stand-up for senior independence (susi) lea blackburn, lisw, acsw riverside methodist hospital john...
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Stand-Up for Senior Stand-Up for Senior IndependenceIndependence
(SUSI)(SUSI)
Lea Blackburn, LISW, ACSWLea Blackburn, LISW, ACSW
Riverside Methodist HospitalRiverside Methodist Hospital
John J. Gerlach Center for Senior HealthJohn J. Gerlach Center for Senior Health
614-566-4225614-566-4225
[email protected]@ohiohealth.com
SUSI Funded By:SUSI Funded By:
Ohio Department of Public SafetyOhio Department of Public Safety– Division of EMSDivision of EMS– HB 138 Special Projects HB 138 Special Projects
Columbus FoundationColumbus Foundation
Needs EvidenceNeeds Evidence
According to Columbus Fire Department According to Columbus Fire Department over 90% of the personal assist runs are over 90% of the personal assist runs are related to patient falls.related to patient falls.– During 6 month period EMS personnel have During 6 month period EMS personnel have
responded to 585 personal assist runs.responded to 585 personal assist runs.– Annual cost of $438,750Annual cost of $438,750– Takes EMS unit out of serviceTakes EMS unit out of service
Needs EvidenceNeeds Evidence
According to CDCAccording to CDC– every hour an older adult dies as the result of every hour an older adult dies as the result of
a falla fall– in 1998, more than 9,600 persons 65 and in 1998, more than 9,600 persons 65 and
older died from fall related injuries, making older died from fall related injuries, making falls the leading cause of death among this falls the leading cause of death among this age groupage group
– 60% of all deaths involve individuals over the 60% of all deaths involve individuals over the age of 75age of 75
– 30-35% of people 65+ fall each year30-35% of people 65+ fall each year– 20% of falls cause serious injury20% of falls cause serious injury
Frailty / Falls RelationshipFrailty / Falls Relationship
Frailty is defined by a constellation of Frailty is defined by a constellation of symptoms including weight loss, symptoms including weight loss, weakness, fatigue, inactivity due to food weakness, fatigue, inactivity due to food intake. An illness or trauma such as a fall intake. An illness or trauma such as a fall can trigger the acceleration of frailty.can trigger the acceleration of frailty.
Leading to loss of independent functionLeading to loss of independent function
GOALGOAL
An older adult who has experienced a fall An older adult who has experienced a fall (not resulting in a fracture) will effectively (not resulting in a fracture) will effectively implement environment modifications and implement environment modifications and individual behavior changes to prevent individual behavior changes to prevent ongoing frequent falls and thus remain ongoing frequent falls and thus remain independent.independent.
STUDY POPULATIONSTUDY POPULATION
Community-dwelling elders aged 70 or Community-dwelling elders aged 70 or greater, who have experienced 2 falls greater, who have experienced 2 falls requiring an emergency squad response requiring an emergency squad response within a 30 day period of time.within a 30 day period of time.– Changed the age criteria to 60Changed the age criteria to 60
119 initial home visits for assessment of 119 initial home visits for assessment of eligibility.eligibility.40 total subjects met the research criteria.40 total subjects met the research criteria.
Exclusion CriteriaExclusion Criteria
Fall was due to exacerbation of chronic Fall was due to exacerbation of chronic medical condition including, but not limited medical condition including, but not limited to, a spontaneous fracture due to to, a spontaneous fracture due to osteoporosis.osteoporosis.
Prior diagnosis of dementia and under Prior diagnosis of dementia and under care of physiciancare of physician
Prior diagnosis of depression and under Prior diagnosis of depression and under care of physiciancare of physician
ObjectivesObjectives
The referral program will reduce the The referral program will reduce the likelihood of falling among community-likelihood of falling among community-dwelling elders who have previously have dwelling elders who have previously have fallen at least twice within 30 days, as fallen at least twice within 30 days, as demonstrated by a fall rate which is demonstrated by a fall rate which is significantly above the baseline rate significantly above the baseline rate among this group.among this group.
