o

f Dea

ths

0

2

4

6

8

10

12

Rat

e pe

r 10,

000

Popu

latio

n

Deaths - In Res Care Deaths - Not in Res Care Rate** - In Res Care Rate** - Not in Res Care Linear Trendline

Direct and Indirect Deaths Due to Falls Among Seniors in Residential Careand Seniors not in Residential Care, B.C., 2000 to 2007

* Statistically significant (p < 0.05).** Age-Standardized to B.C. 1991 population.

Notes:Direct cause of death = the underlying cause of death or what the person died of.Indirect cause of death = contributing, associated, or antecedent causes to the underlying cause of death.Falls = ICD-9 E880 - E888, ICD-10 W00 - W19.Source: B.C. Vital Statistics Agency; Vital Statistics mortality data produced by Health Sector IM/IT Informatics group, June 2009.Prepared by: Population Health Surveillance and Epidemiology, Ministry of Healthy Living and Sport, 2009.

p = 0.011*

p = 0.443

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Fall-Related Hospital Cases and Rates Among Seniors B.C., 2007/08

• Non-residential = 9009

• Residential = 1871

• Percent in RC = 5.6%1

17%

83%

Residential Non-residential

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08Year

Num

ber o

f Cas

es

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Rat

e pe

r 1,0

00 P

opul

atio

n**

Falls Cases Hip Fracture Cases Falls Rate Hip Fracture Rate Linear Trendline

Fall-Related and Fall-Related Hip Fracture Hospital Cases and Rates Among Seniorsin Residential Care, Ages 65+ Years, B.C., 2001/02 to 2007/08

* Statistically significant (p < 0.05).** Standardized to the B.C. 1991 population.

Source: Acute/rehab. separations from the 2001/02 to 2007/08 Canadian Institute of Health Information Discharge Abstract Dataset.Prepared by: Population Health Surveillance and Epidemiology, Ministry of Healthy Living and Sport, July 2009.

p = 0.062

p = 0.006* $21 million

9.6

8.5

11.0

13.4

0

2

4

6

8

10

12

14

16

Ave

rage

Num

ber o

f Day

s

All Causes**

Falls

Average Length of Hospital Stay, Acute and Rehab. (ar)* Levels of Care,All Causes and Fall-Related Hospitalizations, Seniors in Residential Care

and Seniors not in Residential Care, B.C., 2007/08

* ar: Acute and Rehab. are distinct levels of care. For each hospitalization, w hether Acute or Rehab., a proportion of the total days may be designated alc days (alternate level of care). The remainder of the total days are not alc and the Ministry of Health Services has created a variable - ar days - to represent this (Source: Sofiva, Ministry of Health Services).** Excluding falls.

Source: Acute/rehab. separations from the 1996/97 to 2007/08 Canadian Institute of Health Information Discharge Abstract Dataset.Prepared by: Population Health Surveillance and Epidemiology Ministry of Healthy Living and Sport Otober 2009

Residential Non-Residential

20% NR transferred to RC

1.81.6

4.4

4.0

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Ave

rage

Num

ber o

f Day

s

All Causes**

Falls

Residential Non-Residential

Average Length of Hospital Stay, Acute and Rehab. (alc)* Levels of Care,All Causes and Fall-Related Hospitalizations, Seniors in Residential Care

and Seniors not in Residential Care, Ages 65+ Years, B.C., 2007/08

* alc (alternate level of care): A patient has finished the acute care phase of his/her treatment but remains in the acute care bed. How ever, alc can be for reasons other than aw aiting placement, such as convalescence and respite (Source: Canadian Institute of Health Information Discharge Abstract Dataset 2008/09 Abstracting Manual: B.C. Section, p. 13-2). For each hospitalization, w hether Acute or Rehab., a proportion of the total days may be designated alc days. The remainder of the total days are not alc and the Ministry of Health Services has created a variable - ar days - to represent this.** Excluding falls.

Source: Acute/rehab. separations from the 1996/97 to 2007/08 Canadian Institute of Health Information Discharge Abstract Dataset.

60% waiting for transfer to RC

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Summit Report, final Toolkit and full data set available January 2010

for Summit participants at:

http://www.hiphealth.ca/CEMFIA.htm

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Thank You!