Study VariablesStudy Variables
demographic demographic characteristicscharacteristics
home environment home environment and living and living arrangementsarrangements
circumstances & circumstances & location to the falllocation to the fall
baseline and follow-baseline and follow-up functional statusup functional status
co-morbidity’sco-morbidity’s
Clinical assessment Clinical assessment resultsresults– depressiondepression– dementiadementia– nutrition nutrition – home environmenthome environment– Added the CAGE Added the CAGE
(Alcohol screening)(Alcohol screening)
Study VariablesStudy Variables
follow-up after clinical follow-up after clinical recommendationsrecommendations– 1 month by phone1 month by phone– 3 months by phone3 months by phone– 6 month home visit6 month home visit
occurrence of falls occurrence of falls during study periodduring study period
hospital admissions hospital admissions during the study during the study period and reason for period and reason for admissionadmission
Collaborating PartnersCollaborating Partners
Columbus Fire DepartmentColumbus Fire Department
Community Public Health ProfessionalsCommunity Public Health Professionals
Study DesignStudy Design
This is a cohort study, which uses This is a cohort study, which uses historical data to measure the level of historical data to measure the level of success of the SUSI program.success of the SUSI program.
A randomized trial would provide the best A randomized trial would provide the best evidence for evaluating SUSI, it is not a evidence for evaluating SUSI, it is not a practical design.practical design.
Study Begins with:Study Begins with:
Referral for clinical assessment from CFD Referral for clinical assessment from CFD or Public Health Professionalor Public Health Professional
Clinical AssessmentsClinical Assessments
Depression screening - Geriatric Depression screening - Geriatric Depression Scale (GDS)Depression Scale (GDS)
Dementia Screening - Folstein 3MS Dementia Screening - Folstein 3MS Mental Status ExamMental Status Exam
Nutrition Screening - 1991 Nutrition Nutrition Screening - 1991 Nutrition Screening Initiative Level 1Screening Initiative Level 1
Home Environment ScreeningHome Environment Screening
Alcohol screening (CAGE)Alcohol screening (CAGE)
Health Status QuestionnaireHealth Status Questionnaire
Screened to Suggest RiskScreened to Suggest Risk
Educated by the Project CoordinatorEducated by the Project Coordinator
Coordinator will communicate with Primary Coordinator will communicate with Primary Physician regarding the baseline Physician regarding the baseline information.information.
Coordinator with consent (and prescription Coordinator with consent (and prescription if appropriate) from PCP will arrange PT, if appropriate) from PCP will arrange PT, OT, Dietician or Home Medical EquipmentOT, Dietician or Home Medical Equipment
Baseline Location & Reason for FallBaseline Location & Reason for FallSubject fell 2x within 30 daysSubject fell 2x within 30 days
Most Frequent Location of FallMost Frequent Location of Fall– Living Room / DenLiving Room / Den– KitchenKitchen
Qualitative reasons given:Qualitative reasons given:– Lost balance while reachingLost balance while reaching– Legs gave outLegs gave out– Turned around too quickTurned around too quick
# of Falls at 180 days# of Falls at 180 days
FALLSFALLS PERCENTAGEPERCENTAGE
00 40%40%
11 33%33%
22 10%10%
33 13%13%
4-54-5 5%5%
Results n=40Results n=4012.8% screened positive for depression12.8% screened positive for depression
57% screened positive for dementia57% screened positive for dementia
100% required home environment changes100% required home environment changes
47.5% screened positive for nutrition deficit47.5% screened positive for nutrition deficit– 32.5% required a dietician referral32.5% required a dietician referral
80% required a Physical Therapy referral80% required a Physical Therapy referral– 286 visits for 28 subjects286 visits for 28 subjects
25% required Occupational Therapy25% required Occupational Therapy– 89 visits for 1 subjects89 visits for 1 subjects
Qualitative ResultsQualitative Results““I feel like there is hope”I feel like there is hope”– Dentures were too loose, broken hearing aide, Dentures were too loose, broken hearing aide,
depressed and needs bathroom equipmentdepressed and needs bathroom equipment– referred to OSU dental clinic for denturesreferred to OSU dental clinic for dentures– referred to Cols Speech & Hearing for new aidereferred to Cols Speech & Hearing for new aide– referred to home modification company to install referred to home modification company to install
grab barsgrab bars– Ordered PT & OTOrdered PT & OT
I know why I fellI know why I fell– denying need for helpdenying need for help
Qualitative ResultsQualitative Results
““I can simply ask my doctor for an OT / PT I can simply ask my doctor for an OT / PT evaluation?”evaluation?”
““I’ll do anything to stay in my own home.”I’ll do anything to stay in my own home.”
““I’m just too old”I’m just too old”
““Therapy will come to my home?”Therapy will come to my home?”
““Medicare covers PT / OT evaluation and Medicare covers PT / OT evaluation and treatment?”treatment?”
Case ExampleCase Example
89 year old male has fallen 3x within 30 89 year old male has fallen 3x within 30 days. days.
Assessment result needs:Assessment result needs:– Depressed,Depressed,– Dietary needsDietary needs– Home ModificationsHome Modifications– dx with macular degenerationdx with macular degeneration
Case ExampleCase ExampleOutcomesOutcomes– PCP addressed overall PCP addressed overall
health including health including depressiondepression
– dieticiandietician– counselorcounselor– Home modifications - grab Home modifications - grab
bars, shower drain, bars, shower drain, removed carpetsremoved carpets
– medic alert systemmedic alert system– meals on wheelsmeals on wheels– homemaker and home homemaker and home
health aidhealth aid
– services for visually services for visually impaired came to impaired came to home and provided home and provided ‘gadgets’ to allow to ‘gadgets’ to allow to read againread again
– Physical Therapy 3x Physical Therapy 3x wk for 6 weeks wk for 6 weeks improve gait and improve gait and balance.balance.
No falls for 125 daysNo falls for 125 days
ConclusionsConclusions
Falling is not a result of a single factor it is Falling is not a result of a single factor it is a combination of some or all of the a combination of some or all of the following factors:following factors:– DementiaDementia– Over the age of 80Over the age of 80– Reaching for items in kitchen or living roomReaching for items in kitchen or living room– Currently receiving some form of caregiver Currently receiving some form of caregiver
support.support.
Variables that Directly Correlate Variables that Directly Correlate with a Decrease in Fallswith a Decrease in Falls
Improvement in DepressionImprovement in Depression– 71% improvement in GDS71% improvement in GDS
Improvement in Nutritional StatusImprovement in Nutritional Status– 55% improvement55% improvement
Home ModificationsHome Modifications– Carpets removed 45.9%Carpets removed 45.9%– Grab bars added 40.5%Grab bars added 40.5%– Home Medical Equipment 32%Home Medical Equipment 32%
Additional findingAdditional finding
There was no statistical significance There was no statistical significance between co-morbidities and falling.between co-morbidities and falling.
Qualitative Information with Qualitative Information with SignificanceSignificance
Lack of communication about falls to their Lack of communication about falls to their primary physician or family.primary physician or family.
Subjects stated they ‘knew’ why they had fallen.Subjects stated they ‘knew’ why they had fallen.
Subjects are afraid they will fall again.Subjects are afraid they will fall again.
A statistically significant number of physicians A statistically significant number of physicians were unaware that Medicare part B will cover OT were unaware that Medicare part B will cover OT or PT in the home with a prescription regarding or PT in the home with a prescription regarding fall risk.fall risk.
RecommendationsRecommendations
Education for EMS and health care Education for EMS and health care providers.providers.
Education for the older adult and their Education for the older adult and their family.family.
Riverside Hospital Gerlach Center for Riverside Hospital Gerlach Center for Senior Health developed a placemat with Senior Health developed a placemat with fall prevention strategies for EMS to take fall prevention strategies for EMS to take to older adults home or health care to older adults home or health care providers to distribute.providers to distribute.